Lancefield House23 Mains LanePoulton Le FyldeFY6 7LJT: 01253 899215F: 01253 891934E: info@nwlabs.co.uk

HEAD OFFICE& POULTON

LEEDSLABORATORY

SPECIALISTLABORATORY

ABBEY VETERINARY

KNUTTONLABORATORY

Gate Way DriveYeadonLeedsLS19 7XYT: 0113 250 7556F: 0113 250 0198E: info@nwlabs.co.uk

Unit 2Sawston Trade ParkLondon Road, PampisfordCambridge, CB22 3EET: 01223 493400F: 01223 493404E: info@cslabs.co.uk

89 Queen StNewton AbbotDevonTQ12 2BGT: 01626 353598F: 01626 335135E: admin@abbeyvetservices.co.uk

Unit 6, Brock WayKnuttonNewcastle-under-LymeStaffs ST5 6AZT: 01782 948040F: 01782 948041E: results@capl.co.uk

NationWide Labs NEWSISSUE 24 SPRING 2018

Dates for your Diary

We are attending the following large congresses in 2018:BVDSG 4th AprilBSAVA 5th – 7th AprilBEVA 13th-15th Sept

SBSAVA 22nd-23rd SeptBVNA 12th-14th OctBCVA 18th-20th Oct

BVDSG NovLVS 15th-16th Nov

Collision TumoursA 10 year old, female neutered German Shepherd Dog presented with a pyloric/ duodenal mass within the muscular tunic and nodules were identified in the spleen and splenectomy performed. Examination of the mass in the intestinal wall showed a high grade carcinoma. The section of spleen showed two foci of haemangiosarcoma and within one of these a focus of carcinoma (The image shows carcinoma on the right and haemangiosarcoma to the left). The simultaneous occurrence of two neoplasms in one location is described as ‘collision’ and in most sites is unusual. Whilst multiple tumours may arise spontaneously in an individual, two occurring within the same space is uncommon outside of the reproductive tract and mammary gland.

Collision tumours may occur when two foci of neoplasia develop independently but adjacent to one another and colonization may occur when a secondary tumour permeates a primary tumour in situ. Our case therefore represents an example of colonization. Establishment of metastatic tumour foci in their new location is complex and dependent on several factors, and the tumour cells must adhere, invade, establish their own blood supply and grow in their new site. In this case the tumour cells must have travelled haematogenously having accessed blood vessels or lymphatics. Most tumour cells are halted in the first capillary bed they encounter which for portal vein drainage is the liver. To have arrived in the spleen in this case could this be an example of retrograde venous spread or could these cells have travelled more widely? We have no additional history as to the presence of metastatic foci in the liver or lung that could themselves be shedding tumour cells. The vascular spaces of haemangiosarcoma would seem an ideal environment of sluggish blood flow for metastatic tumour cells.In a recent article in JAVMA, ‘Malignant collision tumours in two dogs’, the authors reviewed the database at Colorado State University Veterinary Diagnostic Laboratory and the literature. Haemangiosarcoma featured quite frequently but mostly as collision tumours developing adjacent to another neoplasm and when colonisation is described it appears to be the haemangiosarcoma which infiltrated its neighbouring tumour. Splenic haemangiosarcoma is a very common neoplasm but here at Abbey none of the pathologists have encountered metastatic carcinoma in splenic haemangiosarcoma previously. A look at our database identified 22 collision tumours of which 11 involved testis, ovary or mammary gland. The remainder mostly involved skin with 5 showing mast cell tumour plus another tumour type. There is one haemangiosarcoma described as colliding with low grade spindle cell tumour in the skin but no collision tumours involving the spleen.Scott, JE, Liptak, JM, and Powers BE. Malignant collision tumours in two dogs. JAVMA (2017)251(8) pp 941-945

Welcome to the NWL Spring Newsletter, we hope we have seen the last of the snow and the spring flowers are getting through quickly followed by some warmer weather.

