Please follow this link for more information on canine and feline pancreatitis.
SAMPLE:
0.5 ml fasting (12-18 hours) non-hemolyzed serum
Turnaround: 1-2 business days after receipt of samples. This time may vary depending upon day and time the samples are received. See assay schedule.
Control Ranges:
| Feline (fPLI) | 4.1 - 12.9 µg/L |
| Canine (Spec cPL™) | 0 - 200 µg/L |
INTERPRETATION:
|
< 4.1 µg/L Decreased serum fPLI concentration can be clinically insignificant, but can also be seen in cats with EPI. A serum fTLI should be evaluated to rule out EPI. 4.1 to 12.9 µg/L Serum fPLI concentration within the reference range. 13.0 to 18.0 µg/L Mildly increased serum fPLI concentration can be associated with mild chronic pancreatitis. Patient should be evaluated for risk factors and concurrent conditions and fPLI should be monitored. 18.1 to 36.0 µg/L Moderately increased serum fPLI concentration is associated with pancreatitis. Patient should be evaluated for risk factors and concurrent conditions and fPLI should be monitored. > 36.0 µg/L Severely increased serum fPLI concentration is associated with pancreatitis. Patient should be evaluated for risk factors and concurrent conditions. Supportive and symptomatic care is indicated dependant on the condition of the patient. Serum fPLI should be monitored to evaluate progression of disease. |
|
0 to 200 µg/L Result within the reference range. 201 to 399 µg/L Questionable range. This patient may have pancreatitis and serum cPLI should be reevaluated in 2-3 weeks. Also, the patient should be evaluated for other differential diagnoses. > 400 µg/L Consistent with pancreatitis. Treatment can be monitored by repeated serum cPLI analysis. Please note that the canine pancreatic lipase is now measured using the new SpecPL assay. |
Information on Spec cPL™
Diagnosis of severe acute pancreatitis needs
to be both rapid and accurate in order to optimize patient
management. Recognizing this, the GI Lab has partnered
with IDEXX Laboratories, to improve availability and
turnaround time for cPLI testing.
In collaboration with IDEXX, we are pleased to introduce the
new Spec cPL™ Test for canine pancreatitis. The Spec cPL
Test is an enhanced version of the classical cPLI assay that
utilizes monoclonal rather than polyclonal antibodies, and
recombinant pancreatic lipase rather than lipase purified
from pancreas. The Spec cPL Test is available through
IDEXX Reference Laboratories and the GI Lab.
The GI Lab will also be providing
the new canine Spec cPL Test. Given our primary focus
on diagnosing and researching chronic gastrointestinal
diseases, and the availability of rapid cPLI testing through
IDEXX, we will only make the Spec cPL Test available in
panels and for follow-up testing.
Please note, the GI Lab will remain the only source for feline
PLI testing, and we will continue to provide this assay as
both a standalone test and in panels. Assay of fPLI is the
most sensitive and specific diagnostic tool for the diagnosis
of feline acute and chronic pancreatitis, and we will continue
to provide as rapid a turnaround time as is feasible.
A quick clinical guide for
the use of serum Spec cPL™
We recently described development and validation of a
new assay for canine pancreatic lipase concentrations (cPLI) in serum. We have also reported that serum cPLI
concentration is the most sensitive and specific diagnostic test for the diagnosis of canine pancreatitis available to date. There are other diagnostic tests that specifically assess aspects of pancreatic pathology, such as serum trypsinogen activation peptide (TAP) and serum TLI concentrations.
However, serum TAP concentration lacks sensitivity for pancreatitis, is very labile and is currently not readily available. Serum TLI concentration, while highly sensitive and specific for diagnosis of exocrine pancreatic insufficiency
(EPI) has limited sensitivity for diagnosis of pancreatitis. In a comparison of serum cPLI and cTLI concentrations in a group of dogs with pancreatitis, serum cTLI had a sensitivity of only 36% compared to 82% for serum cPLI. Finally, we have reported that serum cPLI concentration, unlike serum amylase and lipase activities, is not affected by gastritis, renal failure or prednisone administration. In summary, the cPLI is the test of choice for the diagnosis of pancreatitis.
During the past two years, the GI Lab has been closely involved in the development of an improved cPLI assay, now commercially available through IDEXX Laboratories as the Spec cPL™ Test. This new assay performs similarly to the original serum cPLI assay, and given its improved stability and speed of performance, we have also decided to utilize this new technology in the GI Lab from now on.
When should you run a serum Spec cPL assay?
In general we see three indications. Most importantly, we would
encourage you to use this new test for the diagnosis of acute pancreatitis in dogs. We recommend assay of serum Spec cPL concentration in any dog that presents with an acute history of anorexia, vomiting and/or abdominal pain.
Secondly, the Spec cPL Test is warranted in dogs with chronic signs of gastrointestinal disease, including anorexia, vomiting, abdominal pain, weight loss and/or diarrhea. While diarrhea has not been considered a classical clinical sign of pancreatitis, in a recent study, 33% of dogs with pancreatitis had diarrhea, suggesting that dogs with
diarrhea should be assessed for potential pancreatitis.
We therefore suggest that, for these patients, you submit a full profile for gastrointestinal function testing consisting of a serum cTLI, Spec cPL, cobalamin and folate concentration. While these tests are available from other laboratories, we hope that you will continue to support the Gastrointestinal Laboratory with your submissions. As in the past, we will continue to support your practice with accurate diagnostic testing and the option of personalized follow-up consultation regarding interpretation of test results and management of individual patients.
Finally, we believe that there are certain dogs that should be checked for possible chronic pancreatitis regardless of any clinical signs. Currently, we believe that any dog treated with potassium bromide and any miniature Schnauzer that presents with vague clinical signs should be tested. Recent evidence would suggest that dogs treated with phenobarbital are also predisposed to pancreatitis. Thus dogs treated with phenobarbital may also benefit from being intermittently assessed for the presenence of pancreatitis by measurement of a serum Spec cPL concentration. Again, we would suggest that in most patients you initially request a general GI panel (cTLI, Spec cPL, cobalamin and folate) and follow up with repeated intermittent serum Spec cPL and other tests as appropriate.
References
1. Steiner JM, Teague SR, Williams DA. Development and analytic validation of an enzyme-linked immunosorbent assay for the measurement of canine pancreatic lipase immunoreactivity in serum. Can J Vet Res. 2003;67:175–182.
2. Steiner JM. Diagnosis of pancreatitis. Vet Clin North Am Small Anim Pract. 2003;33:1181–1195.
3. Steiner JM, Finco DR, Gumminger SR, Williams DA. Serum canine pancreatic lipase immunoreactivity (cPLI) in dogs with experimentally induced chronic renal failure. J Vet Int Med. 2001;15:311 (abstract).
4. Steiner JM, Lees GE, Willard MD, Teague SR, Williams DA. Serum canine pancreatic lipase immunoreactivity (cPLI) concentration is not altered by oral prednisone. J Vet Int Med. 2003;17:444 (abstract).
5. Newman SJ, Steiner JM, Woosley K, et al. Localization of histologic pancreatitis lesions in dogs. J Vet Int Med. 2004;18:488–493.
6. Hess RS, Saunders HM, Van Winkle TJ, et al. Clinical, clinicopathologic, radiographic, and ultrasonographic abnormalities in dogs with fatal acute pancreatitis: 70 cases (1986–1995). J Am Vet Med Assoc. 1998;213:665–670.
