Quality assurance for veterinary in-clinic laboratories

• Quality assurance and the implementation of a quality management system are as important for veterinary in-clinic laboratories as for reference laboratories. • Elements of a quality management system include the formulation of a quality plan, establishment of quality goals, a health and safety policy, trained personnel, appropriate and well-maintained facilities and equipment, standard operating procedures, and participation in external quality assurance programs. • Quality assurance principles should be applied to preanaltyic, analytic, and postanalytic phases of the in-clinic laboratory cycle to ensure that results are accurate and reliable and are released in a timely manner.http://vetsmall.theclinics.com2022-11-16hj2022Companion Animal Clinical Studie

Validation of a point-of-care clinical chemistry analyser generation of clinical chemistry reference intervals and evaluation of serum protein electrophoresis in the southern white rhinoceros Ceratotherium simum simum

The southern white rhinoceros, Ceratotherium simum simum, is heavily poached in southern Africa, with over 4 000 animals killed in South Africa between 2013 and the end of 2016. White rhinoceros that survive poaching attempts, or those that are wounded during fighting, require veterinary care for their injuries. Both injured and orphaned rhinoceros also require veterinary care during the process of rehabilitation and return to the wild. Clinical pathology plays an important role in the initial evaluation and ongoing monitoring of these animals, but it can only become a truly useful tool for this species if wildlife veterinarians have access to validated analytical methods and accurate reference intervals. The broad objectives of this study were therefore to 1) validate a point-of-care clinical chemistry analyser for use in the white rhinoceros, and assess its performance under field conditions; 2) generate clinical chemistry reference intervals on the point-of-care analyser, and a reference laboratory analyser, for the white rhinoceros; and 3) explore serum protein fractions in both healthy and injured white rhinoceros. Best-practice guidelines for method validation, quality control and reference interval generation, as published by the American Society for Veterinary Clinical Pathology, were followed throughout. The IDEXX VetTest was selected as the point-of-care analyser. Method validation was performed by assessing differences between white rhinoceros heparin plasma and serum, short-term imprecision, long-term imprecision and reportable range. The VetTest was found to be suitable for use in the white rhinoceros, although imprecision was high for alkaline phosphatase (ALP), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) at low activities, and the reportable range for AST and lactate dehydrogenase (LDH) differed from the manufacturer’s specifications. Statistical quality control methods were used to develop a quality control strategy for the analyser and this protocol was used to evaluate the performance of the VetTest under typical field conditions. Eleven analytes were suitable for statistical quality control using the 13s rule, three using the 2s rule; ALP was not suitable. In the field, the observed analytical error was less than the allowable analytical error for all fifteen analytes and sigma metric values were >3.0 for twelve analytes. This study showed that statistical quality control protocols are useful for monitoring the performance of point-of-care analysers, and that the VetTest can be used out in the field for white rhinoceros. Clinical chemistry reference intervals are used as an indication of normal values in health, against which the results of ill animals are compared. These reference intervals should be not only species-, but also analyser-specific, as different analytical methods may produce different results. A method comparison study was carried out to assess analytical differences between the VetTest and the Roche Cobas Integra 400 Plus, using white rhinoceros plasma. Significant differences were found for all of the ten analytes examined. Separate reference intervals were subsequently generated for each analyser from 51 healthy wild rhinoceros. Noteworthy findings from this study were the low ALT activity and high total protein and globulin concentrations in this species.Thesis (PhD)--University of Pretoria, 2017.Companion Animal Clinical StudiesPhDUnrestricte

Acute phase reactants in nondomesticated mammals—a veterinary clinical pathology perspective

Applications for acute phase reactants (APRs) in nondomesticated mammals include identifying inflammatory disease, monitoring the course of specific disease processes and recovery during rehabilitation, detecting preclinical or subclinical disease, being used as bioindicators for monitoring population and ecosystem health, and as markers of stress and animal welfare. Serum amyloid A, haptoglobin, C-reactive protein, fibrinogen, albumin, and iron are most commonly measured. The procedure for evaluating an APR in a nondomesticated mammalian species should follow a stepwise approach beginning with an assessment of analytical performance, followed by an evaluation of overlap performance, clinical performance, and impact on patient outcomes and management. The lack of species-specific standards and antibodies for nondomesticated mammals presents a challenge, and more attention needs to be focused on assessing cross-reactivity and ensuring adequate analytical performance of APR assays. Sample selection for the initial evaluation of APRs should consider preanalytical influences and should originate from animals with confirmed inflammatory disease and healthy animals. Reference intervals should be generated according to published guidelines. Further evaluation should focus on assessing the diagnostic utility of APRs in specific disease scenarios relevant to a species. Greater attention should be paid to assay performance and uniformity of methods when using APRs for population and ecosystem surveillance. Veterinary clinical pathologists should work closely with zoo veterinarians and wildlife researchers to optimize the accuracy and utility of APR measurements in these various conservation medicine scenarios.http://www.wileyonlinelibrary.com/journal/vcphj2022Centre for Veterinary Wildlife StudiesCompanion Animal Clinical Studie

