Dear Martin,
Thank you for your response. For pleural effusions, in addition to distinguishing between transudates and exudates, the pH is the one other more useful test as it helps the respiratory team decide when to drain the chest. If the tap is clear then studies and guidelines state: 'If non-purulent, pH <7.2 or [H+] >63 nmol/L indicates
the need for pleural fluid drainage'. If the fluid is purulent then testing is not necessary and drainage is usually undertaken regardless. In any case you don't want a purulent fluid blocking the analyser so how convenient. Attached please find a review article we wrote a few years ago reviewing the guidelines and the evidence of testing on both pleural and peritoneal (ascitic) effusions.
Regards,
Rav
Dr Rav Sodi
Consultant Clinical Biochemist
Telephone: (+44) 07877263296
On Thursday, 26 March 2020, 12:45:29 GMT, Myers Martin (LTHTR) <[log in to unmask]> wrote:
#yiv6056810296 -- filtered {}#yiv6056810296 p.yiv6056810296MsoNormal, #yiv6056810296 li.yiv6056810296MsoNormal, #yiv6056810296 div.yiv6056810296MsoNormal {margin:0cm;margin-bottom:.0001pt;font-size:12.0pt;font-family:New;}#yiv6056810296 a:link, #yiv6056810296 span.yiv6056810296MsoHyperlink {color:blue;text-decoration:underline;}#yiv6056810296 a:visited, #yiv6056810296 span.yiv6056810296MsoHyperlinkFollowed {color:purple;text-decoration:underline;}#yiv6056810296 p {margin-right:0cm;margin-left:0cm;font-size:12.0pt;font-family:New;}#yiv6056810296 span.yiv6056810296EmailStyle18 {}#yiv6056810296 .yiv6056810296MsoChpDefault {font-size:10.0pt;}#yiv6056810296 filtered {}#yiv6056810296 div.yiv6056810296WordSection1 {}#yiv6056810296
Rav
Preston:
FIT: We are continuing FIT testing as the samples are contained and the patients are symptomatic
Calprotectin: We have carried out a risk assessment for Calprotectin and are continuing to process (but reduced TAT). Essentially, extraction in CL2 cabinet with enhanced PPE. Loading the machine that is adjacent to cabinet. - CL2 Plus
Pleural fluids: agreed to on a case by case basis. If agreed to we use CL2Plus conditions (centrifuge, leave for 20 mins, open in CL2 safety cabinet, load on analyser. Any hint of COVI19 and we store and wait for the result of the SARS COV2 result. There are mixed messages about the viral load in pleural fluid
Pleural fluid pH- we don’t support this anyway- not sure how useful it is
martin
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of R Sodi
Sent: 26 March 2020 12:28
To: [log in to unmask]
Subject: [EXTERNAL] Pleural fluid and faecal testing in patients with, or suspected with, the COVID disease
Please note this message has arrived from an external sender.
Be careful when opening attachments or links, especially if logging in or providing data.
If you require assistance, please contact the LTH IT Service Desk.
---------------------------------------------------------------------------------------------------------------
Dear colleagues,
Thank you to all that replied. Here are the responses received so far from colleagues around the country copied verbatim. Hopefully as a profession we can make decisions in consensus when the evidence is lacking or at best ambiguous and have the courage to change our course of action when the data becomes available. It appears the consensus is to stop testing pleural fluids unless your laboratory has the resources to take extra precautions or triage.
Manchester
We have suspended all faecal and pleural fluid testing. As we hadn't started FIT testing we have made a decision to postpone the start.
Poole & Bournemouth
We have suspended pleural fluid and and faecal (elastase) analyses, apart from baby reducing sub but we are sending straight to Alder Hay. Calpro done by immuno
NHS Lothian
we were advised by our local virology team in edinburgh that the virus is not present in pleural fluid in significant quantities so we are continuing to process these as normal. We have stopped doing routine faecal calprotectins and would only process these now if absolutely essential and only in a patient where covid was not suspected.
Western Sussex Hospitals
We are still doing FCAL but doing the preparation in the fume hood. The work load has dropped massively and many of the patients are on immunosuppressants. Also a microbiologist told us that the COVID isn't particularly viable in the stool samples so not that high risk. Pleural fluid we have refused to analyse in the lab from COVID patients. We don't do ABGs in the lab nor control POCT so we haven't stopped others. I assume if they are doing a pleural tap on a COVID patient they will be in the full PPE and analyse it still in the PPE then clean the machine after. We have a machine or 2 in the COVID areas. They have sent us some COVID pleural taps and they were very turbid indeed.
Barking, Havering and Redbridge University Hospitals NHS Trust
We continue to process stool samples for FCAL in our CL2 MSC but we have for now said all pleural fluids should be processed/aliquoted etc in CL3 MSC. This was on the advice of our Micro lead.
Severn Pathology
We have stopped testing on pleural fluids, but only where the patient either has or is suspected to have SARS-CoV-2. At some point we will have to rethink this when it is likely the majority of patients in hospital will have it. FIT testing is still ongoing for us too.
Bradford Hospital
here in Bedford we are not providing pleural fluid pH. For albumin and glucose analysis the sample is going to Microbiology for centrifugation and aliquoting into a false bottom tube for us to put on the COBAS. We don't do F Cal onsite - send them to King's but this is continuing so I guess they are still analysing.
Stockport NHS Trust
We are doing pleural fluid only if required and staff will be using PPE including a face mask. We are also doing poo prep but in CL3.
Wishing you all the best.
Dr Rav Sodi
Consultant Clinical Biochemist
Telephone: (+44) 07877263296
------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 who posts and they are solely responsible for all message content. The ACB does not monitor posts.
ACB Web Site
http://www.acb.org.uk
Green Laboratories Work
http://www.laboratorymedicine.nhs.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
------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 who posts and they are solely responsible for all message content. The ACB does not monitor posts.
ACB Web Site
http://www.acb.org.uk
Green Laboratories Work
http://www.laboratorymedicine.nhs.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
