I must admit I share the concerns on these specific points, so am 'bumping'
this topic. Would any of the authors care to put us right on these concerns.
Has any one been brave enough to introduce the change yet (our scan software
just being updated as I write!. Has any clinical neurologist noticed or
commented on the change?
Regards
Steve
The Princess Royal Hospital and Hurstwood Park Neurological Centre, Sussex
BSUH NHS Trust
_______________________________________________________
-----Original Message-----
From: Rafaq Azad [mailto:[log in to unmask]]
Sent: 30 June 2008 13:59
To: [log in to unmask]
Subject: Re: concerns re revised national guidelines for CSF
spectrophotometry
Dear Dr. Sharpe,
Thank you for raising this issue. I am also of the same view point and I
have already expressed this locally. What concerns me is that the
guidelines also make no reference/consideration to blood stained specimens.
So for example, in a situation where the CSF protein is high
(infection/inflammation) and the sample gets blood stained during
collection, analytically it will be a positive scan (as both oxyhaemiglobin
and bilirubin peaks will be present), but the clinical diagnosis would be
completely different. I try to follow guidelines as best as I can but I
would never report a positive without discussing the patient with the
clinicians. Clinical liaison is a critical part for the interpretation and
often produces very useful information, but unfortunately this has not been
emphasised in the recent (or previous) guidelines. I agree all CSF are
precious and should be analysed, however, omitting certain information
during interpretation or interpreting scans without patient knowledge can be
dangerous and could lead to unnecessary investigations.
Rafaq Azad
Principle Clinical Scientist
Department of Clinical Biochemistry
Bradford Royal Infirmary
Duckworth Lane
Bradford
BD9 6RJ
Tel: 01274 382683
E-mail: [log in to unmask]
>>> "Sharpe, Peter" <[log in to unmask]> 30/06/2008 12:50
>>>
Dear All,
I am concerned regarding changes in the revised national guidelines for CSF
spectrophotometry published in the Annals in May. In particular NBA > 0.007
AU with NOA > 0.02 AU (with visible OHb peak) is "consistent with SAH" no
matter what the CSF protein or the serum bilirubin. In the old guidelines
both of these would have been taken into account; in particular the NBA
would have been "adjusted" for the serum bilirubin, and this would have made
the NBA < 0.007 (insignificant) in some cases. Also, most of our CSF samples
have OHb peaks due to "traumatic tap", rather than SAH, and we usually do
not have access to view the 3-4 sequential samples to see if the OHb is
tailing off.
I now feel we are going to diagnose a considerable number of false
positives.
Does anyone else have any thoughts on this?
Best wishes
Peter
Dr Peter C Sharpe
Consultant Chemical Pathologist
Southern Health & Social Care Trust
Tel 028 38612657
Fax 028 38334582
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