Reading the Blood Chemistry Panel: An Art and Science

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Mark Hitt, DVM, MS, a veterinary specialist (Diplomate of the American College of Veterinary Internal Medicine - Specialty of Internal Medicine) practicing with the Atlantic Veterinary Internal Medicine group in Annapolis, Maryland, underscores the value of utilizing the Blood Chemistry Panel by citing an interesting case. The successful management of this dog’s medical difficulties would have been doubtful if a chemistry panel was not performed.

Hitt relates:

 

"Hans, a ten year old Doberman, had been seen by his referring veterinarian with the goal of a general health evaluation and potential teeth cleaning because of bad breath. The owners allowed the pet’s veterinarian to run a chemistry profile, CBC, and urinalysis a few days prior to the proposed anesthesia for the dental procedures. Neither owner had been alarmed at the gradual, mild decrease in Hans’s appetite, weight, and vitality. They had presumed he was "just getting older.'

 

When the blood chemistry results were reported there were several abnormal values that related to liver disease (ALT, ALP, bilirubin). And, the red blood cell count was low suggesting an unsuspected anemia was present. These findings led to referral to our center for further tests to assess the liver’s function (serum bile acids), size (radiographs), and textures and patterns (sonography).

 

A large lump was found in one lobe of the liver. This was biopsied without major surgery by using an ultrasound guided needle biopsy technique. A pathologist examined the sample of liver tissue and the assessment was that this patient had a non-malignant form of cancer called a canine hepatoma.

 

Although there was the concern that a more malignant cancer could be present despite the pathologist’s best assessment, the owners wanted to proceed. Hans was transferred to our surgery group to remove this lobe of liver and to examine the other organs. The surgeons commented that the tumor (Latin for a “swelling”) had been bleeding internally and was in danger of rupturing completely at the time it was removed.

 

After the surgery the dog’s liver enzymes returned to normal as did his appetite, weight, and energy levels.

 

Not every case is as dramatic, or has as positive of an outcome, as this case. But it does highlight the importance of routine examinations and testing in older patients. Eventually, Hans did have his teeth cleaned. There are many other similar cases that I have seen where kidney, liver, hormonal, and other medical problems have been detected early through the help of the blood chemistry panel."

Hitt goes on to state that statistically about 1 in 20 tests may be abnormal without truly being relevant. In other words, a dog may have, for example, a higher than normal liver enzyme value for long periods of time and yet be a healthy individual.

"The medical significance of an abnormal test result," Hitt said, "can only be assessed by the veterinarian when the patient, patient history, and degree of value change are kept in mind. And, if a test result is considered significant, it may lead to additional tests for either confirmation of a problem’s significance to the pet or for further information relating to the concern."

Suggestions for Dog Owners

Whenever you find yourself in the veterinarian’s office with a sick dog, be proactive and ask the doctor if doing a blood chemistry evaluation would be helpful. You’d want it done for yourself, wouldn’t you? And expect that a blood chemistry profile would be required prior to any elective anesthesia or surgery. You’d be surprised how many elective procedures are put off until the reason for a previously unnoticed medical problem is evaluated.

Many animal hospitals are providing annual Older Pet Evaluations where results of blood and urine testing are vital in making a proper health evaluation of the patient; so if your dog is eight years of age or older an annual physical exam with laboratory tests can be a very rewarding practice.

Price

An informal survey shows that for a routine blood chemistry panel the dog owner might expect to pay from $17.50 to over $60.00. One reason for the variation in price is that some chemistry panels check for a wider array of values than others. The price reflects the veterinarian’s time and costs in collecting, sending, interpreting the results and a discussion of the report with the dog owner.

Always ask what the cost is but do not be reluctant to have this extremely important laboratory evaluation done. Dr. Hitt adds, "Remember, the most value from a chemistry panel may be obtained when combined with a urinalysis (UA) and a complete blood count (CBC)." The science is necessary for the art to work properly!