Abstract
In laboratory facilities and clinical practice, blood sampling for clinical chemistry and haematology most often involves handling and restraining of the animals. This may impose stress on the animals and hence increase the risk of altering stress-sensitive parameters like glucose, creatine kinase, neutrophil counts and lymphocyte counts. Both in animal experimentation and in the clinic, this effect on the parameters may affect the conclusions drawn on the basis of such measurements.
Von Helversen and Reyer
1
described a method for obtaining blood from animals by the use of Triatominae bugs. Triatominae bugs are blood-sucking insects belonging to the order Hemiptera, family Reduviidae and include among others the species
Animals exposed to
Materials and methods
Animals
For this study a total of 28
Five female New Zealand White rabbits aged approximately 11 weeks at arrival (body weight range: 2.4–2.6 kg) were used for this study (Lidköping Kaninfarm, Sweden). These five animals were part of a larger group of rabbits and they were kept in a pigpen housing a total of six rabbits. The pigpen contained wood shavings and straw bedding and the rabbits had access to shelters. The pigpen was cleaned once a week. New straw was added every day. The rabbits were fed Altromin 2120 (Altromin Specialfutter GmbH & Co KG, Lage, Germany) and had access to water
Blood sampling
Blood samples were drawn from all rabbits using both a conventional method, namely blood collection from vena auricularis, and the ‘bug method’. Blood sampling by means of bugs was done immediately after the blood sampling by the conventional method. A total of eight samples were drawn from each animal, four conventional samples and four ‘bug samples’. The rabbits were not fasted prior to blood sampling.
Blood sampling: the conventional method
One hour before blood sampling, the rabbits were captured and a local analgesic (Emla® 30 g creme AstraZeneca, Albertslund, Denmark) was applied over the vena auricularis caudalis of both ears. The ears were covered with occlusive tape and left for an hour for the analgesic effect to set in. The rabbits were released between application of the Emla creme and blood sampling.
Blood sampling was done from the vena auricularis caudalis with a 30 mm 21 G needle (0.6414 mm in outer diameter). After each extraction the needle was removed, and a new needle was inserted into the vein of the other ear. Blood was extracted from each ear twice in the order left–right–left–right. An amount of 3 mL blood from each ear was extracted per course, giving a total of 12 mL of blood per rabbit.
Handling of the blood sample
From each 3 mL sample, 2 mL of blood was directed into a 2 mL ethylenediaminetetraacetic acid (EDTA) (Vacuette®; Greiner Bio-One, Kremsmünster, Austria) tube and 1 mL blood was directed into two 4 mL serum (Vacuette®) tubes. The EDTA tubes were turned gently 5–7 times and placed vertically. The serum tubes were placed horizontally on the table. The serum tubes were centrifuged at 2000
Blood sampling: the bug method
A glass jar containing four bugs with an unfolded swab secured with a rubber band over the top of the jar was prepared. During blood sampling, each rabbit was placed on the lap of the technician. The glass jar with the bugs was placed on the back of the neck/on the resting ears of the rabbit. After the bugs had finished extracting blood from the rabbit, the glass was removed. A mean time of approximately 15 min was required for the bugs to ingest a blood meal. 2 Each bug was restrained by hand and positioned with the head between two fingers. A syringe with a 21 G needle was inserted into the abdomen, blood was withdrawn and transferred to two microcentrifuge tubes (Plastibrand®; VWR International Ltd, Ireland) in order to make a sample for clinical chemistry and a sample for haematology. In order to fulfil the requirements of the laboratory a sample of a minimum of 500 µL full blood for clinical chemistry and a minimum of 300 µL plasma for haematology was prepared. In case an adequate amount of blood could not be extracted from a bug, one microcentrifuge tube was filled and the blood was used for haematology testing only. Anticoagulants were not added to the test tubes as an anticoagulant (dipetalogastin) was already added by the bug.
