Thanks
Jonathan
On Friday, November 22, 2002, at 02:54 PM, Fry, John wrote:
> Very few of these appear, but there is normally sufficient blood to
> undertake the analysis on the standard anlysers noted in the earlier
> e-mail.
> No overt problems have arisen with this procedure.
>
> John Fry
>
>> ----------
>> From: Jonathan Kay[SMTP:[log in to unmask]]
>> Reply To: ACB Point of Care Testing List
>> Sent: 22 November 2002 13:58
>> To: [log in to unmask]
>> Subject: Re: Bilirubinometers
>>
>> Sorry, I meant neonatal requestss from eg midwives seeing babies at
>> home... need for small specimens, but clinicians not near a blood gas
>> analyser...
>>
>> Best wishes
>>
>> Jonathan
>>
>>
>> On Friday, November 22, 2002, at 01:08 PM, Fry, John wrote:
>>
>>> Jonathan
>>>
>>> Requests for biblrubin assays from non neonatal wards are analysed on
>>> the
>>> Roche Modular for total bilirubin and on the Roche Integra for direct
>>> bilirubin. Approximately 175 uL of serum is required for both
>>> assays.
>>>
>>> Best wishes
>>>
>>> John Fry
>>>
>>>
>>>> ----------
>>>> From: Jonathan Kay[SMTP:[log in to unmask]]
>>>> Reply To: ACB Point of Care Testing List
>>>> Sent: 19 November 2002 16:23
>>>> To: [log in to unmask]
>>>> Subject: Re: Bilirubinometers
>>>>
>>>> Using the blood gas analysers is attractive. How do you handle the
>>>> requests for bilirubin analysis that come from sources other than
>>>> the
>>>> neonatal unit? Have a blood gas analyser in the laboratory, or some
>>>> other approach?
>>>>
>>>> Dr Jonathan Kay
>>>>
>>>>
>>>> On Friday, November 15, 2002, at 05:43 PM, Fry, John wrote:
>>>>
>>>>> All samples on SCBU that are analysed for blood gases automatically
>>>>> have a
>>>>> bilirubin result. Yes, the problem was I believe in one of the
>>>>> mathematical
>>>>> formulae used to 'produce' a bilirubin result.
>>>>>
>>>>> Prior to purchasing this machine, we did look at a number of
>>>>> 'bilirubinometers' but, since the blood gas machine on SCBU was
>>>>> almost due
>>>>> for replacement, combining the two instruments was the most cost
>>>>> and
>>>>> clinically effective method of progress.
>>>>>
>>>>> John Fry
>>>>>> ----------
>>>>>> From: PETER HOWELL[SMTP:[log in to unmask]]
>>>>>> Reply To: ACB Point of Care Testing List
>>>>>> Sent: 15 November 2002 15:34
>>>>>> To: [log in to unmask]
>>>>>> Subject: Re: Bilirubinometers
>>>>>>
>>>>>> Hi John
>>>>>>
>>>>>> The potential 'controversy' was over the performance of bilirubin
>>>>>> on
>>>>>> the
>>>>>> analyser, not the use of the analyser for one-off bilirubin
>>>>>> measurements.
>>>>>> This would not seem to be apparent from your experience, but I
>>>>>> remember
>>>>>> some doubts from somewhere. I'll search my 'memory banks' !
>>>>>> Would your SCBU staff use the blood gas analyser to do JUST a
>>>>>> bilirubin,
>>>>>> or would they measure blood gases/electrolytes at the same time,
>>>>>> even
>>>>>> if
>>>>>> the baby didnt require them ?
>>>>>> Do you see what I mean ??
>>>>>>
>>>>>> Peter
>>>>>>
>>>>>>
>>>>>>> -----Original Message-----
>>>>>>> From: Fry, John [SMTP:[log in to unmask]]
>>>>>>> Sent: 15 November 2002 15:30
>>>>>>> To: [log in to unmask]
>>>>>>> Subject: Re: Bilirubinometers
>>>>>>>
>>>>>>> As far as the analytical side goes, our NEQAS returns are good,
>>>>>>> as
>>>>>>> is
>>>>>> the
>>>>>>> correlation with the main analysers in the department. Neither
>>>>>>> the
>>>>>> technical
>>>>>>> staff or myself are aware of the controversy you have mentioned
>>>>>> regarding
>>>>>>> one off bilirubin in sick neonates.
>>>>>>>
>>>>>>> John Fry
>>>>>>> Clinical Biochemist
>>>>>>>
>>>>>>>> ----------
>>>>>>>> From: PETER
>>>>>>>> HOWELL[SMTP:[log in to unmask]]
>>>>>>>> Reply To: ACB Point of Care Testing List
>>>>>>>> Sent: 15 November 2002 13:18
>>>>>>>> To: [log in to unmask]
>>>>>>>> Subject: Re: Bilirubinometers
>>>>>>>>
>>>>>>>> Isn't there some 'controversy' about how good these analysers
>>>>>>>> are
>>>>>>>> at
>>>>>>>> measuring bilrubin ??
>>>>>>>>
>>>>>>>> And its OK if you are also measuring blood gases/ electrolytes
>>>>>>>> at
>>>>>>>> the
>>>>>> same
>>>>>>>> time, but not really for just a one-off bilirubin on a 'well'
>>>>>>>> baby.
