Binary achievement for Biochemistry
Our people working in Clinical Biochemistry at King’s College NHS Hospital are thrilled to have had two articles published in PubMed during the same week!
This impressive accomplishment is testament to the dedicated team of experts in our laboratories at King’s, and across our organisation who produce interesting, and above all, clinically useful pieces of work.
The abstracts of both articles are available to read on our website, together with details of where you can find the full article. Continue reading for a summary of the articles and use the links at the bottom of this page to find the abstracts.
Audit of the Use of Regular Haem Arginate Infusions in Patients with Acute Porphyria to Prevent Recurrent Symptoms
The use of haem arginate infusion for acute porphyria attacks is a recognised treatment, usually administered through a central line or indwelling device in hospital, but more recently offered to patients in England at home as part of the National Acute Porphyria Service (NAPS).
This audit was conducted to establish the benefits and complications of home treatment to the health of 22 patients with recurrent symptoms of acute porphyria, following regular haem arginate treatment.
Benefits included an increase in physical activity in 50% of patients and an improvement in work attendance in over 30% of patients.
Some of the complications to treatment included a risk of infection or blockage with the use of an indwelling device, which itself only lasts 1-2 years, there was also an identified risk of iron overload, as the infusion contains iron.
The audit concluded that there is a clinical improvement in 50-70% of patients following this treatment, with 14 out of 22 (67%) reporting fewer episodes of acute pain.
Analysis of cerebrospinal fluid for xanthochromia versus modern CT scanners in the diagnosis of subarachnoid haemorrhage: Experience at a tertiary trauma referral centre
Subarachnoid haemorrhage (SAH) is a spontaneous intracranial bleed which is classified as a neurosurgical emergency. SAH represents around 1% of patients presenting to the emergency department with headache, and is associated with high mortality and morbidity.
The first line of investigation is usually a Computed Tomography (CT) head scan when SAH is suspected, and is positive in up to 98% of patients presenting within 12 hours of presentation, however sensitivity drops by 50% after one week.
With the diagnosis of SAH remaining a logistical challenge, this review sought to find out whether the use of cerebrospinal fluid (CSF) xanthochromia analysis to exclude SAH, following a negative computed tomography (CT) scan, is a necessary process given the increased accuracy of modern CT scanners.
The study conducted a retrospective audit of all xanthochromia requests at a tertiary trauma referral centre since its inception. Of 660 requests, 28 were interpreted as being consistent with SAH. Of these, 18 requests were deemed appropriate as the other 10 cases were suggestive of other causes of headache.
Out of the 18 requests, 11 were clinically diagnosed with SAH following the appropriate CSF xanthochromia requesting. Of these 11, five (45%) were initially deemed SAH negative following a CT scan, but were correctly diagnosed following CSF xanthochromia analysis.
The study concluded that despite advancements in CT scanning technology, CSF xanthochromia interpretation aides in definitive diagnosis of SAH.
Further information
Audit of the use of Regular Haem Arginate Infusions...
