IDEXX Laser Cyte TM Laser Cyte Training Laser

IDEXX Laser. Cyte. TM

Laser. Cyte Training Laser. Cyte™ Parameters l Laser. Cyte Parameters l Medical Reasons l l 2 The “What” and “So What” Summary © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training Laser. Cyte™ Parameters Red blood Cells White blood Cell Platlets 3 © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training Red Blood Cells • Is there evidence of anemia? § Regenerative or nonregenerative with reticulocyte count • Is there evidence of dehydration? § Polycythemia 4 © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training Red Blood Cells l HCT (Hematocrit) l l l It is a calculation by the Laser. Cyte l 40 – 59% dogs; 29 – 50% cats l Used to diagnose anemia or polycythemia RBC (Red Blood Cell Count) l l 5 Percentage of the red cell population relative to the total volume of blood Actual number of RBCs in a given quantity of blood 6 Average is 5. 9 - 8. 6 X 10 6 μL for dogs or 5 6 10 X 10 μL for cats © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training Red Blood Cells l HGB (Hemoglobin) l l 6 A measurement of the oxygen carrying capacity of the red blood cells The Laser. Cyte uses four LEDs and photodetectors that measure Hgb concentration by at least three different wavelengths of light and two different aspirates, unlysed and lysed. © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training Red Blood Cells l # Retics l l 7 A retic count offers a quick and easy assessment of an anemia state. A count, unlike a percentage is not affected by dehydration. The number of reticulocytes is a definitive indicator to distinguish between regenerative and non-regenerative anemias. The Laser. Cyte gives aggregate retics in the cat A retic count above 60, 000 μL in cats and 80, 000 μL in dogs in considered a regenerative anemia % Retics l Percentage of reticulocytes in a given quantity of blood l Average is 0. 0 – 1. 5% for dogs or 0. 0 – 0. 4% for cats © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training Red Blood Cells l MCV (Mean Corpuscular Volume) l The mean volume of all the RBCs counted in the sample l Smaller than normal is microcytic larger is macrocytic l l RDW (Red Cell Distribution Width) l l 8 Used to indicate spherocytes, anisocytosis, or schistocytes all of which must be confirmed with a morphology exam Measurement of the variation of size with in the RBC population. Given as a percentage Used to indicate anisocytosis, also used by impedance analyzer users to indicate the presence of retics with MCV © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training Red Blood Cells l MCHC (Mean Corpuscular Hemoglobin Conc) l l l Calculated by dividing the hemoglobin by the hematocrit and expressing the answer as a percentage l Important in classifying anemias l Normal ranges are 30. 0 – 36. 9% MCH (Mean Corpuscular Hemoglobin) l l 9 The mean concentration of hemoglobin in the red cell Mean mass of hemoglobin in each RBC Calculated by dividing the hemoglobin by the number of RBCs © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training White blood cell data answers • Is there evidence of inflammation? § Acute, chronic or overwhelming • Is there evidence of stress or excitement? § High levels of glucocorticoids cause mild neutrophilia, lymphopenia and eosinophilia • Is there a demand for phagocytosis or evidence of tissue necrosis? § Elevated monocytosis is almost always seen in chronic inflammation 10 © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training White Blood Cells l 11 WBC (White Blood Cell Count) l Total count of all White blood cells l Reported as X 10 3 μL l Indicator of infection (not diagnostic alone) 3 © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training White Blood Cells l Lymphocytes l White blood cell that produces antibodies l 20 – 30% of WBC population l l l 12 Lymphocytosis: Prolonged illness, chronic inflammation, Lymphopenia: Acute inflammation, viral infection, stress, steroid therapy Monocytes 3 l Reported as X 10 3 μL l Indicator of infection (not diagnostic alone) © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training White Blood Cells l Neutrophils l Most common leukocyte l Two classifications: Banded and Segmented l l 13 Engulf disease causing bacteria, viruses, and particles (phagocytosis) Eosinophils l Involved in allergies and parasitic infection l Usually only in circulation for about 30 min l . 1 – 1. 5 X 10 3 μL normal range 3 © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training White Blood Cells l Basophils l Having the basophil # and % aids in identifying • Systemic hypersensitivity • Acute allergic reactions • Mast cell sarcomas 14 © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training The Medical Reasons l White Blood Cells Acute WBC NEUTS EOS LYMPHS MONOS Increased Variable Decreased variable Increased/ no Variable Increased/ Increased change Increased/ Decreased/ no Variable change Increased Inflammation Chronic Inflammation Parasites Stress Leukogram 15 © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential no change Increased Variable Increased/ no change Decreased Increased/ no change

