Socrates-Erasmus

Vet. Clin. Path.

22-‹#›

Clinico-laboratory diagnosis:
The patient with pleural and/or
peritoneal effusion

Kostas Papasouliotis
DVM PhD DipRCPath(Vet.Clin.Path.) DipECVCP MRCVS
 Clinical signs
• Distended abdomen
• Exercise intolerance
• Lethargy
• Weight loss
• Cough
• Tachypnoea
• Dyspnoea
• Orthopnoea
• Open mouth breathing
• Pyrexia
• Cyanosis
2
 Three pathomechanisms
• Transudation:
– Increased plasma hydrodrostatic pressure; usually increased venous
pressure (e.g. venous hypertension)
– Decreased lymphatic drainage (increases tissue hydrostatic pressure)
– Decreased plasma oncotic pressure (hypoalbuminemia)
• Exudation:
– increased capillary permeability due to inflammation
• Vasoactive mediators
• Organ/Vessel rupture or leakage
– Hemorrhagic effusion (e.g. vessel, spleen, liver)
– Gallbladder (Bile peritonitis)
– Urinary track (Uroabdomen)
– Gastrointestinal track
 Collection & analysis

• Plain tube
– Colour, odour
– Biochemical analysis
• EDTA tube
– PCV
– Cell count
– Smear for cytology - Smear for Gram stain
• Sterile tube
– Culture
 Physiological characteristics

• Colour
– Dark Red?
• Haemothorax
Haemoperitoneum
– Milky ?
• Chylous
• Pseudochylous

• Odour
– Urine?
– “Foul”?
 Plain tube: Biochemical analysis
• Total Proteins (TP)/Albumin; Abumin to Globulins ratio (A:G)
• Refractometer; for total proteins (solids)
• In-clinic dry biochemistry analysers
– Variable accuracy; not many studies available
– VetScan* can be used for measuring TP and creatinine in
dogs
– Vettest** can be used for measuring TP and albumin in
feline effusions. But do not use the derived A:G ratio
• A:G ratio: Important for FIP diagnosis
– < 0.8 consistent with FIP, < 0.4 very high index
• Creatinine (Uroperitoneum)
• Triglycerides/Cholesterol (Chyle)
• Bilirubin (Bile), Amylase/Lipase (pancreatitis)
* Hetzel et al, J Sm Anim Pract, 2012
**Papasouliotis et al, Vet Clin Path, 2002
 EDTA tube
• PCV
– Centrifuge microhaematocrit tube
– Iatrogenic contamination
– Haemorrhagic effusions have PCV >4%
• Nucleated cell count (TNCC)
– In-clinic Haematology analyser
• Limited studies
• The VetScan HM5* can be used for canine effusions
– Send sample to external lab for accurate TNCC

*Brudwig et al, Vet Clin Path, 2015

 Pleural & peritoneal effusions
• Smears
– Low cellularity fluid
• Centrifuge (1500rpm)
• Resuspend cell pellet in 0.5 ml of supernatant
• Transfer one drop to a glass slide
– High cellularity fluids
• Transfer one drop to a glass slide
• Prepare smears
– keep formalin pots away
• Stain:Diff-Quik, Leishman’s, Gram
 Pleural & peritoneal effusions

• Making a smear
SLIDE & SPREADER: CROSS/FLAT
Benefit - Produce 2 smears from each
 Smear Preparation
• REMEMBER!!
– MAKE THE SMEARS QUICKLY
– DRY THE SMEARS QUICKLY
 Classification of effusions (Guidelines)

Effusion

Transudate Modified transudate Exudates Chylous Haemorrhagic

TP >25 g/l
(F)Trigs>(P)Trigs
TP <25 g/l TP 25-50 g/l TP 25-70 g/l TP 40-80 g/l
(F)Chol<(P)Chol

TNCC<1 x109/L TNCC <5 x109/L TNCC >10 x109/L TNCC <5 x109/L
Few MACROS NEUTROS, NEUTROS, LYMPHOS
PCV >4%
MESOTHELIAL MESOTH/MACROS MESOTH may vary with
LYMPHS/NEUTROS variableRBCs some RBCS/MACROS time

“USE THE FIGURES-DO NOT LET THE FIGURES USE YOU”

RBCs, Neutros, Lymphos, Macros

L
RBCs
 Mesothelial cells

Mesothelial cell in mitosis

L
Numerous neutrophils and intracellular bacteria (septic
peritonitis)
Pleural effusion from a 2 y.o. male DSH with pyrexia & dyspnoea.

Lymphoma
Clumps of carcinoma cells
Causes
 CANINE FELINE

Pleural Peritoneal Pleural Peritoneal

(%) (%) (%) (%)
Neoplasia 44 28 32 24
Cardiac disease 18 38 20 10
FIP - - 19 42
Bacterial infection 13 8 13 6
Haemorrhage 6 9 2 1
Hypoalbuminaemia 4 10 0 6
Tissue/organ 7 2 0.5 3
inflammation
 Remember!
EXUDATES with LOW MODIFIED
TNCC (can be classified as TRANSUDATES with
MODIFIED TRANSUDATES) HIGH TNCC (can be classified
as EXUDATES)
-Fluids collected early in
the time course of -Long standing effusions
disease -Repeated drainage
-Mild inflammation
-Uroperitoneum
-FIP
 Tell me
• Which are the haematological & biochemical
abnormalities?
• What type is the effusion?
– Transudate/modified transudate, exudate,
chylous, haemorrhagic?
• What is your differential diagnosis?
• What other tests would like to do in order to
get closer to a diagnosis?