20260721_131556.jpg
What will be the highest differential for this cbc ?
Looking at the CBC results for TUFFY (Dog), the differential shows:
- LY (Lymphocytes): 33.5% (flagged High - shown in red)
- GR (Granulocytes): 66.5% (flagged with F4)
- MO (Monocytes): not calculated
- EO (Eosinophils): not calculated
The highest differential is Granulocytes (GR) at 66.5%.
In absolute terms, GR = 7.33 × 10³/µL, which is the dominant white cell population.
Quick Interpretation (Canine):
| Parameter | Value | Status |
|---|---|---|
| WBC | 11.0 × 10³/µL | Normal (ref: 6-17) |
| GR% | 66.5% | Highest differential |
| LY% | 33.5% | Flagged High |
| GR absolute | 7.33 × 10³/µL | Within normal range |
Granulocytes (predominantly neutrophils) make up the largest fraction at 66.5%, which is actually within the expected normal range for dogs (typically 60-77% neutrophils). The lymphocyte percentage is flagged high at 33.5%, but the WBC total is normal, suggesting this may be a relative lymphocytosis rather than true lymphocytosis.
Other notable findings:
- Mild anemia (HGB 11.8L, HCT 32.2L, RBC 5.38L) - microcytic (MCV 59.9L)
- Thrombocytopenia (PLT 16.2L - significantly low)
- MCHC 36.6H - slightly elevated
- The RBC histogram shows an "AT" flag (anisocytosis) with a left-shifted peak at 71 fL
The thrombocytopenia (PLT 16.2 × 10³/µL) is the most clinically concerning finding and warrants urgent attention.
In haemoprptozoa ?
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haemoprotozoa dog thrombocytopenia microcytic anemia differential diagnosis CBC
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Based on this CBC profile (thrombocytopenia PLT 16.2L, microcytic anemia MCV 59.9L, HGB 11.8L, HCT 32.2L, normal-to-mild leukocytosis), here is the haemoprotozoa differential ranked by likelihood:
Haemoprotozoa Differential for TUFFY's CBC
🥇 #1 Most Likely - Babesia canis / Babesia gibsoni
| CBC Clue | Explanation |
|---|---|
| Thrombocytopenia (PLT 16.2L) | Hallmark finding - platelet consumption/destruction |
| Microcytic anemia (MCV 59.9L) | Hemolytic anemia from RBC parasitization |
| MCHC 36.6H | Hemolysis causes increased MCHC |
| RBC histogram "AT" flag | Anisocytosis from regenerative response |
| Normal-mild WBC | Typical in babesiosis |
Babesia directly invades and lyses RBCs + causes immune-mediated platelet destruction. This is the classic combination seen here.
🥈 #2 - Ehrlichia canis (Monocytic Ehrlichiosis)
| CBC Clue | Explanation |
|---|---|
| Severe thrombocytopenia | Most prominent feature of Ehrlichia |
| Anemia | Bone marrow suppression in chronic phase |
| Lymphocytosis (LY 33.5H) | Reactive lymphocytosis common |
| MO not calculated | Monocytes may be flagged/abnormal |
Ehrlichia targets platelets and causes progressive pancytopenia. Lymphocytosis flagged here fits Ehrlichia well.
🥉 #3 - Hepatozoon canis
| CBC Clue | Explanation |
|---|---|
| Mild leukocytosis | Neutrophilia is characteristic |
| Anemia | Mild non-regenerative anemia |
| Thrombocytopenia | Less severe than Babesia |
GR 66.5% with absolute granulocytosis (7.33) fits Hepatozoon, though thrombocytopenia this severe is more consistent with Babesia/Ehrlichia.
