An audit of appropriate tests in renal biopsy coagulation screens.

Hematological, biochemical, and clinical data was collected over a 15-month period on all adult (greater than 16 years) patients assessed for percutaneous biopsy of native kidneys in a major renal unit. The frequency, causes, interrelationships, and treatment of the abnormalities, along with factors resulting in delay or cancellation of renal biopsies were subsequently subjected to audit. Overall, 30 of 147 coagulation screens were abnormal. The most common coagulopathy was a prolonged bleeding time (BT), which accounted for 58.6% of these. A prolonged BT was not clearly related to other hematological or biochemical indices, and proved to be treatable with arginine vasopressin (DDAVP). The majority of abnormalities occurred in isolation (23/30), and eight of 30 were related directly to current anticoagulant or antiplatelet medication. All but two patients with abnormalities proceeded to renal biopsy after successful corrective measures, but 21 of 30 were delayed by between 1 hour and 14 days. None of the remaining 117 biopsies were delayed, although seven were cancelled for a variety of reasons. The prothrombin consumption index provided no additional useful management information. Our clotting screen, modified by this audit, should safely and efficiently detect clotting abnormalities before renal biopsy.

Listeria meningitis and paté.

Listeria meningitis occurred in a 63 year old man who was in complete haematological remission following chemotherapy for acute myeloid leukaemia. The patient had followed Department of Health advice to immunocompromised patients and had avoided soft cheeses, cook-chill meals, and salads. He had, however, recently eaten paté produced in Belgium. This was no longer available for examination but a coincidental survey of paté in the Cardiff area found Listeria monocytogenes in 16 out of 73 samples. Paté should be included in the list of foods to be avoided by immunocompromised patients.