Dear all,
This patient had positive blood cultures
for Clostridium Perfringens, which I think is the answer. See attached.
Thanks
Ian
From:
Sent: 15 June 2009 20:56
To: Ian Barlow;
[log in to unmask]
Subject: RE: Samples TOTALLY
haemolysed
Ian
Was the patient
sample ever checked for gram positive cocci or gram negative rods?
Years ago when I
worked in Infectious Disease, we would find that patients who were severely
septic would occasionally have very fragile RBC.
Just a thought
Joe
From:
Clinical biochemistry discussion list [mailto:[log in to unmask]]
On Behalf Of Ian Barlow
Sent: Monday, June 15, 2009 12:01
PM
To:
[log in to unmask]
Subject: Re: Samples TOTALLY
haemolysed
I presume it is occurred in vivo, as that
was the condition of samples on receipt in the lab. But I don’t see how
it could be compatible with life.
The repeats were also the same (totally
lysed)-but the patient died soon after.
From:
Clinical biochemistry discussion list [mailto:[log in to unmask]]
On Behalf Of
Sent: 15 June 2009 16:49
To:
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Subject: Re: Samples TOTALLY
haemolysed
Ian,
Do you mean that this was an in vitro phenomenon and the patient's
Hb, platelets, coagulation, UEs and LFTs were normal prior to this happening?
thanks
Mohammad
Thank you both,
But in these scenarios are ALL the erythrocytes destroyed (s they
were in this case)?
I have only ever seen this occur when we have deliberately
destroyed cells, in vitro, by freezing the sample.
Ian
From: "
To:
Sent: Monday, 15 June, 2009
16:13:29
Subject: RE: Samples TOTALLY
haemolysed
That was my thought as
well. Extravascular gross hemolysis will almost certainly produce potassium
concentrations near the technical limits, whereas intravascularly hemolyzyed
specimens should have a normal potassium, due to physiological mechanisms that
maintain potassium homeostasis. We have seen this several times when we get
multiple hemolyzed specimens on a patient.
Roger
Roger L. Bertholf, PhD
Professor of Pathology
From: Clinical
biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of
Sent: Monday, June 15, 2009 11:01
AM
To:
[log in to unmask]
Subject: Samples TOTALLY
haemolysed
Dear Ian,
This could be due to haemolytic-uraemic
syndrome or microangioapthic haemolytic anaemia associated with
metastatic adenocarcinoma of the prostate.
reagards
Mohammad
Dr. M A Al-Jubouri, MB ChB, MSc, FRCP
Edin, FRCPath
Consultant Chemical Pathologist
Dear all,
Any ideas here:-
We received a number of blood samples
recently for a patient with disseminated Ca prostate that were totally haemolysed. The white cells
were intact but the RBCs were all lysed. FBC, Serum and coag samples all showed
the same phenomenon.
We got repeat bloods and they were the
same. The patient died soon after.
What is the likely cause of the
haemolysis – any ideas??
Best wishes
Ian Barlow
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