A practical guide to maximizing the diagnostic value of in-house quick assessment tests (QATs)
In Low-Cost Veterinary Clinical Diagnostics, the authors provide a hands-on resource designed to facilitate healthcare delivery across the spectrum of care.
Historically, clinicians have been taught to apply the gold standard approach to the practice of medicine. However, recent advances in veterinary medical care and associated technologies have made practitioners question whether a one-size-fits-all approach is truly best. After all, when we perform diagnostic tests, are we testing out of the desire for completeness, to cover all bases for the good of the patient? Or are we testing because we are expected to?
The reality is that gold standard care is not always advisable and not always possible. In clinical practice, veterinarians frequently encounter obstacles that limit their approaches to case management. Cost of care is a significant constraint that requires practitioners to rethink which diagnostic tests are essential.
Not every patient requires a complete blood count (CBC), chemistry profile, urinalysis, and fecal analysis to obtain diagnostic value. This text suggests that the “best” approach to case management be determined by the situation, the context, the patient, and the client.
While sophisticated panels of tests may remain the recommended approach to case management, Low-Cost Veterinary Clinical Diagnostics outlines entry-level, in-house diagnostic blood, urine, fecal, and body cavity fluid tests: how to perform them as well as the breadth and depth of patient-specific data that can be gleaned from quick assessment tests (QATs).
Readers will also find: - A thorough introduction to patient care considerations, communication strategies that facilitate cost-conscious shared decision-making - Comprehensive explorations of quick assessment tests (QATs) in hematology, including packed cell volume (PCV), total solids (TS), buffy coat analysis, blood smears, blood glucose, blood urea nitrogen (BUN), saline agglutination tests, and activated clotting time. - Practical discussions of quick assessment tests (QATs) involving urine, including urine color, dipstick analysis, specific gravity (USG), and urine sediment analysis - Pragmatic evaluation of fecal analysis, including considerations surrounding fecal color, volume, consistency, and odor; saline smears or wet mounts, and fecal flotation. - Discussion on body cavity fluid analysis - Sample case vignettes, complete with question and answer (Q&A)
Perfect for veterinary practitioners, veterinary technicians, veterinary and veterinary technician students, Low-Cost Veterinary Clinical Diagnostics offers a quick and easy reference guide to maximizing diagnostic value in those cases where care is cost-prohibitive.
Table of Contents
About the Authors xiv
About the Contributors xvii
Preface xviii
Acknowledgments xxi
Part 1 Patient Care Considerations 1
1 The Gold Standard, Standards of Care, and Spectrum of Care: An Evolving Approach to Diagnostic Medicine 3
Ryane E. Englar
1.1 Defining the Gold Standard 3
1.2 Limitations of the Gold Standard 4
1.3 Returning to the Case of the Cat with Stranguria: a Different Perspective on Standards of Care 4
1.4 Limitations to Standards of Care 5
1.5 Spectrum of Care 6
References 7
2 Consultation Room Communication Strategies that Facilitate Dialogue on the Diagnostic Approach to Patient Care 9
Ryane E. Englar
2.1 Emergence of Communication as a Clinically Relevant Skill in Human Health Care 9
2.2 The Evolution of Communication in Veterinary Health Care 10
2.3 Communication Skills That Are Essential to Diagnosis-Making 11
2.4 Concepts of Health Literacy and Compliance 13
2.5 Using Easy-to-Understand (Nonmedical) Language 14
2.6 Checking in 15
2.7 Assessing the Client’s Knowledge 17
2.8 Signposting 18
2.9 Addressing the Cost of Care 20
References 22
Part 2 Quick Assessment Tests (QATS) Involving Blood 27
3 Packed Cell Volume 29
Sharon M. Dial
3.1 Procedural Definition: What Is this Test About? 29
3.2 Procedural Purpose: Why Should I Perform this Test? 29
3.3 Equipment 29
3.4 Procedural Steps: How Do I Perform this Test? 30
3.5 Time Estimate to Perform Test 33
3.6 Procedural Tips and Troubleshooting 33
3.7 Interpreting Test Results 34
3.8 Clinical Case Example(s): Can We Link to the Cases in Chapter 5? 35
3.9 Add-On Tests That You May Need to Consider and Their Additive Value 35
3.10 Key Takeaways 36
References 36
4 Total Protein as Measured by Refractometry 37
Sharon M. Dial
4.1 Procedural Definition: What Is This Test About? 37
4.2 Procedural Purpose: Why Should I Perform this Test? 37
4.3 Equipment 38
4.4 Procedural Steps: How Do I Perform this Test? 38
4.5 Time Estimate to Perform Test 42
4.6 Procedural Tips and Troubleshooting 43
4.7 Interpreting Test Result 43
4.8 Clinical Case Example(s) 44
4.9 Add-On Tests That You May Need to Consider and Their Additive Values 44
4.10 Key Takeaways 44
Reference 45
Suggested References 45
5 Gross and Microscopic Evaluation of the Buffy Coat 46
Sharon M. Dial
5.1 Procedural Definition: What Is This Test About? 46
5.2 Procedural Purpose: Why Should I Perform this Test? 46
5.3 Equipment 47
5.4 Procedural Steps: How Do I Perform this Test? 47
5.5 Time Estimate to Perform Test 50
5.6 Procedural Tips and Troubleshooting 53
5.7 Interpreting Test Results 53
5.8 Clinical Case Example(s) 54
5.9 Add-On Tests That You May Need to Consider and Their Additive Value 54
5.10 Key Takeaways 54
Reference 54
6 The Blood Film 55
Sharon M. Dial
6.1 Procedural Definition: What Is This Test About? 55
6.2 Procedural Purpose: Why Should I Perform This Test? 55
6.3 Equipment 55
6.4 Procedural Steps: Preparing the Blood Film How Do I Perform This Test? 56
6.5 Time Estimate to Perform Test 64
6.6 Procedural Tips and Troubleshooting 64
6.7 Interpreting Test Results 69
6.8 Clinical Case Example(s) 70
6.9 Add-On Tests That You May Need to Consider and Their Additive Value 70
6.10 Key Takeaways 70
References 70
Suggested Bench-Side Reference 71
7 Blood Glucose 72
Sharon M. Dial
7.1 Procedural Definition: What Is This Test About? 72
7.2 Procedural Purpose: Why Should I Perform This Test? 72
7.3 Equipment 73
7.4 Procedural Steps: How Do I Perform This Test? 73
7.5 A Note on Quality Control 73
7.6 Procedure for Patient Samples 74
7.7 Time Estimate to Perform Test 76
7.8 Procedural Tips and Troubleshooting 76
7.9 Interpreting Test Results 77
7.10 Clinical Case Example(s) 78
7.11 Add-On Tests That you May Need to Consider and Their Additive Values 78
7.12 Key Takeaways 78
References 78
8 Blood Urea Nitrogen 79
Sharon M. Dial
8.1 Procedural Definition: What Is This Test About? 79
8.2 Procedural Purpose: Why Should I Perform This Test? 79
8.3 Equipment 80
8.4 Procedural Steps: How Do I Perform this Test? 80
8.5 Time Estimate to Perform Test 81
