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Periostitis deformans secondary to prolonged voriconazole treatment: A case study
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PATHOLOGY 2014 ABSTRACT SUPPLEMENT
Objective: To evaluate placental growth factor (PlGF) in abnormal early pregnancies. Methods: Placental growth factor (PlGF) was retrospectively quantified (DELFIA DXpress; Perkin Elmer) in women with known pregnancy outcomes. Study group consisted of: (i) normal (n ¼ 300); (ii) abnormal: trisomy 21 (n ¼ 56), trisomy 18 (n ¼ 23), trisomy 13 (n ¼ 6), triploid (n ¼ 15), monosomy X (n ¼ 7). PlGF MoM values were calculated by LifeCycle v4 (Perkin Elmer), using lot specific derived polynomial regression curve. Results: Median PlGF MoM values were depressed in pregnancies carrying a fetus affected with: trisomy 21 ¼ 0.81 (95%CI 0.72–0.90), trisomy 13 ¼ 0.87 (95%CI 0.79–0.95), trisomy 18 ¼ 0.89 (95%CI 0.78–1.00) and triploidy ¼ 0.68 (95%CI 0.59–0.77). However, in viable sex chromosome aneuploidy, such as monosomy X, PlGF proved less discriminatory with median MoM ¼ 0.91 (95%CI 0.76–1.06). Conclusions: The above findings support the inclusion of PlGF in the marker panel for first trimester screening for fetal aneuploidy. In addition to improving detection of fetal aneuploidy, PlGF has a role in first trimester detection of early onset preecalmpsia1. Reference 1. Akolekar R, Zaragoza E, Poon LC, et al. Maternal serum placental growth factor at 11 þ 0 to 13 þ 6 weeks of gestation in the prediction of preeclampsia. Ultrasound Obstet Gynaecol 2008; 32: 732–9.
PERIOSTITIS DEFORMANS SECONDARY TO PROLONGED VORICONAZOLE TREATMENT: A CASE STUDY Wayne Rankin1, Mohamed Saleem1, Susan Grant2, Christopher Florkowski2 and Penelope Coates1 1Division of Chemical Pathology, SA Pathology, Adelaide, SA, Australia, and 2Canterbury Health Laboratories, Christchurch, New Zealand We report a case of fluoride toxicity manifesting as periostitis deformans occurring as the result of prolonged treatment with the fluoride-rich antifungal voriconazole. A 39-year-old woman was commenced on voriconazole, 400 mg BD, because of Aspergillus infection causing intracranial abscesses as a post-operative complication of orthotopic liver transplant. Three months later, skeletal imaging performed in the context of bone pain and reduced shoulder and elbow mobility showed features consistent with periostitis deformans, with multiple bilateral exostoses adjacent to the radial and humeral shafts and lateral aspects of the scapulae. Bone scan showed diffuse cortically based uptake involving the appendicular skeleton and multiple ribs. Voriconazole was ceased. To address the association with voriconazole, serum fluoride levels were assayed on samples collected 4 days before and 4, 8 and 12 days after ceasing voriconazole: levels were 16.3, 7.9, 8.5 and 6.8 umol/L, respectively (reference interval 0.3– 2.2 umol/L). Corresponding voriconazole levels were 4.1 and < 0.1 mg/L 4 days before and 10 days after cessation. Unlike voriconazole, the fluoride concentration did not fall to baseline following voriconazole cessation, suggesting that the fluoride was sequestered in, and released from, the exostoses. Clinicians should be aware of this complication of prolonged voriconazole treatment.