In this edition we have some interesting articles cover tumours, kidney function, our unique lab and communication. We hope you find it informative, if you have any ideas for future editions please email info@nwlabs.co.uk

NEWSISSUE 24 SPRING 2018

Assessment of Kidney Function in cats and dogs through measurement of Glomerular Filtration RateThis is a measure of kidney function for cats and dogs. It measures glomerular filtration rate (GFR) directly, rather than metabolic markers in the serum that are used to provide an estimate of GFR. Plasma creatinine concentrations can remain within the normal reference interval until more than 60 per cent of nephrons are already non-functional. Because GFR is directly correlated with functional renal mass, quantification of GFR is a direct measure of renal function and can enable earlier identification of kidney disease.Use of the assay Measurement of GFR can help identify renal dysfunction in a dog or cat that is unable to concentrate their urine adequately but is not yet azotemic. It may also be useful as a screening tool for older cats or for some dog breeds known to be at risk of nephropathies.Results may assist in identifying animals that may require more frequent monitoring or are at risk of developing kidney disease. Repeating GFR measurements is advisable as changes of GFR in time are more informative than the absolute GFR value based on a single measurement. Earlier diagnosis of kidney disease may be of benefit to both clients and patients by providing better information on long-term prognosis and enabling protective therapies or diets to be started sooner. Finally, accurate measurement of GFR could enable the dosage of renally excreted drugs to be adjusted when renal disease is present, or when the drugs being used are potentially nephrotoxic.Carrying out the Iohexol assay Iohexol is an iodinated radiographic contrast agent that is eliminated solely through renal excretion following intravenous injection at a rate that is dependent on GFR, and is commercially available to veterinarians as Omnipaque 300. To perform this test, the patients should be well hydrated and fasted 12 hours before the study. A dose of 300 mg iodine/kg is administered intravenously at time 0.The initial starting time is accurately recorded. Serum samples (0.5 ml) are obtained at 2, 3, and 4 hours after administration, and sent for analysis.Analysis Serum iohexol concentration is measured and results are then used to calculate serum/plasma clearance of iohexol. With the knowledge of the

administered dose this enables GFR to be accurately determined

with only 3 samples after application of a correction formula. Comparison of the

obtained result to established reference ranges, together

with the full clinical history of the patient, are then used to provide an assessment of their kidney

function.

Case Example Adjustment of chemotherapy dose according to rate of excretion. Lotta, feline, 10y female British Short Hair, 3.5kg Lotta had presented with a mediastinal adenocarcinoma, which was surgically debulked, but could not be completely resected. Post-surgery, there was evidence of acute kidney injury. Creatinine returned to within normal limits subsequently. The highest USG value recorded post-surgery was 1.027.Lotta subsequently presented with pleural effusion, and metastases were identified within the thorax. Carboplatin was chosen as the most appropriate method of managing Lotta’s developing neoplasia. Carboplatin clearance is proportional to glomerular filtration rate, with the elimination half-life dependent on renal function. In humans, elimination half-life is considered to be typically 2 to 6 hours in individuals with normal glomerular filtration rate, but can be increased to 18 hours in patients with impaired renal function (Dufull and Robinson Clin Pharmacokinet 1997 33(3) 161-83). Increased risk of toxic effects on the bone marrow are described with increased systemic exposure to carboplatin, described as area under the concentration-time curve (AUC). A formula has been developed to utilise the measurement of GFR using the iohexol clearance test in cats to adjust the carboplatin dose appropriately to maximise chemotherapy action, and minimise risk of adverse effects (Bailey DB, Rassnick KM, Prey JD, Dykes NL. Am J Vet Res. 2009 Sep;70(9):1135-40.)Lotta’s GFRiohexol was 1.86mL/kg/min. Her GFR-informed dose of carboplatin was therefore 36.7mg (compared to an empirical dose of 41.5 for 180 mg / m2 to 48.4 mg for 210 mg / m2). She received a series of 7 carboplatin injections at this dose, and survived 11 months after surgery. No myelosuppression was identified during this time.

ISSUE 24 SPRING 2018

Specialist NEWS We have a very unique lab...

Did You Know... Don’t forgetWe can offer a wide range of “specialist saliva assays”

for use in a wide range of species. Hormones such as Cortisol, Progesterone, Oestradiol, Testosterone and Estrone can be measured.

We are also looking into saliva progesterone as an alternative to blood sampling for predicting the time to mate in a bitch.

We now have on-line CPD course available on our website www.nwlabs.co.uk

Please contact NationWide Specialist Laboratories for further information

We have a very unique lab as part of our group, our Specialist lab based in Cambridge which is renowned worldwide for - • The expert analysis of hormones and a very wide range of endocrine tests.

• The use of non-chemiluminescent methods which in some cases are much better suited to animal samples across a wide range of species.

• The analysis of very unusual samples, e.g. Faecal pregnancy testing in large cats.