8.6 Procedural Tips and Troubleshooting 81
8.7 Interpreting Test Results 82
8.8 Clinical Case Example(s) 82
8.9 Add-On Tests That You May Need to Consider and Their Additive Value 82
8.10 Key Takeaways 83
9 Whole Blood Lactate 84
Sharon M. Dial
9.1 Procedural Definition: What Is This Test About? 84
9.2 Procedural Purpose: Why Should I Perform This Test? 84
9.3 Equipment 85
9.4 Procedural Steps: How Do I Perform This Test? 85
9.5 A Note on Quality Control 85
9.6 Procedure for Patient Samples 85
9.7 Time Estimate to Perform Test 87
9.8 Procedural Tips and Troubleshooting 87
9.9 Interpreting Test Results 87
9.10 Clinical Case Example(s) 88
9.11 Add-On Tests That You May Need to Consider and Their Additive Value 88
9.12 Key Takeaways 88
References 88
10 Saline Agglutination Test 89
Sharon M. Dial
10.1 Procedural Definition: What Is This Test About? 89
10.2 Procedural Purpose: Why Should I Perform This Test? 89
10.3 Equipment 89
10.4 Procedural Steps: How Do I Perform This Test? 89
10.5 Time Estimate to Perform Test 91
10.6 Procedural Tips and Troubleshooting 91
10.7 Interpreting Test Results 92
10.8 Clinical Case Example(s) 92
10.9 Add-On Tests That You May Need to Consider and Their Additive Value 92
10.10 Key Takeaways 92
Reference 93
11 Activated Clotting Time 94
Sharon M. Dial
11.1 Procedural Definition: (“What Is This Test About?”) 94
11.2 Procedural Purpose: Why Should I Perform This Test? 94
11.3 Equipment 94
11.4 Procedural Steps: How Do I Perform This Test? 94
11.5 Time Estimate To Perform Test 96
11.6 Procedural Tips and Troubleshooting 97
11.7 Interpreting Test Results 97
11.8 Clinical Case Example(s) 97
11.9 Add-On Tests That You May Need to Consider and Their Additive Value 97
11.10 Key Takeaways 97
Part 3 Quick Assessment Tests (QATS) Involving Urine 99
12 Assessing Urine’s Physical Properties 101
Ryane E. Englar
12.1 Procedural Definition: What Is This Test About? 101
12.2 Procedural Purpose: Why Should I Perform This Test? 101
12.3 Equipment 102
12.4 Procedural Steps 103
12.5 Time Estimate to Perform Test 105
12.6 Procedural Tips and Troubleshooting 105
12.7 Interpreting Test Results 106
12.8 Clinical Case Example(s) 111
12.9 Add-On Tests That You May Need to Consider and Their Additive Value 113
12.10 Key Takeaways 113
12.11 Clinical Pearls 114
References 115
13 Urine Specific Gravity 116
Ryane E. Englar
13.1 Procedural Definition: What Is This Test About? 116
13.2 Procedural Purpose: Why Should I Perform this Test? 117
13.3 Equipment 117
13.4 Procedural Steps 118
13.5 Time Estimate to Perform Test 124
13.6 Procedural Tips and Troubleshooting 124
13.7 Interpreting Test Results 124
13.8 Clinical Case Example(s) 126
13.9 Add-On Tests That You May Need to Consider and Their Additive Value 127
13.10 Key Takeaways 127
13.11 Clinical Pearls 127
References 128
14 Chemical Evaluation of Urine 130
Ryane E. Englar
14.1 Procedural Definition: What Is This Test About? 130
14.2 Procedural Purpose: Why Should I Perform This Test? 132
14.3 Equipment 132
14.4 Procedural Steps 132
14.5 Time Estimate to Perform Test 136
14.6 Procedural Tips and Troubleshooting 136
14.7 Interpreting Test Results 138
14.8 Clinical Case Example(s) 141
14.9 Add-On Tests That You May Need to Consider and Their Additive Value 142
14.10 Key Takeaways 143
14.11 Clinical Pearls 144
References 145
15 Urine Sediment Examination 146
Sharon M. Dial
15.1 Procedural Definition: What Is This Test About? 146
