Dear Dr. Sharpe,
Thank you for raising this issue. I am also of the same view point and I have already expressed this locally. What concerns me is that the guidelines also make no reference/consideration to blood stained specimens. So for example, in a situation where the CSF protein is high (infection/inflammation) and the sample gets blood stained during collection, analytically it will be a positive scan (as both oxyhaemiglobin and bilirubin peaks will be present), but the clinical diagnosis would be completely different. I try to follow guidelines as best as I can but I would never report a positive without discussing the patient with the clinicians. Clinical liaison is a critical part for the interpretation and often produces very useful information, but unfortunately this has not been emphasised in the recent (or previous) guidelines. I agree all CSF are precious and should be analysed, however, omitting certain information during interpretation or interpreting scans without patient knowledge can be dangerous and could lead to unnecessary investigations.
Rafaq Azad
Principle Clinical Scientist
Department of Clinical Biochemistry
Bradford Royal Infirmary
Duckworth Lane
Bradford
BD9 6RJ
Tel: 01274 382683
E-mail: [log in to unmask]
>>> "Sharpe, Peter" <[log in to unmask]> 30/06/2008 12:50 >>>
Dear All,
I am concerned regarding changes in the revised national guidelines for CSF spectrophotometry published in the Annals in May. In particular NBA > 0.007 AU with NOA > 0.02 AU (with visible OHb peak) is "consistent with SAH" no matter what the CSF protein or the serum bilirubin. In the old guidelines both of these would have been taken into account; in particular the NBA would have been "adjusted" for the serum bilirubin, and this would have made the NBA < 0.007 (insignificant) in some cases. Also, most of our CSF samples have OHb peaks due to "traumatic tap", rather than SAH, and we usually do not have access to view the 3-4 sequential samples to see if the OHb is tailing off.
I now feel we are going to diagnose a considerable number of false positives.
Does anyone else have any thoughts on this?
Best wishes
Peter
Dr Peter C Sharpe
Consultant Chemical Pathologist
Southern Health & Social Care Trust
Tel 028 38612657
Fax 028 38334582
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