Pathology (2014), 46(S1)
EVALUATION OF THE BD VACUTAINER RAPID SERUM TUBE ON HAEMOLYSIS MARKERS IN THE EMERGENCY DEPARTMENT J. B. Ryan1, M. P. Than2, L. Stuart1, S. Southby1, C. M. Florkowski1, R. J. Mackay1 and P. M. George1 1Canterbury Health Laboratories, and 2Emergency Department, Christchurch Hospital, Christchurch, New Zealand Aims: Haemolysis is an important source of assay interference, especially in the Emergency Department (ED). A rapid-clotting serum tube, Becton-Dickinson (BD) Vacutainer Rapid Serum Tube (RST), was reported to reduce haemolysis rates compared to standard serum tubes. We evaluated the effect of RST on haemolysis markers compared with our current STAT testing tube, BD Vacutainer Plasma Separator Tube (PST). Methods: Patients presenting to the ED over a 8-day period had an additional RST and BD Vacutainer non-gel heparin plasma tube collected. Blood was collected from 347 patients by trained nursing staff from an intravenous cannula using an adaptor device (Vacutainer Luer-Lok access device). All samples were then analysed for six haemolysis markers: haemolysis index, phosphate, magnesium, potassium, lactate dehydrogenase (LD), and aspartate aminotrasferase (AST). Results: We found 9% of samples were haemolysed (>0.5 g/L free haemoglobin). Significant differences (p0.001) were found between the tubes for haemolysis index, phosphate, potassium and LD. No such difference was detected for magnesium or AST. The RST group medians were not significantly different from PST for haemolysis index but were significantly (p < 0.05) higher for phosphate and potassium and lower for LD. Discussion/conclusion: RST tubes did not improve markers of haemolysis compared to plasma tubes.
A SURVEY OF QUALITY CONTROL PROCEDURES IN USE IN AUSTRALASIAN CHEMICAL PATHOLOGY LABORATORIES Tony Badrick and Peter Turner Faculty of Biomedical Sciences and Medicine, Bond University, Gold Coast, Qld, Australia Aims: A survey of 60 Australasian chemical pathology laboratories was conducted under the auspices of the Australasian Association of Clinical Biochemistry to identify current quality control (QC) procedures. Results: The survey found that there were many different Westgard rules used either every shift, daily or at some other frequency. Most laboratories had automated rules, with about 50% using external software. Not all laboratories reported having a documented procedure to follow in the advent of a QC failure. A significant number of respondents used the QC material manufacturer’s recommendations to set the mean and SD. There were also differences in the way means and SDs were set for multiple instruments using the same analyte and how laboratories assessed comparability of analytes from different analysers. QC targets for means and SDs were reassessed at different time periods. Discussion: Despite the importance of quality assurance there are still inconsistencies in the way laboratories deal with internal QC processes in term of frequency of QC, interpretation and dealing with out of control results and setting QC material targets. There is an argument to harmonise many of these aspects of QC policy.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
PATHOLOGY 2014 ABSTRACT SUPPLEMENT
Objective: To evaluate placental growth factor (PlGF) in abnormal early pregnancies. Methods: Placental growth factor (PlGF) was retrospectively quantified (DELFIA DXpress; Perkin Elmer) in women with known pregnancy outcomes. Study group consisted of: (i) normal (n ¼ 300); (ii) abnormal: trisomy 21 (n ¼ 56), trisomy 18 (n ¼ 23), trisomy 13 (n ¼ 6), triploid (n ¼ 15), monosomy X (n ¼ 7). PlGF MoM values were calculated by LifeCycle v4 (Perkin Elmer), using lot specific derived polynomial regression curve. Results: Median PlGF MoM values were depressed in pregnancies carrying a fetus affected with: trisomy 21 ¼ 0.81 (95%CI 0.72–0.90), trisomy 13 ¼ 0.87 (95%CI 0.79–0.95), trisomy 18 ¼ 0.89 (95%CI 0.78–1.00) and triploidy ¼ 0.68 (95%CI 0.59–0.77). However, in viable sex chromosome aneuploidy, such as monosomy X, PlGF proved less discriminatory with median MoM ¼ 0.91 (95%CI 0.76–1.06). Conclusions: The above findings support the inclusion of PlGF in the marker panel for first trimester screening for fetal aneuploidy. In addition to improving detection of fetal aneuploidy, PlGF has a role in first trimester detection of early onset preecalmpsia1. Reference 1. Akolekar R, Zaragoza E, Poon LC, et al. Maternal serum placental growth factor at 11 þ 0 to 13 þ 6 weeks of gestation in the prediction of preeclampsia. Ultrasound Obstet Gynaecol 2008; 32: 732–9.
