Dear Tom,
I believe I had a case series of 5 of these patients about 12 years ago (at
another hospital). All on haemodialysis, all developed abdominal pain, most had
raised amylase and lipase, 2 had to go to Emergency, all had brown serum. From
memory the first came to light when a scientist said the Roche H index was not
high enough for the dark colour of the serum. The brown-ness, in the right
setting, is almost pathognemonic of methaemalbuin, ie intravascular haemolysis.
Whenever we get one I show everyone in the lab so they can recognise it if they
see it again. The proof was scanning spectrophotometry with a slight peak at about
620 - 625 nm and a slight shift of the soret peak from about 418 to 410 nm. I
used these patients to work out the time-scale of appearance and dissappearance of
methaemalbumin (peak at about 12 - 24 hours from memory - I am not at my desk). We
think the cause was possibly kinked dialysis lines but I understand inadequate
flushing of the machine after cleaning can also cause the problem.
Let me know if you want any more details of the cases.
Regards,
Graham
Graham Jones
Staff Specialist in Chemical Pathology
St Vincent's Hospital, Sydney
Ph: (02) 8382-9160
Fax: (02) 8382-2489
>>> "Hayes, Tom" <[log in to unmask]> 11/01/08 7:57 AM >>>
Young female under regular haemodialysis presented initially with
abdominal pain. Lab investigations reveal haemolysis ( Index 1200 on
Roche Modular). Radiological investigations suggest pancreatitis. Over
24 hrs the Haemolytic Index has fallen to near normal however the serum
still appears brown rather than reddish brown. Literature search
suggests possibly Methaemalbumin but not detected by reversion
spectroscopy. Are there any other methods for measuring Methaemalbumin?
Are there any other reasons for a brown serum?
Tom Hayes
Clinical Biochemistry Dept.
Belfast Health and Social Care Trust
Belfast City Hospital
Tel:028 9032 9241 Ext:2615
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