Temporally specific adrenocorticotropic hormone reference intervals for horses in South Africa

An endogenous adrenocorticotropic hormone (ACTH) concentration above the reference interval (RI) is commonly used as means for diagnosing equine pituitary pars intermedia dysfunction (PPID). Basal ACTH concentrations are highly dependent on photoperiod and RIs should be month- and location-specific. To date, no ACTH RIs have been specifically established for South Africa. This study aimed to determine geographically and seasonally relevant RIs for equine ACTH in the Gauteng province of South Africa. A longitudinal prospective study was conducted over twelve months to determine ACTH RIs for a representative population of healthy South African horses in the Gauteng province. Eighty clinically healthy horses under 12 years of age were recruited for monthly venous blood sample collection, from July 2019 to June 2020. ACTH was measured using a chemiluminescent assay. RIs were constructed for each month of the year. This South African population showed similar temporal changes in ACTH concentrations to those previously observed in other locations. Upper reference limits were at their lowest in early summer (21.4 pg/ml, 90% CI 20.8–21.7) with a pronounced increase in autumn (60.6 pg/ml, 90% CI 53.1–62.7), and tapered off in winter (22.3 pg/ml, 90% CI 19.9–23.2). The month-specific ACTH RIs generated in this study will improve the accuracy of diagnosis and monitoring of PPID in the local equine population. These results highlighted the previously recommended need for seasonal and location-specific RIs.The Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, and by a postgraduate bursary from the Health and Welfare Sector Education and Training Authority of South Africa.http://www.jsava.co.zaam2023Companion Animal Clinical Studie

Effects of storage time and temperature on thromboelastographic analysis in dogs and horses

Please read abstract in the article.Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria.http://www.wileyonlinelibrary.com/journal/vcphj2022Companion Animal Clinical Studie

Reference intervals for selected hematology and clinical chemistry measurands in Temminck's pangolin (Smutsia temminckii)

Pangolins are the world’s most trafficked non-human mammals. A significant number of Temminck’s pangolins (Smutsia temminckii) are presented for veterinary care and rehabilitation in southern Africa. Little is known about the physiology and normal health of this species, making diagnosis and medical management difficult. This study aimed to establish reference intervals (RIs) for hematology and plasma clinical chemistry in the Temminck’s pangolin. RIs were generated according to international guidelines using samples from 27 healthy free-living (n = 18) and rehabilitated (n = 9) pangolins. Hematology was performed using the Abaxis VetScan HM5 analyzer with manual differentials; clinical chemistry was performed using heparin plasma on the Abaxis VetScan VS2 and Cobas Integra 400 Plus analyzers. Hematology RIs were: RBC 3.88–8.31 × 1012/L, HGB 73–150 g/L, HCT 26–51%, MCV 59–72 fL, MCH 15.6– 21.4 pg, MCHC 257–325 g/L, RDW 14.3–19.1%, WBC 1.80–10.71 × 109/L. Vetscan VS2 clinical chemistry RIs were: albumin 27–41 g/L, ALP 26–100 U/L, ALT 25–307 U/L, amylase 267–826 U/L, bilirubin 4–10 μmol/L, calcium 2.1–2.2 mmol/L, globulin 21–55 g/L, glucose 3.8–10.0 mmol/L, phosphate 1.3–2.6 mmol/L, potassium 3.6–5.9 mmol/L, sodium 132–140 mmol/L total protein 52–84 g/L, and urea 5.3–11.4 mmol/L. RIs for creatinine were not calculated as analytical imprecision exceeded analytical performance goals. Cobas Integra clinical chemistry RIs were: albumin 22–33 g/L, ALP 20–104 U/L, ALT 17–291 U/L, amylase 466–1,533 U/L, bilirubin 1–14 μmol/L, calcium 2.0–2.4 mmol/L, creatinine <58 μmol/L, globulin 23–49 g/L, glucose 3.6–10.1 mmol/L, phosphate 1.0–2.2 mmol/L, potassium 3.1–5.8 mmol/L, sodium 137–150 mmol/L, total protein 47–72 g/L, and urea 6.0–12.5 mmol/L. There was significant bias between the two chemistry analyzers for several measurands. Differences were found for some analytes between free-living and rehabilitated animals, probably reflecting differences in nutrition and hydration. These are the first RIs generated for Temminck’s pangolin. These results will allow veterinarians to better determine pangolin health status, formulate optimal treatment plans and increase patient survival rates in this endangered species.The South African Veterinary Foundation, the Health and Welfare Sector Education and Training Authority of South Africa, dnata4good-UP’s Wild over Wildlife (WoW) program and Johannesburg Wildlife Veterinary Hospital.https://www.frontiersin.org/journals/veterinary-science#am2022Companion Animal Clinical StudiesParaclinical Science

