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numbers equate with normal cells and look carefully for: • Toxic change • Left shift • reactive cells • Presence of cells, such as lymphoblasts, mast cells, and histiocytes, that signify the need for more diagnostic investigation. CONCLUSIONS & RECOMMENDATIONS Blood flm review is a critical component of in-clinic hematology. A cursory review may be suffcient for healthy animals, while more detailed analysis is required for sick patients. Key components every practice should have in place for in-clinic hematology include: 1. Written guidelines to determine when samples should be sent to a reference laboratory for evaluation 2. staff training in blood flm review, with attention to ongoing educational activities 3. Quality assurance checks, performed by routinely sending samples to a reference laboratory to compare their results with those generated in the practice. Address any signifcant discrepancies with additional training and re-evaluation of guidelines for reference laboratory verifcation of results. Following the guidelines outlined in this article will ensure that in-clinic hematology is a safe and effective tool in your practice. cBc = complete blood count; rBc = red blood cell; WBc = white blood cell References 1. Hodges J, christopher MM. diagnostic accuracy of using erythrocyte indices and polychromasia to identify regenerative anemia in dogs. JAVMA 2011; 238(11):1452-1458. 2. McManus PM. Frequency and severity of mastocytemia in dogs with and without mast cell tumors: 120 cases (1995-1997). JAVMA 1999; 215(3):355-357. 3. Piviani M, Walton rM, Patel rT. signifcance of mastocytemia in cats. Vet Clin Pathol 2013; 42(1):4-10. 4. Kelley J, sharkey Lc, christopherson PW, rendahl A. Platelet count and plateletcrit in cavalier King charles spaniels and Greyhounds using the Advia 120 and 2120. Vet Clin Pathol 2014; 43(1):43-49. 5. Auburn University department of Pathobiology. congenital Macrothrombocytopenia Test Form. Available at www.vetmed.auburn.edu/ wp-content/uploads/2014/11/congenital- Macrothrombocytopenia-cKcs.pdf?5f5dc8. Caution Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. Indications SENTINEL ® SPECTRUM ® (milbemycin oxime/lufenuron/praziquantel) is indicated for the prevention of heartworm disease caused by Diroflaria immitis; for the prevention and control of fea populations (Ctenocephalides felis); and for the treatment and control of adult roundworm (Toxocara canis, Toxascaris leonina), adult hookworm (Ancylostoma caninum), adult whipworm (Trichuris vulpis), and adult tapeworm (Taenia pisiformis, Echinococcus multilocularis and Echinococcus granulosus) infections in dogs and puppies two pounds of body weight or greater and six weeks of age and older. Dosage and Administration SENTINEL SPECTRUM should be administered orally, once every month, at the minimum dosage of 0.23 mg/lb (0.5 mg/kg) milbemycin oxime, 4.55 mg/lb (10 mg/kg) lufenuron, and 2.28 mg/lb (5 mg/kg) praziquantel. For heartworm prevention, give once monthly for at least 6 months after exposure to mosquitoes. Dosage Schedule Body Weight Milbemycin Oxime per chewable Lufenuron per chewable Praziquantel per chewabl e Number of chewable s 2 to 8 lbs. 2.3 mg 46 mg 22.8 mg One 8.1 to 25 lbs. 5.75 mg 115 mg 57 mg One 25.1 to 50 lbs. 11.5 mg 230 mg 114 mg One 50.1 to 100 lbs. 23.0 mg 460 mg 228 mg One Over 100 lbs. Administer the appropriate combination of chewables To ensure adequate absorption, always administer SENTINEL SPECTRUM to dogs immediately after or in conjunction with a normal meal. SENTINEL SPECTRUM may be offered to the dog by hand or added to a small amount of dog food. The chewables should be administered in a manner that encourages the dog to chew, rather than to swallow without chewing. Chewables may be broken into pieces and fed to dogs that normally swallow treats whole. Care should be taken that the dog consumes the complete dose, and treated animals should be observed a few minutes after administration to ensure that no part of the dose is lost or rejected. If it is suspected that any of the dose has been lost, redosing is recommended. Contraindications There are no known contraindications to the use of SENTINEL SPECTRUM. Warnings Not for use in humans. Keep this and all drugs out of the reach of children. Precautions Treatment with fewer than 6 monthly doses after the last exposure to mosquitoes may not provide complete heartworm prevention. Prior to administration of SENTINEL SPECTRUM, dogs should be tested for existing heartworm infections. At the discretion of the veterinarian, infected dogs should be treated to remove adult heartworms. SENTINEL SPECTRUM is not effective against adult D. immitis. Mild, transient hypersensitivity reactions, such as labored breathing, vomiting, hypersalivation, and lethargy, have been noted in some dogs treated with milbemycin oxime carrying a high number of circulating microflariae. These reactions are presumably caused by release of protein from dead or dying microflariae. Do not use in puppies less than six weeks of age. Do not use in dogs or puppies less than two pounds of body weight. The safety of SENTINEL SPECTRUM has not been evaluated in dogs used for breeding or in lactating females. Studies have been performed with milbemycin oxime and lufenuron alone. Adverse Reactions The following adverse reactions have been reported in dogs after administration of milbemycin oxime, lufenuron, or praziquantel: vomiting, depression/lethargy, pruritus, urticaria, diarrhea, anorexia, skin congestion, ataxia, convulsions, salivation, and weakness. To report suspected adverse drug events, contact Novartis Animal Health at 800-637-0281 or the FDA at 1-888-FDA-VETS. Manufactured for: Novartis Animal Health US, Inc. Greensboro, NC 27408, USA NADA #141-333, Approved by FDA © 2013 Novartis Animal Health US, Inc NAH/SSC/BS/1 1/14 in-cLinic HeMAToLoGy D A niel Heinri CH Daniel Heinrich, DVM, is a second-year resident in clinical patholo- gy at University of Minnesota. Dr. Heinrich received his DVM from University of Wisconsin–Madison; completed a rotating small ani - mal internship at VCA Veterinary Specialty Center of Seattle, Wash- ington; and practiced at a small animal hospital in Chicago, Illinois, prior to his residency. His interests include diagnostic cytology, the scholarship of teaching and learning, and promotion of clini - cal pathology continuing education for general practitioners. He is currently completing research evaluating the use of the cell block method to diagnose causes of canine peripheral lymphadenopathy. leslie sHArkey Leslie Sharkey, DVM, PhD, Diplomate ACVP (Clinical Pathology), is a professor of clinical pathology in the University of Minnesota Veter - inary Clinical Sciences Department, where she is Director of Clinical Pathology Laboratory. Her clinical interests include critical evalua - tion of the diagnostic application of testing. She is also involved in comparative and translational research, studying the long-term effects of chemotherapy and radiation in cancer survivors. Dr. Shar - key completed her DVM and post graduate training at Ohio State University and was on faculty at Tufts University before joining the faculty at Minnesota. tvpjournal.com | July/August 2015 | TodAy's VeTerinAry PrAcTice 53 Continued from page 49