Handling of the blood sample
The microcentrifuge tube with blood for haematology testing was centrifuged at 2000
Laboratory tests
The biochemistry and haematology analyses were conducted at Veterinary Clinical Pathology, Department of Small Animal Clinical Sciences, Faculty of Life Sciences, University of Copenhagen.
The EDTA tubes collected by the conventional method and the full blood samples collected by the bug method were delivered to the laboratory the same day as the blood was extracted. The serum samples collected by the conventional method and plasma samples collected by the bug method were delivered to the laboratory the day after the last blood samples were extracted.
Results for clinical chemistry in blood sampled from either vena auricularis (conventional method) or by the use of kissing bugs (bug sampling)
SD: standard deviation; ALT: alanine aminotransferase; ALP: alkaline phosphatase; GGT: gamma-glutamyl transferase
*Significant difference between the two methods
Haematology in blood sampled either from vena auricularis (conventional method) or by the use of kissing bugs (bug sampling)
SD: standard deviation
*Significant difference between the two methods
Statistical analysis
Each parameter was analysed by means of a one-way analysis of variance (one-way ANOVA) model with additional rabbit-specific random effects to account for the fact that repeated measurements were taken from each rabbit and different residual standard deviations for the two methods allow different variation for each method. This model allows assessment of differences between the two methods with reference to both the mean level and the precision of each parameter. A likelihood-ratio test was used to assess differences between the two methods with reference to the residual standard deviations: The difference between −2 Res Log Likelihood values as reported by the statistical software was calculated, and the critical value was found using a
Results
In total, 28 bugs were used for blood sampling. Only 17 bugs did sting, and thus blood was only extracted from 17 bugs, giving a total of 11 bugs (39.3%) not stinging or not sucking blood.
The mean value of blood extracted from the bugs was 1.2 mL with a minimum of 0.4 mL and a maximum of 2.6 mL. This gave a total of 13 bug samples for biochemistry testing and 17 bug samples for haematology testing. From rabbit 1 the first two conventional blood samples had coagulated and could not be used for haematology testing. None of the bug samples coagulated.
Clinical chemistry
There was no significant difference between the two sample methods with regard to albumin, glucose, total protein, alanine aminotransferase (ALT), creatinine, amylases, carbamide and magnesium.
Alkaline phosphatase (ALP), cholesterol, lipase, phosphate, gamma-glutamyltransferase (GGT), calcium and sodium were all significantly higher in the conventional blood samples compared with bug blood, whereas potassium was significantly lower in the conventional blood samples (Table 1).
Five of the 13 bug samples for GGT had the value 0 IU/L and were excluded from the data. The conventional GGT samples all had values above 2 IU/L. The sodium value was significantly lower in the bug blood, whereas the potassium value was significantly higher in the bug blood.
Total bilirubin was measured, but since 12 of the 13 bug samples had a value of 0 µmol/L, whereas the values of the conventional method were between 0.1 and 0.4 µmol/L, no comparative statistics were done on this parameter, and hence the parameter was not included in Table 1.
Haematology
No significant differences were found for haemoglobin, haematocrit, reticulocytes and eosinophilic granulocytes. White blood cell count, red blood cell count, platelets, neutrophilic and basophilic granulocyte counts as well as lymphocyte and monocyte counts were all significantly higher in blood samples collected by the conventional method, whereas mean platelet volume and mean corpuscular volume (MCV) were significantly higher in samples collected by the use of bugs. The results are listed in Table 2. Two of the conventional blood samples coagulated and could not be used for haematology. None of the bug blood samples coagulated.
