Training module II - Heartworm Testing

Jacquelyn Burns
Jacquelyn BurnsD.V.M. at Holmes Veterinary Hospital
Training Module II,[object Object],The Heartworm Test and,[object Object],Heartworm Preventatives,[object Object]
Who needs a heartworm test?,[object Object],Wellness testing,[object Object],Heartworm testing in dogs over six months old is done routinely as a part of wellness testing in most parts of the U.S.  In most practices, it is incorporated into the annual physical exam and/or along with routine immunizations. ,[object Object],Sick dogs,[object Object],Dogs who have never had preventative or  whose owners have lapsed in administering heartworm preventatives,[object Object],Why?  It’s rare, but administering preventative to a positive dog can cause death.  We had one this year—owner gave pill and his dog died in under 2 hours!,[object Object],Rarely, we will test cats, but it’s too complicated for this presentation.,[object Object]
Patient Selection,[object Object],Screening test for dogs and puppies over 6 months old,[object Object],Required for prescribing heartworm preventative prescriptions,[object Object],Recommended yearly by American Heartworm Society,[object Object],In our clinic, we allow dogs with a purchase history consistent with giving the pills monthly to be tested every other year.  Some vets require a test yearly, and some are downright lax about testing.  ,[object Object],Coughing dogs,[object Object],Dogs with labored breathing,[object Object],Dogs with syncope (fainting),[object Object],Dogs with ascites (swollen, fluid-filled abdomen),[object Object],Outdoor dogs with vague clinical signs,[object Object],Dogs with stroke-like signs,[object Object]
Heartworm PREVENTATIVES ,[object Object],Oral monthly,[object Object],Ivermectin-based,[object Object],Heartgard Plus,[object Object],Iverheart Plus,[object Object],Tri-Heart Plus,[object Object],Iverheart Max,[object Object],Milbemycin-based,[object Object],Interceptor,[object Object],Sentinel,[object Object],Trifexis,[object Object],[object Object]
Advantage Multi
Proheart InjectionEvery six months,[object Object]
We can never truly tell if a client is faithfully giving the pill, or if their dog is actually taking the pill (as opposed to burying it in the sofa cushions or in the yard).,[object Object],But we do have a purchase history regarding heartworm preventatives,[object Object],If a client purchases the product, we assume they are administering the medication,[object Object],But, always ask anyway!  Sometimes they will admit that they didn’t give them all,[object Object],Heartworm Preventative & Compliance-Is the dog actually taking the medicine?,[object Object]
What if they “missed a few months?”,[object Object],If the client missed one month, we tell them to give the pill and their dog needs to be retested 6-7 months after the dose was missed.,[object Object],We can manually insert a retest date into the Electronic Medical Record,[object Object],If the client missed more than a month, we require a retest before we will refill the heartworm preventative, and we also recommend retesting the patient during their next annual exam,[object Object]
[object Object]
Regular Patient here but buys Heartworm Rx from On-line Pharmacy?We have no record of purchase history because they buy their heartworm preventative elsewhere ,[object Object],“Traveling vet” or mobile vets,[object Object],On-line Pharmacies,[object Object],Home-brew,[object Object],We require a heartworm test every 12 months.  If they buy it from us, we let them go 2 years.,[object Object],We will not fill Rx here or approve prescriptions to outside pharmacies without a test,[object Object],If they are a patient of record here, we will fill Rx,[object Object],Inconsistent Preventative Purchase History?,[object Object]
Four types of in-house tests:,[object Object],Heartworm Antigen Test,[object Object],Direct Blood Smear,[object Object],Modified Knott’s Test (“Filter test”),[object Object],Canine Wellness Profile on the Abaxis machine,[object Object],Hasn’t proven totally accurate!  Recently, we ran an Abaxis heartworm test with every Canine Wellness Profile to confirm discrepancies—after 25 tests there were none,[object Object],Blood Tests for Canine Heartworm Infection,[object Object]
Products we prescribe/endorse here,[object Object],Interceptor,[object Object],Trifexis,[object Object],Advantage Multi,[object Object],Tri-Heart Plus ,[object Object]
Heartworm Antigen Test,[object Object],Our mainstay heartworm test,[object Object],Many manufacturers,[object Object],We use Abaxis here,[object Object],Occasionally, due to a really great deal, we may have a different test kit, but most of them are similar,[object Object],Industry standard ,[object Object],Tests for a protein in the blood that is associated with adult female heartworms,[object Object],All male infections may test negative,[object Object],Immature infections may test negative,[object Object],Most dogs do not test positive unless they have been infected for at least 5 to 6 months,[object Object]