>>>>>>>>
>>>>>>>> Peter
>>>>>>>>
>>>>>>>> Peter Howell
>>>>>>>> Head Biomedical Scientist
>>>>>>>> Medical Biochemistry Department
>>>>>>>> Wrexham Maelor Hospital
>>>>>>>> Wrexham
>>>>>>>>
>>>>>>>>
>>>>>>>>> -----Original Message-----
>>>>>>>>> From: Fry, John [SMTP:[log in to unmask]]
>>>>>>>>> Sent: 15 November 2002 13:16
>>>>>>>>> To: [log in to unmask]
>>>>>>>>> Subject: Re: Bilirubinometers
>>>>>>>>>
>>>>>>>>> One possible answer is to purchase one of the Radiometer 7
>>>>>>>>> series
>>>>>> blood
>>>>>>>> gas
>>>>>>>>> analysers which incorporates an analytical uniit for bilirubin
>>>>>> assays on
>>>>>>>> the
>>>>>>>>> whole blood sample. Centrifugation of capillary samples is
>>>>>>>>> then a
>>>>>> part
>>>>>>>> of
>>>>>>>>> history.
>>>>>>>>>
>>>>>>>>> John Fry
>>>>>>>>> Worthing Hospital
>>>>>>>>>
>>>>>>>>>> ----------
>>>>>>>>>> From: Evans, Francis -
>>>>>>>> RCHT[SMTP:[log in to unmask]]
>>>>>>>>>> Reply To: ACB Point of Care Testing List
>>>>>>>>>> Sent: 15 November 2002 11:58
>>>>>>>>>> To: [log in to unmask]
>>>>>>>>>> Subject: Re: Bilirubinometers
>>>>>>>>>>
>>>>>>>>>> I have been concerned for 'ages' about the infection risk
>>>>>>>>>> involved
>>>>>> in
>>>>>>>>>> spinning capillaries for bilirubins in our SCBU laboratory.
>>>>>>>>>> We
>>>>>>>>>> do
>>>>>>>> have a
>>>>>>>>>> separate lab to contain the gas analyser and bilirubinometer
>>>>>>>>>> but
>>>>>> the
>>>>>>>>>> aerosol
>>>>>>>>>> problem when capillaries leak and eject their contents is of
>>>>>>>> considerable
>>>>>>>>>> concern. I have not been able to get any manufacturer to
>>>>>>>>>> supply a
>>>>>>>>>> properly
>>>>>>>>>> sealed rotor to contain spills.
>>>>>>>>>>
>>>>>>>>>> I would also be interested to hear other views on suitable
>>>>>>>> alternatives.
>>>>>>>>>>
>>>>>>>>>> Francis Evans
>>>>>>>>>> Chief BMS
>>>>>>>>>> Clinical Chemistry
>>>>>>>>>> Royal Cornwall Hospitals Trust
>>>>>>>>>> Truro TR1 3LJ
>>>>>>>>>>
>>>>>>>>>>
>>>>>>>>>>
>>>>>>>>>> -----Original Message-----
>>>>>>>>>> From: Paul Eldridge [mailto:[log in to unmask]]
>>>>>>>>>> Sent: Friday, November 15, 2002 10:05
>>>>>>>>>> To: [log in to unmask]
>>>>>>>>>> Subject: Bilrubinometers
>>>>>>>>>>
>>>>>>>>>>
>>>>>>>>>> I have sent this to both the POCT list and ACB clin chem list.
>>>>>>>> Apologies
>>>>>>>>>> to those who get it twice.
>>>>>>>>>> Two problems/questions:
>>>>>>>>>> 1. Infection in ward areas by centrifuges.
>>>>>>>>>> It has been reported by a new paediatric doctor here that
>>>>>>>>>> bilirubinometers have been removed from wards in 2 SW London
>>>>>> hospitals
>>>>>>>>>> because of infection risks from the centrifuges used to spin
>>>>>>>>>> down
>>>>>> the
>>>>>>>>>> capillary tubes.
>>>>>>>>>> Have others experienced this problem?
>>>>>>>>>> Is there a centrifuge available that can be sealed?>
>>>>>>>>>> Is there any good experience with non invasive bilirubin
>>>>>> measurements?
>>>>>>>>>>
>>>>>>>>>> 2. We recently replaced our TIME ward bilirubinometer with the
>>>>>> Digital
>>>>>>>>>> Analogue Systems NEO BIL instrument distributed by Schuco in
>>>>>>>>>> the
>>>>>> UK.
>>>>>>>> It
>>>>>>>>>> very simple to operate by the ward staff but cannot be
>>>>>>>>>> calibrated
>>>>>> by
>>>>>>>> the
>>>>>>>>>> lab. It has a non linear response noted by positive bias below
>>>>>>>>>> 300
>>>>>> and
>>>>>>>>>> negative above this level. This has been shown by studies on
>>>>>>>>>> EQAS
>>>>>>>>>> samples and our dilution studies.
>>>>>>>>>> Do others have the problem and how do you overcome it ?
>>>>>>>>>>
>>>>>>>>>> Many thanks in advance.
>>>>>>>>>>
>>>>>>>>>>
>>>>>>>>>> Dr Paul H Eldridge
>>>>>>>>>> Clinical Biochemist
>>>>>>>>>> University Hospital Lewisham
>>>>>>>>>> London SE13 6LH
>>>>>>>>>> UK
>>>>>>>>>> Phone: (44) 020 8333 3255
>>>>>>>>>> Fax: (44) 020 8690 8891
>>>>>>>>>>
>>>>>>>>>>
>>>>>>>>>> [log in to unmask]
>>>>>>>>>>
>>>>>>>>>>
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