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ACB-CLIN-CHEM-GEN  September 2007

ACB-CLIN-CHEM-GEN September 2007

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Subject:

Re: Hb derivative problem

From:

Jeffrey Davies <[log in to unmask]>

Reply-To:

Jeffrey Davies <[log in to unmask]>

Date:

Tue, 11 Sep 2007 10:24:51 +0100

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Thanks to all who offered suggestions, the most common being the presence of a haemoglobin variant; one possible specific being haemoglobin Saskatoon, which is associated with methaemoglobinaemia that would give a low oximetry reading. The observation that such interference on older Omni's (ours is a 6) is not seeen on the S is interesting.
The haemoglobinopathy screen showed Hb A/A with normal levels of Hb's A2 and F. There was no evidence of HbS, common Hb variants or beta-thalassaemia. Further Hb studies will take some time. For those who might have wondered, his blood lead was low.
The boy has improved clinically and his jaundice (originally 11% conjugated) has cleared. His haptoglobin was low as expected. His Hb is still low despite transfusion but his reticulocyte count has increased from 2.1% on admission to 19.6% now. 
No similar abnormalities had been found during a previous admission for a hydrocoele operation and the cause of the recent presumably haemolytic episode  is still unexplained.
Best wishes,
Jeff

>>> Jeffrey Davies <[log in to unmask]> 07/09/2007 11:22:13 >>>
A request for carboxy- and methaemoglobin on a 4y old Asian male child gave "interferences" on all the haemoglobin and derivative channels on  Roche Omni blood gas analysers. Why? Suggestions gratefully received!

The child had been admitted with a 2 day history of diarrhoea and vomiting. Routine oximetry showed a saturation of 74% and oxygen was administered at 15L/min. The PO2 (not measured previously) was >30kPa, but the O2 saturation remained low. The metHb etc. were requested in an attempt to explain this disparity. (MetHb apparently interferes with pulse oximetry.)

There was no past medical history of note, and no exposure to medications (prescribed or not) or environmental or diagnostic agents was elicited. 

The child was very anaemic with a Hb of 5.2g/dL. MCV, PCV and RBC count were all low, with 9% hypochromic cells and a retculocyte count of 2.1%. The total bilirubin was raised to 99umol/L and the LDH was high at 3,612 IU/L. The urea is slightly high at 6.8mmol/L.  The Hb and O2 sats. responded to blood transfusion but the Hb is falling again. 

The blood gas interferences were repeated on fresh pre-transfusion samples and another analyser of the same type, both of which are otherwise functioning well. Spectrophotometry of a haemolysate showed no abnormal peaks in the range 300 - 700nm, and that haemolysate produced the same interferences on the Omni. Known interfering substances such as methylene blue and lipid suspensions have been excluded.

Presumably the child is haemolysing, cause as yet unknown (direct Coomb's test negative). Possibly the cause of interference and the presence of this condition and the request for Hb derivatives is a rare coincidence. But neither we nor neighbouring colleagues are aware that this causes such interference, which persisted in a centrifuged haemolysate prepared off the analyser.  If any colleagues have had such an experience or have any other comments I'd be pleased to hear from them.

Best wishes,
Jeff Davies
Consultant Chemical Pathologist
Bradford Teaching Hospitals NHS Foundation Trust


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Your Hospital needs YOU! 
We need you to register as a Public, Patient or Staff member and help shape the future of your healthcare.
Call 0870 707 1532 to register by phone or, to register online visit www.bradfordhospitals.nhs.uk where you can also find out more about Membership.

This message is confidential. It may also contain privileged information. The contents of this e-mail and any attachments are intended for the named addressee only. Unless you are the named addressee or authorised to receive the e-mail of the named addressee you may not disclose, use or copy the contents of the e-mail.  If you are not the person for whom the message was intended, please notify the sender immediately at Bradford Teaching Hospitals NHS Foundation Trust and delete the material from your computer. You must not use the message for any other purpose, nor disclose its contents to any person other than the intended recipient.  Bradford Teaching Hospitals NHS Foundation Trust does not accept responsibility for this message and any views or opinions contained in this e-mail are solely those of the author unless expressly stated otherwise.  

------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.
ACB Web Site
http://www.acb.org.uk
List Archives
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