Multicoagulant resistant pseudothrombocytopenia.

Pseudo thrombocytopenia is the estimation of low platelet counts by a Haematology analyzer despite of shortage in platelets. EDTA-induced pseudo thrombocytopenia, commonly seen in clinical practice, occurs mainly due to the anti-platelet antibodies. Pseudo thrombocytopenia is seen in normal healthy individuals and other disorders like cardiovascular, liver, autoimmune diseases and malignancy. We are presenting a case of multi-coagulant resistant dependent thrombocytopenia. The purpose of this letter is to review approaches to pseudo thrombocytopenia. The case has coagulant resistant dependent thrombocytopenia in association with Anasarca and was a known case of cardiomyopathy with severely dilated left atrium, left ventricle and right atrium.

Diagnostic efficacy of 0, 30, 45, 60, 90 and 120 min growth hormone samples in insulin tolerance test: utility of growth hormone measurement at different time-points and a cost-effective analysis.

OBJECTIVE: To determine the utility of growth hormone (GH) measurement with the insulin tolerance test (ITT), and to carry out a cost-effective analysis of the diagnosis of GH deficiency. MATERIAL AND METHODS: Ninety-nine patients clinically suspected of GH deficiency were evaluated over a period of 14 months (January 2005 to April 2006). Post-insulin samples of GH and blood glucose (BG) samples were drawn at six different time-points. Serum GH levels of <10 microg/L (prepubertal) and <6.1 microg/L (adolescents) were taken as cut-off for the normal response. RESULTS: Ninety-nine ITTs were carried out during the study period, and GH levels were found to be deficient in 47 subjects. Specificities at different time-points were 0%, 54%, 77%, 62%, 39% and 23% for 0, 30, 45, 60, 90 and 120 min, respectively, in the prepubertal group, and 5%, 41%, 80%, 87%, 77% and 46% at the same time-points for the adolescent group. Accuracy was highest at 45 and 60 min in both the prepubertal and adolescent groups. The receiver operating characteristic curve showed that the highest area under the curve was found in samples drawn at 45, 60 and 90 min in both the prepubertal and adolescent groups. CONCLUSION: Our data suggest that 0, 45, 60 and 90 min samples are sufficient for diagnosing GH deficiency, which could lead to potential cost reductions of up to 29.8%.

Correlation of serum cortisol levels and stress among medical doctors working in emergency departments.

OBJECTIVE: To assess and correlate serum cortisol levels and self-perceived work-related stress among medical doctors working in emergency departments in different tertiary care hospitals of Karachi. DESIGN: Cohort study. PLACE AND DURATION OF STUDY: The study was conducted in Section of Chemical Pathology, Department of Pathology and Microbiology, AKUH, from December 2004 to August 2005. SUBJECTS AND METHODS: A total of 64 doctors participated from one private and two public tertiary care hospitals of Karachi. Thirty-four doctors were from emergency departments and 30 from non-emergency departments. Serum cortisol levels were measured in the morning (between 8.00-8.30 am) and in the evening (between 8.00-8.30 pm). Cortisol was measured by Florescence Polarization Immunoassay (FPIA) technique. Two questionnaires, modified mental Professional Stress Scale (PSS) and Aga Khan University Anxiety and Depression Scale (AKUADS) were used to assess stress levels. RESULTS: Emergency room physicians (ERP) were 1.2-year younger than non-emergency room physicians (NERP). Mean evening cortisol of emergency physicians was 60.72nmol/L higher than non-emergency physicians. The difference between morning and evening cortisol was marginally significant (p = 0.051). Morning diastolic blood pressure was 3mmHg higher in emergency physicians. Forty-one percent of emergency physicians and 20% of non-emergency physicians had AKUADS more than or equal to 20, the difference was borderline significant (p = 0.068). Mean value of professional stress scale for emergency physicians was significantly higher than non-emergency physicians. Evening serum cortisol concentration was significantly associated with PSS (p = 0.011). The sub-scales such as work-load (p = 0.007) and lack of resources were highly significant with evening cortisol (p = 0.005). CONCLUSION: In this study, evening serum cortisol levels significantly correlated with work overload and lack of resources, however, there was marginally significant correlation between morning and evening serum cortisol difference. Study suggests that emergency physicians perceive more stress than non-emergency physicians. Work overload and lack of resources are major contributing factors for stress in these doctors.

Comparison of two methods (precipitation manual and fully automated enzymatic) for the analysis of HDL and LDL cholesterol.

OBJECTIVE: To compare accuracy and throughput time for the measurement of HDL and LDL cholesterol by manual precipitation and fully automated enzymatic methods. METHODS: Fifty, serum samples collected over a 4 months period (February - May 2004) were analyzed for HDL and LDL cholesterol by two different methods i.e. precipitation manual and automatic enzymatic method in the section of chemical pathology, Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi Pakistan. RESULTS: The mean standard deviation for HDL Cholesterol by precipitation method and automated method were 43.12 +/- 8.97mg/dl and 43.86 +/- 10.34mg/dl respectively (p-value = 0.301). The mean standard deviation for LDL cholesterol by precipitation method and automated method were 111.76 +/- 25.57mg/dl and 111.8 +/- 28.41mg/dl respectively (p-value = 0.981). The calculated "t" and "F" value for HDL-C was 0.0172 and 0.75 respectively, and calculated "t" and "F" values for LDL-C were 0.047 and 0.809 respectively. Average time for manual method was 45 minutes and automation 20 minutes. CONCLUSION: Both the precipitation (manual) method and the automated method provide reliable, precise and accurate results. In both the methods "t" and "F" values were less than critical. Automated method provide high throughput and are less labor intensive. The choice of method can depend on laboratory facilities and workload

To compare the total cholesterol and HDL-cholesterol before and after ultra-centrifugation in lipemic samples.

OBJECTIVE: It is an everyday routine in laboratories to encounter interference in the analysis of lipids. These likely interferences (hemolysis, icterus and lipemia) are countered by asking physicians and patients to send fresh and properly collected samples. At the Aga Khan University (AKU) Laboratory, we receive 2-3 lipemic/turbid samples per day. Previously it was our departmental policy to advise these patients to go for lipoprotein electrophoresis, which though accurate was time consuming and not cost effective. We therefore studied ultra centrifugation/airfuge as an alternate method to clear lipid interference and provide accurate, reliable and cost effective results. METHODS: Daily 2-3 grossly turbid samples are identified on the lipid bench, 48 samples were received in 4 months (February to May 2004). These samples were analyzed for total cholesterol (TC) and High Density Lipoprotein-Cholesterol (HDL-C) before and after ultra centrifugation/airfuge. RESULTS: There was a positive correlation between the lipemia and the false high TC and HDL-C. The mean TC and HDL-C before ultra centrifugation were 263.06 mg/dl and 39.42 mg/dl respectively and after centrifugation these became 191.77 mg/dl and 33.06 mg/dl. P value showed a significant difference in both results. CONCLUSION: This study suggests that the removal of turbidity by ultra centrifugation/airfuge is cost effective, less time consuming and provides accurate reliable results of TC and HDL-C in patients with lipemia interference.