I thought I'd use the new list to summarise the responses I had to my questionnaire about the effect of jaundice on creatinine measurements. I had 5 responses so far. I've summarised the questions below and the number is the number of respondents out of the total number of responses (n/5):
1. Were you aware that bilirubin interferes with creatinine, causing a concentration-dependent underestimation?
Yes 5/5; No 0/5
2. If your answer to 1 is yes, how do you handle this:
a. No correction: Because of the uncertainty around attempts to correct for underestimation we simply issue the creatinine result *with or *without a comment that says creatinine is underestimated in jaundiced samples (*delete as appropriate)
Yes 2/5; No 3/5
b. Dilution: we dilute out the bilirubin interference
Yes 1/5, if user requests it; No 4/5
c. Percentage correction applied by neonatal / paediatric team: We have evaluated the effect on [creatinine] of high [bilirubin] across a range of [bili], and have established a percentage correction. We expect the team to apply the correction themselves and document it in the patient’s notes
Yes 0/5; No 5/5
d. Percentage correction applied in laboratory: We have evaluated the effect on [creatinine] of high [bilirubin] across a range of [bili], and have established a percentage correction. We apply the correction in the lab and report the corrected result and document it in the patient’s notes
Yes 0/5; No 5/5
e. Other
Yes 1/5 The creatinine result is removed when bilirubin is equal or greater than 513umol/L (for Jaffe). Comment added to say measurement not valid due to interference. However the SIEMENS enzymatic method is not much better and is affected by concentrations ??560.; No 4/5
3. Did you know this is not a chromatic effect and affects both Jaffe and Enzymatic assays?
Yes 4/5 No 1/5
4. In your opinion, what are the implications for patient care of underestimating [creatinine] at times of significant jaundice?
AKI 5/5; Other renal impairment 4/5
5. Any other comments?
Variety of comments around need for more information
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