We set up this assay as a result of clinical requests a few years ago,
primarily because there was felt to be a need to shift patients rapidly
to the regional neurosurgery centre if warranted by the results.
My impression is that not only has the frequency of requests has
diminished, but it is being used less specifically i.e. "We've taken a
csf, lets see if there is any xanthochromia there"
David G Williams
Stuart Robertson wrote:
>
> Ian,
> One of the things that worries me about reporting
> presence or absence of xanthochromia (however it is
> 'measured'), is that sometimes I get the impression
> that an inordinate amount of weight is given to the
> result if a CT scan does not show the presence of
> blood. The decision to proceed with cerebral
> angiography may be based on the presence of
> xanthochromia alone.
> I think most would agree that the detection of
> bilirubin (not just oxyhaemoglobin) in CSF is
> necessary to confirm SAH, but what about the time of
> lumbar puncture in relation to the bleed?
> I think the earliest that bilirubin appears is about
> 10 hours post bleed, but it may not appear for a few
> days.
> In other words, absence of xanthochromia does not
> necessarily exclude SAH.
> Stuart
>
> Stuart Robertson
> Biochemistry Dept
> Hull Royal Infirmary
>
> --- Ian Holbrook <[log in to unmask]> wrote:
> > We will scan CSF on a spectrophotometer to look for
> > the presence of
> > haemoglobins and/or xanthochromia as it is claimed
> > to be more sensitive than
> > visual inspection alone.
> > One of our clinicians wants this service available
> > "out of hours". Up to now
> > we have centrifuged the sample on receipt to clear
> > it of any red cells and
> > performed the scan the following working day when a
> > clinical scientist or
> > chemical pathologist will "interpret" the scan. Our
> > biomedical scientists
> > are reluctant to do this interpretation, especially
> > in the middle of the
> > night.
> > I have 2 questions
> > 1. How many labs scan CSFs rather than just
> > "eyeballing"?
> > 2. Of those that do scan, how many offer this
> > service out of hours?
> >
> > Many thanks
> >
> >
> > Dr Ian Holbrook
> > Department of Chemical Pathology
> > York District Hospital
> > Wigginton Road
> > YORK YO31 8HE
> > UK
> >
> >
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--
David G Williams
Department of Biochemistry
Sunderland Royal Hospital
[log in to unmask]
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