• Provision of endocrine expertise over the phone “how to get the most information out of your sampling”.

• Finding and developing new assays for our clients “finger on the pulse”.

What’s unique:

We are the reference laboratory for industry as we are used by many other labs for their endocrine referral work.

We have radioactive capability which allows us greater freedom with analysis and to be able to “experiment with kits and methods” not always possible on automated machines.

Unusual tests are Androstenedione, AMH, Aldosterone, EPO, IGF1, 17-OH-Progesterone, Normetanephrine, PTH, PTHrP, Renin, TK.

Extensive background and experience in endocrine testing and interpreting endocrine results, biochemistry assay knowledge and troubleshooting.

We have access to two of the best endocrinologists in the world.

Supported by :

Provision of very good literature and information for clients.

Excellent customer service with a very personal touch.

Excellent attention to detail in all analysis, most samples analysed in duplicate and assays (all endocrine) are done manually.

Specialist LaboratoryPrice List 2018Specialists in Endocrinology. Experts in Immunoassay.

NationWide Specialist LaboratoriesUnit 2, Sawston Park,London Road, Pampisford,Cambridge, CB22 3EE

T. 01223 493400F. 01223 493404Email: info@cslabs.co.ukwww.thehormonelab.com

Head Office23 Mains Lane, Poulton-le-Fylde,Lancashire FY6 7LJT: 01253 899215 www.nwlabs.co.uk

Trust in Excellence. Trust us.NationWide Laboratories is a trading business of National Veterinary Services Ltd

NEWSISSUE 24 SPRING 2018

The importance of communicationGood communication is an essential tool in achieving productivity and maintaining strong working relationships at all levels of an organisation.Employers who invest time and energy into delivering clear lines of communication will rapidly build up levels of trust amongst employees, leading to increases in productivity, output and morale in general.Poor communication in the workplace will inevitably lead to unmotivated staff that may begin to question their own confidence in their abilities and inevitably in the organisation.

Some Tips on communications -Define goals and expectations – Managers need to deliver clear, achievable goals to both teams and individuals, outlining exactly what is required on any given project, and ensuring that all staff are aware of the objectives of the project, the department and the organisation as a whole.Clearly deliver your message – Ensure your message is clear and accessible to your intended audience. To do this it is essential that you speak plainly and politely – getting your message across clearly without causing confusion.Choose your medium carefully – Once you’ve created your message you need to ensure it’s delivered in the best possible format. While face to face communication is by far the best way to build trust with employees, it is not always an option. Take time to decide whether information delivered in a printed copy would work better than an email or if a general memo will suffice.Keep everyone involved – Ensure that lines of communication are kept open at all times. Actively seek and encourage progress reports and project updates. This is particularly important when dealing with remote staff.Listen and show empathy – Communication is a two way process and no company or individual will survive long if it doesn’t listen and encourage dialogue with the other party. Listening shows respect and allows you to learn of any outstanding issues you may need to address as an employer.

What are the benefits of effective communication?Engaged Employees – If people are communicated to regularly and in an effective manner they are much more engaged with the company/team and have a more positive attitude towards their work and their customer.Ensures Consistency – If everyone understands what the company/team is trying to achieve and their role within it, you will get a much more consistent approach and less tendency for people to come up with their interpretation of what they think something means.Promotes 2 Way Feedback – Regular and effective communications invite people to engage in discussion (communication is a dialogue after all!) and provide 2 way feedback between management and employees, departments and colleagues. This in turn promotes a culture of sharing ideas and knowledge, but also making these happen.Ensure Compliance with Regulatory Bodies – Effective communications and training information ensures that our employees are compliant with all regulatory requirements and aware of all the company guidelines/policies and/or where to find them.Ensure Common Understanding of Strategy and Goals – Employees understand how their work fits into the bigger picture and what the team/company as a whole is trying to achieve.Promotes a Positive Attitude Towards Change – Employees that are communicated to effectively around change respond much more positively to it. Communication can also identify champions within the company/team willing to help embed change.Engaged employees are highly motivated, providing a valuable, productive and cost-effective service. They make an extra effort or ‘go the extra mile’, making a measurable difference to our results and the value perceived by our customers.Failure to communicate will lead to a negative shift in any or all of the above benefits. This could have a serious detrimental effect not only on your company’s operational efficiency, but also customer satisfaction and ultimately your profits and market share.In order to achieve engagement in our workforce we have to keep employees informed and engaged through regular and effective communications, which are relevant and timely.