CBC Analysis - Buffalo 0001 (27 Jul 2026)

Key Values Extracted

Haemoprotozoa Suspicion - YES

1. RBC Histogram Flag - "(AT)" = Atypical Cells

• Infected/parasitized erythrocytes
• Altered RBC morphology from intra-erythrocytic parasites (e.g., Theileria piroplasms, Babesia merozoites)

2. Granulocytosis with Relative Lymphopenia

• GR: 5.1 H (53.0% H) - elevated granulocytes (neutrophilia)
• LY: 41.3% L - relative lymphopenia
• This neutrophilia + lymphopenia pattern is characteristic of acute haemoprotozoa infections (especially Theileria annulata or Babesia bovis/bigemina in bovines/buffaloes)

3. MCH Mildly Elevated (17.7 H)

• Elevated MCH can occur due to RBC membrane damage from parasitic invasion, causing altered intracellular haemoglobin concentration relative to cell size
• Combined with normal MCV, this suggests early or mild haemolytic process

4. MCHC Relatively Low-Normal (30.4 g/dL)

• Despite the MCH flag, MCHC is at the lower end, suggesting possible early haemolytic anaemia that has not yet manifested in HGB/HCT - possibly because the infection is in the early/acute phase

5. No Frank Anaemia Yet

• HGB (12.7 g/dL) and HCT (41.8%) are within normal range for buffalo - suggesting this may be an early or pre-anaemic stage of infection, or a mild/chronic subclinical infection

Most Likely Organisms in Buffalo

Recommended Next Steps

1. Giemsa-stained thin and thick blood smears - mandatory to visualize intra-erythrocytic parasites. Look for:
   • Theileria: small ring forms (piroplasms), "Maltese cross/tetrad" forms
   • Babesia: pear-shaped paired merozoites
   • Anaplasma: dark marginal inclusion bodies
2. Buffy coat smear - more sensitive for low parasitemia
3. PCR testing - definitive identification of species
4. Repeat CBC in 48-72 hours - to monitor for progressive anaemia (HGB and HCT may drop as infection progresses)

Biochemistry Report - Buffalo 0001 (27 Jul 2026)

Extracted Values (Buffalo row with flags)

Interpretation in Context of Haemoprotozoa

1. Massive Hyperbilirubinaemia - BIT 7.84 mg/dL (H)

• Total Bilirubin 7.84 mg/dL is markedly elevated
• Indirect (unconjugated) bilirubin = 7.41 mg/dL - the dominant fraction
• Direct bilirubin = 0.43 mg/dL (mildly elevated)
• This is a predominantly pre-hepatic (haemolytic) pattern - exactly what occurs when intra-erythrocytic parasites (Theileria/Babesia) cause massive red cell lysis
• The animal may show clinical jaundice/icterus

2. SGOT (AST) = 861.5 U/L - Massively Elevated (H)

• Normal range for buffalo AST is approximately 60-120 U/L
• 861.5 U/L is ~7-14x the upper limit of normal
• This indicates severe hepatocellular and muscle damage
• In haemoprotozoan infections (especially Theileria annulata), AST rises due to:
  • Direct hepatic invasion by schizonts (Theileria infects lymphocytes and hepatocytes)
  • Hypoxic hepatic necrosis from haemolytic anaemia
  • Associated myopathy

3. ALP = 175 U/L (H)

• Elevated alkaline phosphatase suggests hepatobiliary involvement (cholestasis component)
• Combined with elevated bilirubin, this indicates both haemolytic and hepatic components of jaundice (a mixed picture)

4. Total Protein High (7.69 g/dL H) with Reversed A/G Ratio (0.63)

• Total protein elevated due to hyperglobulinaemia (GLOB = 4.72 g/dL)
• Albumin is relatively low-normal (2.97 g/dL)
• Reversed A/G ratio (0.63) - a hallmark of chronic infection/inflammatory states
• In haemoprotozoa, this occurs due to:
  • Acute phase protein response - globulins rise massively
  • Chronic antigenic stimulation producing immunoglobulins
  • Liver damage reducing albumin synthesis

5. Low Urea (17.9 mg/dL - L)

• Reduced hepatic urea synthesis suggests hepatic insufficiency from liver damage
• Also consistent with reduced protein catabolism or anorexia

6. Creatinine Normal (0.97 mg/dL)

• Kidney function appears intact at this stage, though haemoglobin/myoglobin-induced nephropathy is a risk with severe haemolysis

Clinico-Pathological Diagnosis

• Haemolytic anaemia (elevated indirect bilirubin)
• Hepatic schizogony with liver destruction (massive AST rise)
• Immunopathology (reversed A/G, neutrophilia)

Recommended Immediate Management

1. Confirm diagnosis: Giemsa blood smear + lymph node biopsy aspirate (for Theileria schizonts - "Koch's blue bodies")
2. Specific treatment:
   • Buparvaquone (Butalex) 2.5 mg/kg IM - drug of choice for Theileria annulata
   • If Babesia suspected: Diminazene aceturate 3.5 mg/kg IM
3. Supportive care:
   • Hepatoprotectives (silymarin, SAMe)
   • IV fluids to support renal perfusion given impending haemoglobinuria risk
   • B-complex vitamins
   • Anti-pyretics (flunixin meglumine)
4. Monitor: Repeat AST, bilirubin, and PCV every 48-72 hours to track treatment response