Hemolysis icterus

Plasma creatinine is an imperfect marker of GFR and therefore it is not altogether surprising that formulas based predommantly upon it are imperfect. Their use cannot circumvent the very significant spectral interferences affecting plasma creatinine measurement (i.e., hemolysis, icterus, and lipemia) and the formulas are unsuitable for use in patients with acute renal failure, in whom plasma creatinine concentrations are changing rapidly. Additionally, the formulas are critically susceptible to variations in creatinine assay calibration and specificity. Notwithstanding the MDRD formula is thought to improve the estimation of GFR compared with plasma creatinine alone. 

Adsorption or precipitation of calcium Spectrophotometric interference Hemolysis, icterus, hpemia... 

Disadvantages include the greater interference of hemolysis, icterus, and lipemia at 340 nm. Approximately 70% of laboratories participating in the College of American Pathologists Comprehensive Chemistry Survey in 2004 used a direct UV procedure, with most of the others using a reduced photometric method. 

Level detection and evaluation of specimen adequacy (specimen integrity) An area in which sensors are used to evaluate the volume of specimen in each specimen container and to look for the presence of hemolysis, lipemia, or icterus. 

Clinical manifestation. It includes several syndromes a) pulmotoxic and irritative syndrome - expressed by catarrhal changes on the contact mucosa and respiratory tract, toxic pulmonary oedema b) hemotoxic syndrome - expressed by severe hemolysis of different degrees, in the severe forms - hemolytic shock and anaemia c) hepatal syndrome - characterised by subicterus or icterus, increased liver and bilirubinaemia d) renal syndrome - by oliguria or anuria, pathological deviations in the urine and acute kidney insufficiency. In the extremely severe forms consciousness is disordered. Laboratory blood and urine chemical tests show evidence of phenol metabolites, data for blood damage (increased values of free hemoglobin, reduced number of erythrocytes), positive liver tests etc. 

Clinical manifestation. It includes the following syndromes a) irritative-pulmotoxic syndrome - with evidence of catarrhal tracheobronchitis, combined with toxic oedema in the severe cases b) cerebral toxic syndrome characterised by ataxia, Menier s syndrome, the severe forms manifest disordered consciousness c) hepatotoxic syndrome - observed in the extremely severe cases of poisoning, manifested as icterus, hepotomegalia and increased blood bilirubin and transaminase values sometimes it is manifested as hepatorenal syndrome d) hemotoxic syndrome - rarely met in acute intoxication by methemoglobinaemia, hemolysis, leukopoenia. 

Finally, analytical accuracy, precision, and freedom from interferences must meet contemporary needs. Precision of modern instruments is largely excellent bias from the true value is a common problem with enzyme assays, and interferences from lipemia, hemolysis, and icterus is still a problem with some instruments and methods. 

Refractometry Refractometry is a quick and reasonably accurate alternative to chemical analysis for serum total protein when a rapid estimate is required. The refractive index of water at 20°C is 1.330 if solute is added to the water, the refractive index of a dilute solution increases linearly and proportionally to the solute concentration at higher concentrations of dissolved solids (50-200gl ), the increase is nearly linear. Temperature affects appreciably the refractive index of a solution, so refracto-meters for clinical use compensate for temperature effects. Serum contains dissolved solids in concentrations of 80-100 gl, most of which are proteins. In the refractometry of serum, it is assumed that the concentration of inorganic electrolytes and nonprotein organic compounds does not vary appreciably from serum to serum and that the differences in the refractive index reflect primarily the differences in protein concentrations. The assumption has been shown to be reliable for clear, nonpigmented samples, but hemolysis, lipemia, icterus, and azotemia produce erroneously high results. The method cannot be used for urine protein measurement because of excess solutes in relation to the protein. 

Cross lesions include hepatic icterus an enlarged, pulpy spleen (indicative of hemolysis) and dark, bluish-Uadc kidneys (known as "gunmetal kidneys ). 

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