Dear Peter,
We carried out an audit several years ago at Wishaw General Hospital looking at cases where there was significant oxyhaemoglobin present, but the bilirubin was below the 0.007 cut-off. See attached poster.
Best wishes,
Sarah
________________________________________
From: Clinical biochemistry discussion list [[log in to unmask]] On Behalf Of Sharpe, Peter [[log in to unmask]]
Sent: 16 November 2012 12:47
To: [log in to unmask]
Subject: Re: Xanthochromia
Dear Colleague,
To further expand the discussion regarding CSF spectrophotometry the standard comment that causes us some difficulty and occurs quite often is:
"Oxyhaemoglobin is present is sufficient concentration to impair the ability to detect bilirubin. SAH not excluded"
Whilst I fully appreciate the science and evidence-base behind this comment, it is difficult to communicate the actual risk of missing a SAH to the clinician. I usually state that the result is negative but there is a small chance of a SAH being missed because of the presence of a sufficient amount of oxyHb to theoretically disguise/mask bilirubin. But what is this risk? It simply leads to more ambiguity and loss of confidence in the reliability/robustness of this test.
Your thoughts would be much appreciated.
Best wishes
Peter
Dr Peter Sharpe
Consultant Chemical Pathologist
Director of Research and Development
Southern Health & Social Care Trust
Ext 2657
Tel 028 38612657
Fax 028 38334582
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Sharpe, Peter
Sent: 16 November 2012 12:29
To: [log in to unmask]
Subject: Re: Xanthochromia
I have to agree with David. Many CSFs are performed by junior doctors and arrive in the lab many hours after the patient was first admitted to the ward - due to transport delays and because it’s easier to do when the ward is quieter. There is no good clinical reason why the samples cannot wait until the following morning until they are analysed, unless the patient is clinically deteriorating. In fact, our senior clinicians agree with this reasoning and are happy for us to leave them until the following morning. If a result is actually required immediately the physician can telephone us and arrange for it to be done (so we do offer an emergency 24/7 service). In 14 years I have been contacted on 2 occasions to authorise an emergency analysis.
We run CSF spectrophotometry routinely Monday to Friday 9 am to 12 mid-night, Saturday, Sundays & Public Holidays 9 am - 5 pm with an emergency service available by arrangement outside these hours.
The bottom line is to speak to your clinicians and find out what they want and actually need. Try and find out why/how a result during the middle of the night will improve/alter patient care. Is there a safety issue in waiting several hours? A full 24:7 routine service may not be required.
Best wishes
Peter
Dr Peter Sharpe
Consultant Chemical Pathologist
Director of Research and Development
Southern Health & Social Care Trust
Ext 2657
Tel 028 38612657
Fax 028 38334582
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of [log in to unmask]
Sent: 16 November 2012 12:03
To: [log in to unmask]
Subject: Xanthochromia
As I see it, this test should not be automated. To do so would simply facilitate the analysis to be inappropriately performed on more people. Like so much of what we do, providing this analysis easily, feeds the myth that it somehow part of the diagnostic pathway for the investigation of headache. I'm afraid there are very few hospitals where the decision to perform the analysis is taken by a senior clinician. The lumbar puncture is often performed in the evening because it's easier when the ward is quiet. To facilitate the discharge of of an elderly person to a cold lonely house late at night having previously (often inexpertly) removed CSF by lumber puncture is not in the patient's best interests. The vanishingly low detection rate of genuine positives suggests that we are testing the wrong patients. Let's see this in the context of the whole patient pathway, Regards, David
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Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content.
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