Laser. Cyte Training Is it a stress leukogram or inflammation? Parameters 16 Stress Inflammation WBC Count High Neutrophils High Lymphocytes Low Normal Eosinophils Low Normal Monocytes Slightly high © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training 3 -part versus 5 -part differential 3 -part No 5 -part Yes Infection No Yes Stress No Yes Excitement No Yes Steroid therapy No Yes Decreased neutrophils Parvo No Yes Elevated neutrophils Inflammation Erhlichiosis Overwhelming infection FIV 17 © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training 3 -part versus 5 -part differential 3 -part 5 -part Parasites No Yes Allergies No Yes Mast cell tumors No Yes Heartworm No Yes Addison’s disease No Yes Elevated basophils 18 © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training Platelet data answers • Is there evidence of autoimmune disorders, occult infections or inflammation? • Suspected coagulopathies? 19 © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training With Laser. Cyte , your platelet information increases** ® • PLT • Involved in clotting • PLT is a platelet count • Thrombocytopenia can be seen in Ehrlichia, FIV, FELV • MPV (mean platelet volume) aids in the identification of what may be causing a severe thrombocytopenia • PDW (platelet distribution width) is an objective measure of the degree of variability in the size of **Absolute count—Available using indicate the Laser. Cyte analyzer. platelets and can bone marrow response 20 © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training The CBC is a time-sensitive test • Hematology samples are composed of living cells and should be analyzed as soon as possible: § To prevent cell distortions due to shipment or storage § To prevent artifacts created by long-term exposure to EDTA 21 © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training Blood cells continue to develop and change • Samples should be processed within three hours to avoid artificially increased Hct and MCV, and decreased MCHC • Platelet counts should be performed within one hour after collection • Red cells crenate, reticulocytes mature, and lymphocytes’ nuclei become distorted Rebar A, et al. Guide to Hematology in Dogs and Cats. Jackson, WY: Teton New Media; 2002: 11. 22 © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training Which system is ideally suited for your needs? Laser. Cyte QBC Vet. Autoread™ Lab Impedence RBC Count Yes --- Yes PCV/Hct Yes Yes Hgb Yes Yes Yes % only Request --- MCV Yes --- Yes MCHC Yes Yes RDW Yes --- Yes Reticulocytes 23 © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training Which system is ideally suited for your needs? 24 Yes, corrected Not corrected for n. RBC Lymphocytes Yes, absolute count and % Grouped with monocytes Monocytes Yes, absolute count and % Grouped with lymphocytes Neutrophils Yes, absolute count and % --- © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential Yes, corrected for n. RBC Yes, absolute count and % Small-sized cells number and % Middle-sized cells number and % Yes, absolute count and % --- n. RBCs misclassified

Laser. Cyte Training Which system is ideally suited for your needs? Laser. Cyte 25 QBC Vet. Autoread™ Impedence Eosinophils Yes, absolute count and % Basophils Yes, absolute count and % Platelet Count Yes, optical signature, clump s do not interfere with WBC count MPV Yes, absolute count --- Yes PDW Yes, absolute count --- Yes © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential Elevated canine and bovine Lab Yes, good correlation with clumped platelet samples Yes, bsolute count and % --- Not always, usually reports broad categories (i. e. , adequate) Yes, size only, clumps may go uncounted or misidentified as WBCs

Laser. Cyte Training The Doctor’s view “I have a QBC Vet. Autoread that is nearly paid off, why should I go in debt again for a new one” l l A five part differential is a must for diagnosing many very common diseases or states. l l 26 The QBC Vet Auto. Read is and was a good in-clinic system. However, as with anything the advances in technology now make it affordable and possible to practice the best medicine available right in your clinic. … allergies, parasitic infection, chronic inflammation, stress, feline asthma, systemic toxemia, and more. © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training The Doctor’s view l “I let my lab deal with the equipment cost and maintenance, they get me the results I need in plenty of time” l l As discussed, a CBC is a time sensitive test. Platelets clump, red cells change shape and size, bands change to segs, lymphocytes, neutrophils, and eosinophils can change size, etc. This immediate information is critical in many cases. l 27 Not only does the cells change, the animals condition changes between draw and results from the lab © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training The Doctor’s view l “Other in-clinic analyzer’s are just as good, and cost about $5 k to $8 k less” l Laser Flow Cytometry is the standard in automated hematology. l 28 Other in-clinic analyzers interrogate cells based on size only. This can cause erroneous results in the case of artifacts, n. RBCs, reticulocytes, and more. © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training Summary (1 of 3) You need to show a Dr. why the Laser. Cyte® is a good investment medically. l l 29 Increased ability to diagnose common problems Immediate results mean immediate treatment and decreased effects from artifacts © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training Summary (2 of 3) The Laser. Cyte® is not meant to “replace” the reference lab, it is meant to give the Dr. reference lab results for their in-clinic testing needs. l l 30 Do not try to compare to ref lab prices or say that they can now make more $ by doing test in-house. They will however, increase their testing volume by having ref lab accuracy immediately available. © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

Laser. Cyte Training Summary (3 of 3) Do not try to sell the Laser. Cyte. TM on price or testing volume. l l 31 If the Dr. is already doing in-clinic testing, the Laser. Cyte. TM will not make them more money right away, it will give them the ability to make more accurate and rapid diagnosis. If the Dr. is using the reference lab, the Laser. Cyte. TM will be more expensive to use, but he will do more testing if he/she has the availability to do so. © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential