Annals of clinical biochemistry
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Acute kidney injury (AKI) is frequently under-recognized and contributes to poor outcomes. Electronic alerts (e-alerts) to highlight AKI based on changes in serum creatinine may facilitate earlier recognition and treatment, and sophisticated algorithms for AKI detection have been proposed or implemented elsewhere. However, many laboratories currently lack the resources or capability to replicate these systems. ⋯ This study demonstrates that a simple automated delta check can detect and flag AKI in real time, continuously, at little extra cost and without manual input.
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Ann. Clin. Biochem. · Mar 2015
Case ReportsNear-fatal persistent anion- and osmolal-gap acidosis due to massive gamma-butyrolactone/ethanol intoxication.
We report a case of an ethanol and massive gamma-butyrolactone (GBL) intoxication, the precursor of the recreational drug gamma-hydroxybutyric acid (GHB), resulting in life-threatening metabolic acidosis (pH 6.5) with a highly increased anion- and osmolal gap. Rapid analysis using gas chromatography revealed a GHB plasma concentration of 4400 mg/L, far above the upper limit concentration of 1000 mg/L found in adult fatalities attributed to GBL. Full recovery was established following supportive treatment including haemodialysis. This is the first report of a combined ethanol/GBL intoxication as a cause of high serum anion- and osmolal-gap metabolic acidosis.
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Ann. Clin. Biochem. · Jan 2015
Comparative StudyA comparison of different methods of demand management on requesting activity in a teaching hospital intensive care unit.
Laboratory services in the UK have witnessed an annual increase in requesting activity often with no associated increase in budget. This study evaluated the impact of different demand management strategies on biochemistry test requesting activity from a tertiary Intensive Care Unit (ICU) at a UK teaching hospital. ⋯ Implementation of MRIs reduced biochemistry test requesting activity on the ICU. Introduction of an agreed test schedule and removal of the MRIs, however, produced a further reduction in ICU requesting activity. Variation in ICU workload does not account for all the observed changes.
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Ann. Clin. Biochem. · Sep 2014
ReviewSerum-free light-chain assay: clinical utility and limitations.
In the last decade, the introduction of the serum-free light-chain (sFLC) assay has been an important advance in the diagnosis and management of plasma cell dyscrasias, particularly monoclonal light-chain diseases. The immunoassay was developed to detect free light chains in serum by using anti-FLC antibodies which specifically recognised epitopes on light chains that were 'hidden' in intact immunoglobulins. Since its introduction in 2001, there have been several publications in the English language literature discussing the clinical utility as well as analytical limitations of the sFLC assay. ⋯ The contribution and significance of the sFLC assay in the management of light-chain myeloma, primary amyloid light-chain (AL) amyloidosis and non-secretory myeloma are well recognised and will be addressed in this review. The aim of this article is to also review the published literature with a view to providing a clear understanding of its utility and limitations in the diagnosis, prognosis and monitoring of plasma dyscrasias including intact immunoglobulin multiple myeloma (MM) and monoclonal gammopathy of unknown significance (MGUS). The increasing interest in using this assay in other haematological conditions will also be briefly discussed.
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Ann. Clin. Biochem. · Jul 2014
Measurement of plasma viscosity by free oscillation rheometry: imprecision, sample stability and establishment of a new reference range.
Plasma viscosity (PV) is used in the investigation of hyperviscosity syndrome. We have evaluated the performance of a new bench-top free oscillation rheometer, ReoRox from Medirox, and established a new reference range. ⋯ We have established a FOR PV reference range to support clinical decision-making. Furthermore, we found high pre-analytical stability of the samples and an analytical imprecision comparable to other PV methods.