CSF xanthochromia testing is mainly used by clinicians as a rule out strategy in cases of suspected SAH with negative CT scan. Positive cases will be referred for carotid angio, an invasive procedure. Those cases with positive oxyHb only and no bilirubin cause the most headache for clinicians especially when they aren't sure if the CSF sample was collected >12 h post-event, and we are seeing quite few of these.
And does negative xanthochromia in a CSF sample taken more than 12h, is a definite rule out test?
 
Best wishes
 
Mohammad

"Mainwaring-Burton Richard (RGZ)" <[log in to unmask]> wrote:
Has anyone yet dared to experience the automated approach as in
Clin.Chem. 50;10 (Oct04) page 1854 Ungerer et al
Which uses tweaked autoanalyser bilirubin estimation ?

I am reluctant to go out and spend a few K on a spectrophotometer which may
only save one life every 5 years and be used for a test which the clinicians
say is probably redundant since the advent of high resolution CT scans. The
say they would never diagnose CAH on the basis of a CSF scan !

We are already putting the CSF through our analyser so a viable bilirubin
assay would be sensible, especially at 03:00 am

with best wishes
Richard

Richard Mainwaring-Burton
Consultant Biochemist
Queen Mary's Hospital
Sidcup, Kent
DA14 6LT
020-8308-3084


-----Original Message-----
From: Eric Kilpatrick [mailto:[log in to unmask]]
Sent: 03! May 2005 16:37
To: [log in to unmask]
Subject: Re: CSF spectrophotometry out-of-hours

Mohammad

I believe several of the regional audit groups are auditing many of these
aspects of xanthochromia measurement as we speak.

Eric
Dr. Eric S. Kilpatrick
Consultant in Chemical Pathology
Department of Clinical Biochemistry
Hull Royal Infirmary
Anlaby Road
Hull HU3 2JZ

Tel 01482-607708
Fax 01482-607752




>From: Mohammad Al-Jubouri <[log in to unmask]>
>Reply-To: Mohammad Al-Jubouri <[log in to unmask]>
>To: [log in to unmask]
>Subject: Re: CSF spectrophotometry out-of-hours
>Date: Tue, 3 May 2005 15:30:49 +0100
>
>Dear Peter
>
>We only offer Monday-Friday 9 am - 5 pm service. Occasionally, out of hours
>tests have been performed on authorisation by a consultant biochemist.
>
>This CSF spectrophometic examination for h! aem pigments has been running in
>many UK hospitals for more than two years now, I am sure that some of you
>has audited the clinical effectiveness of their service, yet there is no
>publication of a UK wide or even a local audit. Several elements can be
>examined in such audit, for e.g:
>
>- type of service provision (weekdays, weekends 24/7)
>- type of pectrophometer used
>- any software used for reading scans
>- total test number performed so far
>- timing of LP in relation to onset
>- has CT been performed in all patients prior to LP
>- number of tests with negative oxyHb and bilirubin and outcome of patients
>- number of tests with positive oxyHb only and outcome of patients
>- number of tests with positive oxyHb and bilirubin and outcome of patients
>- number of tests with positive bilirubin only and outcome of patients
>- how you define a traumatic tap
>- do you report n! umber of RBC and protein alongside NBA and oxyHb
>- how do you report oxyHb (e.g postive/negative only, do you give
>indication on how big is the oxyHb peak in AU)
>
>I would be quite interested if people has already looked at the
>effectiveness of their service and willing to share their findings with us.
>
>Best wishes
>
>Mohammad
>
>
>
>
>"Sharpe, Peter Dr" <[log in to unmask]>wrote:
>Dear All,
>
>I'm keen to find out what service (if any) laborotories offer for CSF
>spectrophotometry. We used to offer a Monday-Friday 9am - 5pm service only.
>However, there are increasing requests out-of-hours and we would now run
>CSF samples at weekends and Bank Holidays, after consultation with myself.
>Several of the Biomedical Scientists have sufficient experience to
>interpret the scans but the others do not, necessitating my involvement yet
>again.
>
>I'm fairly peaved off with this arrangement and therefore limit the service
>to Mon-Fri 9am - 5pm, Sat/Sun/Bank Holidays 9 am - 1 pm on request.
>
>What do other labs offer? Does anyone have experience of scanning software
>which would allow all BMS's to issue a report?
>
>Best wishes
>
>Peter
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>
>Dr. M A Al-Jubouri
>Consultant Che! mical Pathologist
>Send instant messages to your online friends http://uk.messenger.yahoo.com
>
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>they are responsible for all message content.
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------ACB discussion List Information--------
This is an open discussion list for the academic and clinical
community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the individual and
t! hey are responsible for all message content.

ACB Web Site
http://www.acb.org.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
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------ACB discussion List Information--------
This is an open discussion list for the academic and clinical
community working in clinical biochemistry.
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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Dr. M A Al-Jubouri
Consultant Chemical Pathologist

Send instant messages to your online friends http://uk.messenger.yahoo.com ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. 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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