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- W21950470 abstract "Introduction: Sub-arachnoid haemorrhage (SAH) occurs when cerebral artery ruptures and blood leaks out into the sub-arachnoid space. This is often a catastrophic event for the individual and morbidity and mortality rates are significantly influenced by early intervention. This makes the role of the clinical biochemistry laboratory in early diagnosis vitally important, as delays in diagnosis can have a major clinical impact.The cerebrospinal fluid (CSF) of healthy individuals is optically clear. It has, however, been recognised for over a century that it can become coloured (xanthochromia) following a cerebrovascular incident such as a SAH. This has made the main role of the clinical biochemistry laboratory in SAH diagnosis that of detecting xanthochromia in the CSF.The majority of laboratories which offer a xanthochromia screening service use the national guidelines that are based upon ultra-violet scanning spectrophotometry (350 nm to 600 nm). This analytical technique is not without its problems: it is subjective, has a possibility of inter-operator variability and due to the specialised nature of the test can take many hours or even days for a result to be issued.This project aimed to improve the current laboratory service by investigating: turnaround times, users opinions of the current service and potential alternative analytical methods.Methods: An audit of the current analytical provision was used to assess its effectiveness and in order to elucidate the service users’ perception. This was effected by a questionnaire that was distributed to service users across three different NHS Trusts in England and Wales.In an attempt to improve the laboratory service, alternatives to scanning spectrophotometry were investigated. These were selected through consideration of the nature of SAH i.e. blood is released into the subarachnoid space and the brain is damaged. Laboratory analysis therefore needed to focus on detecting the presence of blood and/or its breakdown products, any change in CSF constituents that arise as a direct consequence of blood being introduced in to the subarachnoid space or a specific analyte which would only be present if brain damage occurred.Investigation of current research into subarachnoid haemorrhage identified the following analytes as potential alternatives: CSF diazo bilirubin, CSF Ferritin, CSF protein S100 and serum protein S100.Results: The audit revealed the average turnaround time for reporting xanthochromia results to be 26 hours, with almost 20% of samples being reported as equivocal. The service user’s questionnaire revealed a general lack of awareness of current United Kingdom National External Quality Assurance Scheme (UKNEQAS) guidelines for the ‘Analysis of cerebrospinal fluid for bilirubin in suspected Subarachnoid haemorrhage’ and a lack of understanding regarding the timing of lumbar punctures. Additionally, one third of users felt that the turnaround time for results was inadequate.CSF protein S100 was found to be unsuitable due to the difficulty in achieving a suitable balance between sensitivity and specificity; at a cut-off of 0.40 μg/l sensitivity is 80% and specificity is 4%, at a cut-off of 1.60 μg/l sensitivity is 40% and specificity is 94%. Serum protein S100 was found to be unsuitable due to the difficulty in achieving a suitable balance between sensitivity and specificity at appropriate cut-offs (66 % and 73%, respectively, at a cut-off of 0.09 μg/l). When the CSF diazo bilirubin and CSF ferritin were compared to current laboratory practises using pre-defined criteria then CSF diazo bilirubin was found to be the analyte of choice to base new guidelines upon. CSF diazo bilirubin was then used as an initial ‘rule-out’ step in a new set of guidelines for the determination of SAH utilising CSF analysis.Conclusion: The new guidelines employ CSF diazo bilirubin analysis as a ‘rule-out’ step with all samples that are above the cut-off (300 nmol/l) being processed through the UKNEQAS guidelines. In order for the guidelines to be introduced and accepted, local training and education programmes for laboratory and clinical staff will need to be developed and implemented and they will need to be disseminated through publication of articles in journals relevant to both the clinical biochemistry community and requesting clinicians." @default.
- W21950470 created "2016-06-24" @default.
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- W21950470 date "2013-01-01" @default.
- W21950470 modified "2023-09-24" @default.
- W21950470 title "Determining sub-arachnoid haemorrhage in the clinical biochemistry laboratory utilising cerebrospinal fluid samples" @default.
- W21950470 cites W148093677 @default.
- W21950470 cites W1557562404 @default.
- W21950470 cites W1578728271 @default.
- W21950470 cites W1601483406 @default.
- W21950470 cites W1842069448 @default.
- W21950470 cites W184573485 @default.
- W21950470 cites W1903133883 @default.
- W21950470 cites W1913451808 @default.
- W21950470 cites W1922883825 @default.
- W21950470 cites W1926231966 @default.
- W21950470 cites W1966748394 @default.
- W21950470 cites W1972476946 @default.
- W21950470 cites W1977692562 @default.
- W21950470 cites W1981116145 @default.
- W21950470 cites W1981511375 @default.
- W21950470 cites W1984763088 @default.
- W21950470 cites W1987601332 @default.
- W21950470 cites W1990488590 @default.
- W21950470 cites W1991591266 @default.
- W21950470 cites W2003561168 @default.
- W21950470 cites W2006012997 @default.
- W21950470 cites W2008025181 @default.
- W21950470 cites W2008456506 @default.
- W21950470 cites W2012321895 @default.
- W21950470 cites W2013033776 @default.
- W21950470 cites W2016424725 @default.
- W21950470 cites W2019175468 @default.
- W21950470 cites W2021405365 @default.
- W21950470 cites W2024210337 @default.
- W21950470 cites W2032391566 @default.
- W21950470 cites W2037289794 @default.
- W21950470 cites W2048825331 @default.
- W21950470 cites W2055547768 @default.
- W21950470 cites W2057045896 @default.
- W21950470 cites W2062862876 @default.
- W21950470 cites W2067766731 @default.
- W21950470 cites W2074205948 @default.
- W21950470 cites W2081204243 @default.
- W21950470 cites W2085717392 @default.
- W21950470 cites W2089578483 @default.
- W21950470 cites W2092895501 @default.
- W21950470 cites W2103680976 @default.
- W21950470 cites W2104813545 @default.
- W21950470 cites W2105694856 @default.
- W21950470 cites W2109272950 @default.
- W21950470 cites W2115294186 @default.
- W21950470 cites W2116241776 @default.
- W21950470 cites W2121321671 @default.
- W21950470 cites W2121737415 @default.
- W21950470 cites W2125272611 @default.
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- W21950470 cites W2132276423 @default.
- W21950470 cites W2140158539 @default.
- W21950470 cites W2142297029 @default.
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- W21950470 cites W2157312318 @default.
- W21950470 cites W2168925567 @default.
- W21950470 cites W2169436924 @default.
- W21950470 cites W2314740872 @default.
- W21950470 cites W2315025792 @default.
- W21950470 cites W2324814459 @default.
- W21950470 cites W2329767934 @default.
- W21950470 cites W2410356582 @default.
- W21950470 cites W2913112014 @default.
- W21950470 cites W3133763570 @default.
- W21950470 cites W3139949178 @default.
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