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Dear All,

We have had a query from one of our neurologists regarding a xanthochromia result, and wondered if anyone might be able to help. The request originated from a myxoedematous patient (TSH 82 mu/L, previous diagnosis several years ago of Hashimoto's encephalopathy) who has had xanthochromia requested (due to sudden onset left frontal headache).

NBA = 0.015
NOA = 0.008
CSF protein = 1.3 g/L
Serum total protein = 76 g/L
Serum bilirubin = 53 umol/L

If I have followed the algorithm correctly, this leads to the comment:
Increased CSF bilirubin. This finding may be consistent with: SAH; an increased bilirubin accompanying the increased CSF protein; or other source of CSF blood. Interpret result with caution in relation to SAH especially if within first week of event.

The CT scan is negative, CT Angio negative. The time between onset of headache and LP is not known.

The question from the neurologist is: are we aware of false positive xanthochromia results in myxoedematous patients, possibly due to a carotenaemia? Or do we just explain this result through the CSF protein. I believe carotene does absorb across this region, but not sure if it would be in sufficient quantity to interfere. A quick literature search has not yielded any recent papers/case reports.
 
Any help / comments appreciated.

Many thanks,
Jon

 

 

Mr. Jonathan Vernazza

Registered Clinical Scientist

Clinical Biochemistry Department

Imperial College Healthcare NHS Trust

Telephone: 020 331 15181

Email: [log in to unmask]


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