August 11th, 2008

Devcolor

Things I've Learned Recently

 This whole thing with Devon is so upsetting to me for all the obvious reasons, not the least of which is how passive an advocate for my dog I've been.

I just asked for and received copies of Devon's CBCs from this year and last year. In June of '07 his platelets were listed as 10,000 (normal is 170,000-400,00 according to this laboratory) with clumping present. And there's a comment attached to the result explaining how clumping means you can't get "a precise determination". It also says that clumping "falsely decreases the platelet number". Then it goes on to explain the possible causes of clumping in a CBC and how a sample should be drawn with a large bore needle from the jugular using a vacutainer. It also provides a "platelet estimate" which is either "decreased" or "adequate".

I didn't know if anyone at the reference lab would speak to me so I called the hospital lab where I used to work and asked to speak to the hematology tech. No one asked me who I was or why I was calling. I guess  they didn't care because I wasn't asking for any patient data. I just asked the tech to explain to me what it meant when a result had the attached comment of "clumping present" and how accurate their estimates were.

The tech very nicely explained to me that when there's clumping present no number result or estimate can be considered accurate since there's no way of knowing how many cells are in the clumps. And, no, I didn't ask the next obvious question, "Then why do you bother giving any values at all?" because I know the answer. Doctors and clinicians want an answer when they send in a sample. It used to happen all the time when I worked at the hospital that someone would send down a clotted sample and want to know why I had had to reject it as "not suitable for analysis". A doctor or nurse would get irate with me that I had called them to report that they'd have to draw another sample because the one they'd sent had had so many clots there wasn't enough serum to assay. I'd try to explain that sometimes the body doesn't cooperate with our testing methods and insists on doing what it was meant to do when assaulted and clot. Sometimes they'd get so angry with me (typical kill the messenger reaction) they'd ask to speak to my supervisor to complain about my "attitude". so, I guess in self defense the labs started putting numbers and comments in so that clinicians could feel like they were getting some kind of answer.

I don't know if there's any way an unclumped sample can be obtained on Devon but I'm going to suggest we try a couple of the methods I've learned about and see what happens. If they still come back clumped then I'll just assume that his platelets are really good at their job and not worry that he'll ever bleed to death :-)

But none of this absolves me or Devon's vet of our responsibility to him to think before we act. It's not like Devon was in any danger--especially since a year ago his platelets were also clumping up a storm. we should have looked at this situation logically and asked more questions before assuming anything. So, lesson learned--I hope. No more jumping off the roof because there's a fire in the ashtray.

I'm not sure if I'll continue with this vet or go elsewhere. I've decided to postpone making that decision until I'm satisfied that Devon really is OK and weaned completely off the Prednisone. Maybe working through this with my vet will make her that much better at taking care of my dogs--any maybe others', too.