Dear Wolfgang,
So there was a question of SAH!
When the interpretation of bilirubin is a bit problematic, we tend to
measure ferritin in the CSF, on the premiss that it is expressed by the
glial cells to mop up the toxic iron that has come from haemoglobin
secondary to an SAH. It also hangs around longer than bilirubin because of
a longer half-life (increased concentrations persist for a couple of weeks
or so). However, be aware that a very traumatic tap can increase CSF
ferritin. Alternatively, the information in the site that Dr. Holbrook
quoted should guide you.
Best wishes,
Reza
At 17:07 14/05/03, Wolfgang Schneider wrote:
>Hi,
>
>just an update. The patient does not have liver failure, has always had
>normal transaminases, only slightly elevated PT and PTTs ; but his ALP is
>up at 3x normal. GGT is normal.
>
>By accident he took an overdose of Vepesid (Etoposide) for prostate cancer,
>which led to myelosuppression , and he has been in the ICU for a month.
>Etoposide supposedly is not hemolytic but can increase bilirubin.
>
>Recently it was noted that his mental status deteriorated and that he had a
>stiff neck and Babinski's sign (big toe curls up, little ones down,
>indicating pyramidal tract involvement), and at some point they suspected
>subarachnoid hemorrhage that must had occurred previously.
>
>They are now looking for other causes of his mental status , like viral
>infection.
>
>Most people thought that Xanthochromia by spectroscopy wouldn't be
>meaningful with serum bilirubins as high as they are.
>
>
>Wolfgang
>***********************************************************
>Wolfgang Schneider
>Division of Medical Biochemistry, Montreal General Hospital
>1650 Cedar Avenue, Montreal, Quebec H3G 1A4, Canada
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