15.2 Procedural Purpose: Why Should I Perform This Test? 146
15.3 Equipment 147
15.4 Procedural Steps: How Do I Perform This Test? 147
15.5 Time Estimate to Perform Test 149
15.6 Procedural Tips and Troubleshooting 151
15.7 Interpreting Test Results 152
15.8 Clinical Case Example(s) 157
15.9 Add-On Tests That You May Need to Consider and Their Additive Value 157
15.10 Key Takeaways 157
Reference 157
Suggested Bench-Side References 158
Part 4 Quick Assessment Tests (QATS) Involving Feces 159
16 Assessing the Physical Properties of Fecal Matter 161
Ryane E. Englar
16.1 Procedural Definition: What Is This Test About? 161
16.2 Procedural Purpose: Why Should I Perform This Test? 161
16.3 Equipment 164
16.4 Procedural Steps 166
16.5 Time Estimate to Perform Test 166
16.6 Procedural Tips and Troubleshooting 166
16.7 Interpreting Test Results 172
16.8 Clinical Case Example(s) 183
16.9 Add-On Tests That You May Need to Consider and Their Additive Value 183
16.10 Key Takeaways 185
16.11 Clinical Pearls 186
References 187
17 Direct Smears 191
Ryane E. Englar
17.1 Procedural Definition: What Is This Test About? 191
17.2 Procedural Purpose: Why Should I Perform This Test? 191
17.3 Equipment 194
17.4 Procedural Steps [1-5, 20, 30, 60-62] 194
17.5 Time Estimate to Perform Test 196
17.6 Procedural Tips and Troubleshooting 196
17.7 Interpreting Test Results 197
17.8 Clinical Case Example(s) 198
17.9 Add-On Tests That You May Need to Consider and Their Additive Value 201
17.10 Key Takeaways 203
17.11 Clinical Pearls 204
References 204
18 Fecal Flotation 207
Ryane E. Englar and Jeremy Bessett
18.1 Procedural Definition: What is This Test About? 207
18.2 Procedural Purpose: Why Should I Perform This Test? 210
18.3 Options Available for Fecal Flotation 211
18.4 Equipment 213
18.5 Procedural Steps: Fecal Flotation with Fixed-Angle
Centrifuge [1-4, 8, 11, 22, 23, 28] 213
18.6 Time Estimate to Perform Fecal Flotation with Fixed-Angle Centrifuge 216
18.7 Brief Consideration of the Procedural Steps in the Event a Swinging Bucket Centrifuge Is Used 217
18.8 Equipment 217
18.9 Procedural Steps 217
18.10 Time Estimate to Perform Passive Fecal Flotation 221
18.11 Procedural Tips and Troubleshooting for Fecal Flotation 221
18.12 Interpreting Test Results 221
18.13 Clinical Case Example(s) 227
18.14 Add-On Tests That You May Need to Consider and Their Additive Value 227
18.15 Key Takeaways 229
18.16 Clinical Pearls 229
References 230
Part 5 Quick Assessment of Body Cavity Fluids 235
19 Body Cavity Fluid Analysis 237
Sharon M. Dial
19.1 Procedural Definition: What Is This Test About? 237
19.2 Procedural Purpose: Why Should I Perform This Test? 237
19.3 Equipment 238
19.4 Procedural Steps: How Do I Perform This Test? 238
19.5 Time Estimate to Perform Test 240
19.6 Procedural Tips and Troubleshooting 240
19.7 Interpreting Test Results 241
19.8 Clinical Case Example(s) 244
19.9 Add-On Tests That You May Need to Consider and Their Additive Value 244
19.10 Key Takeaways 245
References 245
Suggested Bench-Side References 245
Part 6 Clinical Cases 247
20 Clinical Cases 249
Jeremy Bessett, with support from Sharon M. Dial
Case 1: Fred 249
Case 2: Bella 253
Case 3: Benji 258
Case 4: Mittens 266
Case 5: Star 272
Case 6: Earl 277
Case 7: Sammy 281
Case 8: Coffee 286
Case 9: Dexter 291
Case 10: Tabitha 297
Case 11: Ace 301
Case 12: Timothy 304
Case 13: Duckie 307
Case 14: Angel 311
Case 15: Chase 314
Index 321
