History: It's Essential

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Submitting slides for a clinical pathology review is a bit time-consuming at best, downright schedule-derailing at worst. Using an automatic slide scanner (cough, Lacuna, cough) can reduce your time immensely. Perfecting the art of history submission can speed up the process as well.  A concise yet thorough explanation is key. Here's an example that one of our Lacuna pathologists encountered last week: 

 A complete blood count and blood film review on an older cat with ADR symptoms was submitted for review through the Lacuna portal via an ER clinician. CBC one week prior at the regular veterinarian revealed a moderate lymphocytosis that was not repeatable via the ER blood hematology analyzer, and as such, a blood film review was ordered. Lacuna autoscan blood film evaluation confirmed the analyzer findings of normal numbers of typical lymphocytes. So where did the previously noted lymphocytes go?

With little to go on, the pathologist asked the submitting ER clinician about any historical steroid administration, which can lyse lymphocytes leading to decreased counts.  This is especially important because if the previous lymphocytosis was composed of neoplastic cells, these could have lysed from therapy, masking the diagnosis.   

 While there was no history of steroids, the ER doctor luckily remembered something else. The cat was diagnosed as hyperthyroid a few weeks prior and methimazole was instituted for disease control. Both hyperthyroidism and methimazole can cause transient lymphocytosis. Armed with this information, the pathologist was able to work with the clinician to reprioritize differentials and use the client's funds on other diagnostics. 

 Even with just a minute to write a history, you can easily and efficiently relay a lot of information to the reviewing pathologist. Keys to a medical history for a pathology review include:

  • Current medical problem(s) with presenting clinical signs, degree of severity, and duration 

  • Pertinent physical exam findings

  • Brief summary of laboratory findings and other diagnostics performed

  • Current medications

  • Any notable medical history (especially endocrine diseases, immune-mediated conditions, neoplasia) 

  • If you don't know any of the above or if it is not applicable to your patient, please note that as well. 

 How do you streamline your histories? Any tips? What are your stories of histories that made the diagnosis? 

 Remember, Lacuna pathologists are here 24/7 to help you with your CBCs, blood films, and much more: www.lacunadiagnostics.com