8 July 2014 (Tuesday) - Duff Result

A sodium result of over 200? And a potassium of over 10? It's just not possible. On inspection electrolytes had been mistakenly requested on a glucose sample. I've always known that the anticoagulant and preservative in glucose samples is flouride oxalate. Buut today I made the realisation that it's sodium fluoride and potassium oxalate...

Rather obvious really...

7 July 2014 (Monday) - Renal Failure

Here's an interesting case - look at the potassium and creatinine.

CARTMAN, ERIC 08/08/2014 15:55 MR 22/05/1945 69 yrs M 667269 Northgate M/P Canterbury U NORC Specimen No : AC660246W Selected Auth Level : S --------------------T-------------------T-------------------T------------------- NA 134 S000 |ALT 35 S000 | | K 8.2 S000 |CA 2.6 S000 | | KBIC 14 S008 |$CORCA 2.6 S000 | | CR 243 S000 |CRP 1 S000 | | _GFR 23 S000 |HINT ^0.1 S000 | | PROT 82 S000 |IINT ^16 S000 | | ALB 38 S000 |LINT ^0.1 S000 | | GLOB 44 S000 | | | TBIL 18 S000 | | | ALKP 73 S000 | | | --------------------T-------------------T-------------------

High potassiums are always suspect; were samples taken in the wrong order leading to EDTA contamination? In this case probably not - look at the (if anything) raised calcium. Creatinine is seriously up; GFR down. Renal failure?

Historically there has been raised creatinine.

CARTMAN, ERIC 08/08/2014 15:55 MR 22/05/1945 69 yrs M 667269 Northgate M/P ------T-----------------------------------------------------------------------] Date|07/07/2014 07/07/2014 07/07/2014 17/06/2014 15/06/2014 13/06/2014 | Time|u/k 19:50 15:55 08:45 u/k 11:00 | Spec|AC660200Q AC660186R AC660246W AC642143X AC640438G AC638999V | |BIO BIO BIO BIO BIO BIO | Test--+-----------------------------------------------------------------------{ NA |131 H 134 139 137 139 | K |7.9 H 8.2 4.4 3.8 4.0 | KBIC |7 H 14 | CR |235 H 243 132 127 114 | _GFR |24 H 23 47 49 56 | PROT | H 82 79 80 | ALB |36 H 38 35 37 | GLOB | H 44 44 43 | TBIL | H 18 15 21 | ALKP |70 H 73 75 81 | ALT | H 35 16 14 | CA |2.6 H 2.6 | ------T-----------------------------------------------------------------------]

Results were phoned; patient admitted, repeat samples sent. The patient *was* in renal failure

2 July 2014 (Wednesday) - Anti - D

Whilst issuing anti-D this morning I found myself wondering if my knowledge on the subject was as current as it might have been. I did a little literature search and came up with a few references:

www.nice.org.uk/nicemedia/live/12047/41690/41690.pdf

http://www.bcshguidelines.com/documents/Anti-D_bcsh_07062006.pdf

http://www.rcog.org.uk/files/rcog-corp/GTG22AntiDJuly2013.pdf

The last reference was perhaps for me the most interesting... it was from the obstetric point of view, and I was approaching the topic from a laboratory point of view. And it turned out that I was au-fait with current policies and procedures for the ante-natal administration of anti-D.

Mind you the whole thing is rather pertinent to me as I was watching when my daughter was given an anti-D injection a couple of months ago.