Introducing the special issue on acute phase proteins in veterinary medicine

Measurement of acute phase proteins (APPs) has now become part of routine laboratory testing for companion animals in many areas of the world. As useful markers of infectious and inflammatory diseases, APPs have been shown to have value in many areas, including health assessments, prognosis, herd health, and animal welfare. The increased use of all acute phase reactants in domesticated animals has been paralleled by an increase in research detailing the measurement and application in non-domesticated mammals. There are many challenges for future research in this still-developing field.http://wileyonlinelibrary.com/journal/vcp2023-02-26hj2023Centre for Veterinary Wildlife StudiesCompanion Animal Clinical Studie

Analytic and quality control validation and assessment of field performance of a point-of-care chemistry analyzer for use in the white rhinoceros

BACKGROUND : A chemistry point-of-care analyzer would be useful for evaluating injured wildlife, particularly white rhinoceros (Ceratotherium simum) that survive poaching attempts. The IDEXX VetTest® could be suitable, but species-specific validation, development of a statistical quality control (QC) strategy and evaluation under field conditions is necessary. OBJECTIVES : The objectives were to 1) validate the VetTest for the white rhinoceros, 2) perform QC validation on the VetTest and generate a statistical QC strategy and 3) apply this QC strategy to monitor performance under typical field conditions. METHODS : Differences between white rhinoceros heparin plasma and serum, short-term imprecision and reportable range using rhinoceros plasma and long-term imprecision using commercial quality control material (QCM) was assessed against prescribed total allowable error (TEa) for up to 15 analytes. QC validation was performed using data from the long-term imprecision study and TEa. A QC strategy using QCM was developed and used to monitor performance under field conditions. RESULTS : Imprecision was acceptable for all analytes except for ALP, ALT and AST at low activities. The reportable range for AST and LDH differed from the manufacturer’s specifications. Eleven analytes were suitable for statistical QC using the 13s rule, three using the 2s rule; ALP was not suitable. In the field, observed error was less than TEa for all fifteen analytes and the sigma metric was >3.0 for twelve analytes. CONCLUSIONS : The VetTest is suitable for use in the white rhinoceros. Statistical QC is possible for most analytes and useful for evaluation of field performance.The South African Veterinary Foundation, the Department of Companion Animal Clinical Studies of the University of Pretoria and Saving the Survivors.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1939-165X2018-03-31hb2017Companion Animal Clinical Studie

Thromboelastographic platelet mapping in dogs with complicated Babesia rossi infection

Please read abstract in the article.Department of Companion Animal Clinical Studies of the University of Pretoria; South African National Research Foundation; IDEXX Laboratories (Pty) Ltd.http://wileyonlinelibrary.com/journal/vcp2020-03-01hj2019Companion Animal Clinical Studie

Markers of inflammation in free-living African elephants (Loxodonta africana) : reference intervals and diagnostic performance of acute phase reactants

INTRODUCTION: Acute phase reactants (APRs) have not been investigated in free-living African elephants (Loxodonta africana), and there is little information about negative APRs albumin and serum iron in elephants. OBJECTIVES: We aimed to generate reference intervals (RIs) for APRs for free-living African elephants, and to determine the diagnostic performance of APRs in apparently healthy elephants and elephants with inflammatory lesions. METHODS: Stored serum samples from 49 apparently healthy and 16 injured free-living elephants were used. The following APRs and methods were included: albumin, bromocresol green; haptoglobin, colorimetric assay; serum amyloid A (SAA), multispecies immunoturbidometric assay, and serum iron with ferrozine method. Reference intervals were generated using the nonparametric method. Indices of diagnostic accuracy were determined by receiver-operator characteristic (ROC) curve analysis. RESULTS: Reference intervals were: albumin 41-55 g/L, haptoglobin 0.16-3.51 g/L, SAA < 10 mg/L, and serum iron 8.60-16.99 μmol/L. Serum iron and albumin concentrations were lower and haptoglobin and SAA concentrations were higher in the injured group. Serum iron had the best ability to predict health or inflammation, followed by haptoglobin, SAA, and albumin, with the area under the ROC curve ranging from 0.88-0.93. CONCLUSIONS: SAA concentrations were lower in healthy African vs Asian elephants, and species-specific RIs should be used. Serum iron was determined to be a diagnostically useful negative APR which should be added to APR panels for elephants.University of Pretoriahttp://www.wileyonlinelibrary.com/journal/vcpdm2022Centre for Veterinary Wildlife StudiesCompanion Animal Clinical StudiesProduction Animal Studie