#4 - Anaplasma platys (Cyclic Thrombocytopenia)
- Specifically targets platelets - causes cyclic thrombocytopenia
- PLT 16.2 is severely low - fits acute phase of Anaplasma platys
- Anemia is mild/absent usually - this dog has anemia, making it less classic
#5 - Trypanosoma cruzi / Leishmania
- Usually cause chronic disease with mild hematologic changes
- Less likely given the acute severe thrombocytopenia picture
Priority Diagnosis Summary
Babesia spp. > Ehrlichia canis > Anaplasma platys > Hepatozoon canis
Recommended Confirmatory Tests:
- Blood smear - look for intra-erythrocytic piroplasms (Babesia), morulae (Ehrlichia/Anaplasma)
- PCR - most sensitive for all haemoprotozoa
- Rapid 4Dx/SNAP test - screens for Ehrlichia, Anaplasma
- Immunofluorescence antibody (IFA) titers
⚠️ The combination of severe thrombocytopenia (PLT 16.2) + microcytic hemolytic anemia + normal WBC is most consistent with Babesia in this dog. Urgent blood smear is warranted.
20260721_155954.jpg
What will be the highest differential in terms of haemoprotozoa in this cbc ?
CBC Analysis - SHERO (Dog, 21 Jul '26)
Reading the values from this Nihon Kohden analyzer:
| Parameter | Value | Status |
|---|---|---|
| WBC | 3.01C | 🔴 LOW (leukopenia) |
| RBC | 5.50 | Normal |
| HGB | 12.9 | Normal |
| HCT | 33.8L | 🔴 Low |
| MCV | 61.5 | Low-normal (microcytic) |
| MCH | 23.5 | Normal |
| MCHC | 38.2! | 🔴 HIGH (flagged !) |
| PLT | 5.1C | 🔴 CRITICALLY LOW |
| LY | 1.32 → 43.9% F1 | Flagged |
| MO | -- → F3 | Flagged |
| GR | 1.69L → 56.1% F4 | 🔴 Low absolute |
| RBC histogram | (AT) flag | Anisocytosis |
Highest Haemoprotozoa Differential
🥇 Ehrlichia canis - TOP DIAGNOSIS
This CBC pattern is the textbook picture of Ehrlichia canis. Here's why:
| CBC Finding | Ehrlichia canis Explanation |
|---|---|
| WBC 3.01C (Leukopenia) | Bone marrow suppression - hallmark of Ehrlichia |
| PLT 5.1C (Severe thrombocytopenia) | Most consistent Ehrlichia feature - immune destruction + marrow suppression |
| GR 1.69L (Neutropenia) | Bone marrow hypoplasia in chronic/subacute phase |
| MCHC 38.2! High | Hemolysis component |
| LY 43.9% F1 | Relative lymphocytosis (lymphocytes are spared) |
| MO F3 flag | Monocyte abnormality - Ehrlichia lives in monocytes! |
| HCT 33.8L (mild anemia) | Non-regenerative anemia from marrow suppression |
The monocyte flag (F3) is particularly telling - Ehrlichia canis is a monocytotropic organism that infects and replicates inside monocytes/macrophages. The analyzer flagging monocytes as abnormal is a red-flag clue.
Comparison with TUFFY (previous case):
| Feature | TUFFY | SHERO |
|---|---|---|
| WBC | Normal (11.0) | Leukopenic (3.01C) |
| PLT | Very low (16.2L) | Critically low (5.1C) |
| Anemia | Microcytic hemolytic | Mild, non-regenerative |
| GR | High-normal | Low (neutropenia) |
| Monocyte flag | Not flagged | F3 flagged |
| Top Dx | Babesia | Ehrlichia canis |
Haemoprotozoa Ranking for SHERO:
1. Ehrlichia canis ← MOST LIKELY (pancytopenia + monocyte flag)
2. Anaplasma platys ← Severe thrombocytopenia, but less marrow suppression
3. Babesia canis/gibsoni ← Less likely (no hemolytic picture, leukopenia unusual)
4. Hepatozoon canis ← Less likely (usually causes leukocytosis, not leukopenia)
Urgent Recommendations:
- Blood smear - look for morulae (inclusion bodies) inside monocytes
- SNAP 4Dx test - rapid in-clinic Ehrlichia antibody detection
- PCR for Ehrlichia canis - most sensitive
- Bone marrow aspirate if pancytopenia worsens
- Start Doxycycline 10 mg/kg/day empirically if Ehrlichia strongly suspected
⚠️ PLT of 5.1 × 10³/µL is life-threateningly low - spontaneous bleeding risk is HIGH. Handle this patient with extreme care and minimize venipuncture/invasive procedures.
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