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ACB-CLIN-CHEM-GEN  July 2013

ACB-CLIN-CHEM-GEN July 2013

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Subject:

Re: Spurious hypocalcaemia and hyperphosphataemia

From:

"COLLINS MICHAEL (RM1) Norfolk and Norwich University Hospital" <[log in to unmask]>

Reply-To:

COLLINS MICHAEL (RM1) Norfolk and Norwich University Hospital

Date:

Wed, 31 Jul 2013 15:56:12 +0000

Content-Type:

text/plain

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text/plain (130 lines)

We check sodium on all samples with total protein > 90 g/L or lipaemia index (Abbott Architect) >1.0 using a direct electrode.
A sodium of <125 will reflex total protein.

Mike Collins
BMS3
Biochemistry Automation
Norfolk & Norwich University Hospital
England
[log in to unmask]
http://www.nnuh.nhs.uk/
 



-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of John Martin
Sent: 31 July 2013 15:51
To: [log in to unmask]
Subject: Re: Spurious hypocalcaemia and hyperphosphataemia

The pseudohyponatremia is not due to hyperviscosity per se but due to the reduced amount of water per litre of plasma as a consequence of a total protein of 112 g/L. One gram of protein has a partial volume of solution of ~ 1ml; hence one litre of plasma contains ~ 940ml of water assuming  a 'normal' total protein of 60g/L. A litre of plasma with a total protein of 112g/L will contain ~ 888 ml of water therefore the [Na] in the water phase will be ~ (127/888)*940=134; the value obtained on the gas analyser direct ISE.

Regards
John Martin

Sent from my iPad

On 31 Jul 2013, at 14:05, "Veronique Stove" <[log in to unmask]> wrote:

> May I ask a further question on the inferences seen with some myeloma patients?
> 
> We have a myeloma patient with the following results:
> 
> Tot. Protein 112 g/L
> IgG 78,7 g/L
> Na 127 mmol/L K 3,6 mmol/L (indirect ISE) Cl 98 mmol/L Ca 2.05 mmol/L 
> Phosph 0.85 mmol/L Osmolality 280 mOsm/kg
> 
> Here, we probably have a pseudohyponatremia due to hyperviscosity. How are others dealing with this low sodium result? Do you advise to measure via direct ISE? Prior to centrifugation, we analysed this sample on our bloodgas meter, with 134 mmol/L as a result.
> 
> Kind regards,
> 
> Veronique
> 
> ----------------------------------------------------------------------
> Universitair Ziekenhuis Gent
> Klinisch Ondersteunende Sector
> 
> Veronique Stove
> PharmD PhD     -     Klinisch bioloog 24u lab
> Klinische Biologie - Gebouw 2P8
> Interne brievenbus: 2P8-klinische biologie De Pintelaan 185 - B-9000 
> Gent
> 
> tel.: +32 (0)9 332 5871
> [log in to unmask]
> www.uzgent.be
> ----------------------------------------------------------------------
> 
> -----Oorspronkelijk bericht-----
> Van: Clinical biochemistry discussion list 
> [mailto:[log in to unmask]] Namens Fiona Davidson
> Verzonden: woensdag 31 juli 2013 10:42
> Aan: [log in to unmask]
> Onderwerp: Re: Spurious hypocalcaemia and hyperphosphataemia
> 
> Thanks for all your responses.
> 
> I think the consensus is delayed separation.  On closer inspection this sample seems to have been taken on a Friday and received in the lab on Monday.  I have no idea why we analysed the sample as our policy is to take out all affected tests if a sample has been left unseparated overnight.
> 
> We have recently picked up a case of undiagnosed myeloma causing a spuriously raised phosphate, however, as this is a young, asymptomatic patient whose phosphate and calcium were back to normal on the next sample I think this would be an unlikely explanation.
> 
> Thanks
> 
> Fiona
> 
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------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.
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------ACB discussion List Information--------
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