Conducting the Test,[object Object],“Wet the needle” of a TB syringe with heparin before drawing blood,[object Object],	(prevents 	clotting),[object Object],Draw some heparin into the syringe and then shoot it all back up into the bottle,[object Object]
Open the heartworm test kit,[object Object],Write patient name or room number on test,[object Object],Add 1 drop of heparinized whole blood, serum or plasma to the test well on the left (arrow),[object Object],Add 2 drops of conjugate to the test well on the left,[object Object],Set timer for 10 minutes,[object Object],Conducting the test,[object Object]
Reading the test,[object Object],Negative test: ,[object Object],No Color on the left side,[object Object],Within 10 minutes.  ,[object Object],Only the Positive control ,[object Object],on the right side,[object Object],develops color,[object Object],Positive Test,[object Object],Color develops ,[object Object],On the left side ,[object Object],Within 10 minutes,[object Object],Positive Control,[object Object]
Invalid Test/Quality Control,[object Object],Positive control stripe fails to develop color—means the test is invalid and must be repeated.,[object Object],Entire test window is opaque and bloody,[object Object],Blood and conjugate do not flow across the test window within 2 minutes,[object Object],Sometimes it helps to elevate the left side of the test by leaning it against the syringe containing the blood sample,[object Object],Sometimes happens if the sample clots,[object Object]
Questionable Results?,[object Object],Sometimes results are questionable!,[object Object],Very weak or almost no color development on the test stripe,[object Object],Clinical signs are not consistent with test results,[object Object],The vet thinks it’s a positive and it tests negative,[object Object],The vet thinks it’s a negative and it tests positive,[object Object]
What the vet may want done if results are questionable,[object Object],Run a direct blood smear,[object Object],If live microfilaria are seen, it confirms Heartworm Positive.,[object Object],If no microfilaria are seen, it does not confirm negative status.  Further testing is needed.,[object Object],Do chest x-rays,[object Object],Send a serum sample to AViD Labs,[object Object],Wait and retest in 1 month ,[object Object]
Direct Blood Smear,[object Object],Not accurate enough to be a used-alone test!!!,[object Object],1 drop of heparinized whole blood on a slide,[object Object],Put cover slip on,[object Object],Tech or Vet read slide looking for living, moving microfilaria,[object Object],100% accurate if microfilaria are seen,[object Object],If no microfilaria are seen, it still could be a positive,[object Object]
Modified Knott’s Test or Difil Test,[object Object],Obsolete—we no longer use this,[object Object],Used to concentrate microfilaria and trap them in a filter and is read by a tech under the microscope,[object Object]
Samples Sent to AViD Labs,[object Object],For questionable tests,[object Object],Is an antigen test similar to ours,[object Object],Run on serum,[object Object],Collect blood in a Vacuutainer serum separator (red top) tube,[object Object],Spin down the tube ,[object Object],Transfer serum into a transfer tube,[object Object],Fill out AViD submission form, ,[object Object],Call AviD for courier pickup,[object Object],Place sample in AViD box outside,[object Object],Sometimes even this is questionable!,[object Object]
The Abaxis Canine Wellness Test,[object Object],We have gotten some questionable results with this test,[object Object],Sometimes they test positive on an antigen test and negative on the Wellness rotor,[object Object],Sometimes they test negative on the antigen test and positive on the Wellness rotor.,[object Object],Recently Abaxis asked us to run one of their Antigen test kits on each patient we are doing a Canine Wellness on.  We did this 25 times,[object Object],All of our tests agreed,[object Object],But we remember no test is perfect,[object Object]
Quiz,[object Object],The industry standard heartworm test is,[object Object],	a. AViD Laboratories,[object Object],b. Direct blood smear,[object Object],c. Antigen test,[object Object],d. Modified Knott’s test,[object Object],We run all of the following heartworm tests except,[object Object],	a.  Modified Knott’s tests,[object Object],b.  Abaxis Canine Wellness Profiles,[object Object],c.  Direct blood smear,[object Object],d.  Antigen tests,[object Object]
Quiz, continued,[object Object],Our heartworm antigen tests do all except,[object Object],  a.  Are semi-quantitative and tell how many heartworms the pet has,[object Object],  b. Have built-in quality control,[object Object],  c.  Can be run on one drop of whole blood,[object Object],  d.  Take only 10 minutes,[object Object],Heartworm antigen tests checks for,[object Object],a.  Heartworm microfilaria,[object Object],       b.  A protein secreted by adult female heartworms,[object Object],       c.  Heartworm ova,[object Object],       d.  Adult heartworms in the blood stream,[object Object]
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Training module II - Heartworm Testing

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