ABSTRACT
Most diagnostic tests for biliary atresia [BA] are invasive. This study evaluates the sensitivity and specificity of serum tumor necrosis factor-alpha [TNF-alpha] for diagnosing extra hepatic biliary duct atresia [EHBA] in infants. Infants with cholestasis who were admitted to Children's Medical Center Hospital were evaluated. A total of 50 infants [20 with EHBA and 30 non-EHBA] were included in this study. We evaluated the definite cause of cholestasis. Intra-operative cholangiography and, if possible, Kasai portoenterostomy were performed in infants with high suspicion for EHBA. Upon admission and prior to surgical intervention, infants had their serum TNF-alpha levels measured by ELISA. We compared the mean TNF-alpha level between the two groups, in addition to the sensitivity and specificity of serum TNF-alpha for diagnosis of EHBA. This study enrolled 28 [56%] male and 22 [44%] female infants. Infants'' mean age was 2.87 months in the EHBA group and 2.6 months in the non-EHBA group. Sensitivity of serum TNF was 60% and its specificity was 76.66% for predicting EHBA. The positive predictive value was calculated as 63.1%, the negative predictive value was 74.1%, and accuracy was 70%. There was a significantly higher mean serum TNF-alpha level in the EHBA group [220 pg/ml] compared to the non-EHBA group [79.8 pg/ml, p=0.023]. Serum TNF-alpha cut off point for determining EHBA from non-EHBA was calculated as 80 pg/ml. Mean serum TNF-alpha in males [171.28 pg/ml] was more than females [90.80 pg/ml]. There was a significantly higher mean serum TNF-alpha level in the EHBA group than the non-EHBA group. Serum TNF-alpha could be a proper test that has comparatively good sensitivity, specificity, positive predictive value and negative predictive value for predicting EHBA
ABSTRACT
Blood is a life saving product and has no equivalent. Limitation time for storing and cost of typing and cross matched in respect of lab equipment and personnel, may lead to importance of proper request and use of them. In a cross sectional descriptive study, 500 patients with elective surgery were participated. Variable and data collection were done with check list. Data analyzed with SPSS soft ware. The standard ratio of cross matched per transfused was less than 1/5 pack. Results shown that of 500 patients, the blood transfused only for 80[16%] of them. The mean of hemoglobin for patients who have transfused were 12/4. The mean of hemorrhage for patients who have transfused were 822 milliliters and for the rest were 424. The whole products which used were, 325 packs and 15 units were platelet and the rest were whole blood and packed cell. In this study the ratio of cross matched blood with transfused was 4 packs higher than standard. Because of costs for storing, reservation, transport to hospitals, and costs of cross matched in respect of lab costs and staffs, the request of blood must be by real indication and exact needs