Discussion
The set-up for this study originally included four bugs per rabbit, giving a total of 20 bugs each of which representing a blood sample. In the study conducted, 28 bugs were used as a total of 11 bugs did not sting. Eight of these bugs were replaced and a total of 17 bug blood samples were obtained. Hence in this study the ‘stinging success rate’ was only 60%. The bugs had been fasted for five weeks prior to the study; however, they did not sting in the experiment. One reason could be that the bugs normally feed on resting/sleeping animals when it is dark, and in this study they were placed in a see-through glass jar in a bright room. This means that the conditions for the bug were very different from natural conditions. Furthermore, warm-blooded animals may not only signal a blood meal, but they may also represent a possible predator which the bug will try to avoid. 14,15 This hypothesis is consistent with our observations of bugs moving in the opposite direction of the rabbit and might indicate that the bugs that did not sting perceived the rabbit as a predator. The blood sampling was done in the rabbit housing facility, and as the bugs were housed at approximately 28°C the temperature drop may also have influenced the performance of the bugs.
Two of the conventional blood samples coagulated and could not be used for haematology. EDTA was added to the conventional blood samples in this study, but occasionally rabbit blood clots despite the anticoagulants added. 16 The bug adds dipetalogastin to the ingested blood and clotting did not occur in the bug blood samples. This gives the bug method an advantage over the conventional method, as no bug samples were destroyed.
There was no significant difference between the two sample methods for albumin, glucose, total protein, ALT, creatinine, amylases, carbamide and magnesium. The measured values for ALP were 489 and 440 U/L in the conventional and the bug samples, respectively, which seem to be quite high. Reference values provided in the literature vary (e.g. 40–140 U/L 17 and <120 U/L 18 ) but are much lower. Since ALP is an age-dependent parameter with relatively high values during the early growth phase due to osteoblastic activity, the young age of these rabbits may have resulted in these high values. Skeletal growth for the New Zealand White rabbit is completed at 28 weeks. 19 As the rabbits used for this study had an approximate age of 17 weeks this could be the explanation for the high ALP values.
Our rabbits had not been fasted prior to the blood sampling and abnormal values were therefore to be expected as cholesterol levels should always be measured in fasted rabbits. In fasted rabbits, the reference value for cholesterol level is 0.9–1.7 mmol/L, 17 which is much lower than our findings that had a mean cholesterol level at 2.59 mmol/L (SD: 0.23) for conventional sampling and 2.24 mmol/L (SD: 0.12) for bug sampling. However, all rabbits in this study were handled the same way for both methods, so not being fasted is believed to have had no influence on the purpose of determining a difference between the two methods. Since we do not know if bug metabolism in the anterior midgut had an impact on cholesterol values, it is suggested not to use the bug method until studies on fasted rabbits have been carried out.
The bug method for lipase had lower values than the conventional method. This could indicate that the bug's metabolism had an influence on the test results.
For phosphate and calcium measures, the likelihood ratio test showed that there was no significant difference between the SD of the two methods. This could indicate that it might be possible to use the bug method despite the significant difference.
Five of the 13 bug samples for GGT had the value 0 IU/L. The conventional samples all had values above 2 IU/L and there was a significant difference between the two methods. This could indicate that the bug’s metabolism had an influence on the test results.
The sodium value was significantly lower in the bug blood, whereas the potassium value was significantly higher in the bug blood.
In 12 of the 13 bug samples the total bilirubin had the value 0 µmol/L. Due to this, a significant difference between the bug method and the conventional method could not be calculated. The values of the conventional method were between 0.1 and 0.4 µmol/L and this could indicate that the metabolism of the bug had an influence on the results and that the method using bugs should probably not be used for determining the bilirubin content.
The bug method values for red blood cell count, white blood cell count, neutrophil count, lymphocyte count, basophil and monocyte counts, and platelet count were lower than the values of the conventional method. This could indicate that the bug’s metabolism had an influence on the results.
The erythrocytes contain much of the bugs’ protein source in the form of haemoglobin, and in the anterior midgut haemoglobin is made accessible to digestion by lysis of the erythrocytes. 24 Destruction of the erythrocytes by lysis could explain why the red blood cell value was lower for the bug method than for the conventional method.
The MCV values of the bug method were higher than the values for the conventional method. An increase in MCV can be produced by cell swelling, and it could be hypothesized that cell swelling of erythrocytes precedes cell lysis in the midgut of the bug. However, as there was no significant difference between the two methods with regard to haematocrit (the packed cell volume) and haemoglobin, these results are not consistent as cell swelling, for example, should have influenced the haematocrit as well as the MCV. Further experiments including manual evaluation of blood smears and assessment of, for example, red cell distribution width and mean corpuscular haemoglobin concentration are needed to assess the exact fate of the erythrocyte in the bug.
Platelets are activated by vessel damage and platelet response to vascular injury by adhesion to the vessel wall after which they adhere to one another and swell. It could be hypothesized that the higher values for platelets could be caused by platelet activation resulting from the insertion of needles into the vena auricularis caudalis. However, all the rabbits were bled from the ears prior to blood sampling using bugs, and it is not possible to state whether such activation would have been seen had the bugs been used prior to the conventional method. To further assess the influence of the bug method on platelet activation/platelet counts, a study randomizing the use of the two methods (conventional sampling followed by bug blood compared with bug blood followed by conventional sampling) should be done. The number of neutrophil granulocytes was significantly lower in the bug samples, which could be hypothesized to be due to adhesion to the interior of the bug midgut.
For the blood parameters with a significant difference between the two methods, it has been postulated that the difference could be due to the metabolism of the bug. However, other factors may contribute as well. Conventional blood samples are collected from the veins. The bug blood samples derive from unknown sources as it is not known whether the blood originates from a vein or an artery. A study in dogs by Lue
The bug method may provide an alternative for both haematology and clinical chemistry with further optimization and validation. It is important to realize that some parameters may be affected by the use of the bug; however, this study and others studies have demonstrated that all tested parameters in haematology, clinical chemistry and endocrinology are measurable using the bug method. 2,4,6,9
The major limitation of the method seems to be the varying success of stinging. Other studies have tried to optimize the method by hiding the bugs in containers/shelters for monkeys and lynxes and hollowed artificial eggs for birds, 6,9,26 but still it is recognized that to ensure the number of blood samples needed, more bugs should initially be used. 7 Such a practice will also ensure that the required volume is obtained. For larger laboratory animals such as pigs and goats, purpose-made collars or body harnesses with small, attachable, dark, isolated boxes containing the bugs could be produced to improve the stinging rate. The bugs used in this study were fasted for five weeks which should have been sufficient to ensure stinging. However, prior to selecting bugs for blood sampling, the researcher could place his hand close to the bugs and choose only bugs that respond positively to the hand by protruding the proboscis.
Another limitation may be the small blood volume taken by some of the bugs. This fact emphasizes the need for starting up more bugs than the actual number of blood samples needed.
In relation to laboratory animal science the bug method also has limitations in pharmacokinetics, for example, where high demands are made on precision when timing the blood samples and on the inter-sample intervals. Another possible limitation of the use of the bug method in laboratory animal science is the exposure of the test animal to the bug antigens. 7 This may induce an unwanted, uncontrolled immune response. However, it is equally important to recognize the potential in especially experimental animal behaviour research where the sampling of blood from completely undisturbed animals may be crucial, and in the veterinary clinic, where the bugs may be able to sample from patients who are difficult to handle or patients who either have very small vessels or have vessels that for some other reason are difficult to access. Aside from being painless and hence probably stress-free, blood sampling using bugs does not include the risk of haematomas, and the blood is instantly mixed with a potent and reliable anticoagulant. 7 The present study has shown that the blood samples obtained by the bug method are of a high quality. Hence the use of bugs for blood sampling seems to provide a feasible and manageable tool in both the laboratory animal facility and the veterinary clinic. However, further validation and improvements should be done to optimize the stinging rate and to evaluate possible immunomodulatory effects of the bug method.