PERIOSTITIS DEFORMANS SECONDARY TO PROLONGED VORICONAZOLE TREATMENT: A CASE STUDY Wayne Rankin1, Mohamed Saleem1, Susan Grant2, Christopher Florkowski2 and Penelope Coates1 1Division of Chemical Pathology, SA Pathology, Adelaide, SA, Australia, and 2Canterbury Health Laboratories, Christchurch, New Zealand We report a case of fluoride toxicity manifesting as periostitis deformans occurring as the result of prolonged treatment with the fluoride-rich antifungal voriconazole. A 39-year-old woman was commenced on voriconazole, 400 mg BD, because of Aspergillus infection causing intracranial abscesses as a post-operative complication of orthotopic liver transplant. Three months later, skeletal imaging performed in the context of bone pain and reduced shoulder and elbow mobility showed features consistent with periostitis deformans, with multiple bilateral exostoses adjacent to the radial and humeral shafts and lateral aspects of the scapulae. Bone scan showed diffuse cortically based uptake involving the appendicular skeleton and multiple ribs. Voriconazole was ceased. To address the association with voriconazole, serum fluoride levels were assayed on samples collected 4 days before and 4, 8 and 12 days after ceasing voriconazole: levels were 16.3, 7.9, 8.5 and 6.8 umol/L, respectively (reference interval 0.3– 2.2 umol/L). Corresponding voriconazole levels were 4.1 and < 0.1 mg/L 4 days before and 10 days after cessation. Unlike voriconazole, the fluoride concentration did not fall to baseline following voriconazole cessation, suggesting that the fluoride was sequestered in, and released from, the exostoses. Clinicians should be aware of this complication of prolonged voriconazole treatment.
Pathology (2014), 46(S1)
EVALUATION OF THE BD VACUTAINER RAPID SERUM TUBE ON HAEMOLYSIS MARKERS IN THE EMERGENCY DEPARTMENT J. B. Ryan1, M. P. Than2, L. Stuart1, S. Southby1, C. M. Florkowski1, R. J. Mackay1 and P. M. George1 1Canterbury Health Laboratories, and 2Emergency Department, Christchurch Hospital, Christchurch, New Zealand Aims: Haemolysis is an important source of assay interference, especially in the Emergency Department (ED). A rapid-clotting serum tube, Becton-Dickinson (BD) Vacutainer Rapid Serum Tube (RST), was reported to reduce haemolysis rates compared to standard serum tubes. We evaluated the effect of RST on haemolysis markers compared with our current STAT testing tube, BD Vacutainer Plasma Separator Tube (PST). Methods: Patients presenting to the ED over a 8-day period had an additional RST and BD Vacutainer non-gel heparin plasma tube collected. Blood was collected from 347 patients by trained nursing staff from an intravenous cannula using an adaptor device (Vacutainer Luer-Lok access device). All samples were then analysed for six haemolysis markers: haemolysis index, phosphate, magnesium, potassium, lactate dehydrogenase (LD), and aspartate aminotrasferase (AST). Results: We found 9% of samples were haemolysed (>0.5 g/L free haemoglobin). Significant differences (p0.001) were found between the tubes for haemolysis index, phosphate, potassium and LD. No such difference was detected for magnesium or AST. The RST group medians were not significantly different from PST for haemolysis index but were significantly (p < 0.05) higher for phosphate and potassium and lower for LD. Discussion/conclusion: RST tubes did not improve markers of haemolysis compared to plasma tubes.
A SURVEY OF QUALITY CONTROL PROCEDURES IN USE IN AUSTRALASIAN CHEMICAL PATHOLOGY LABORATORIES Tony Badrick and Peter Turner Faculty of Biomedical Sciences and Medicine, Bond University, Gold Coast, Qld, Australia Aims: A survey of 60 Australasian chemical pathology laboratories was conducted under the auspices of the Australasian Association of Clinical Biochemistry to identify current quality control (QC) procedures. Results: The survey found that there were many different Westgard rules used either every shift, daily or at some other frequency. Most laboratories had automated rules, with about 50% using external software. Not all laboratories reported having a documented procedure to follow in the advent of a QC failure. A significant number of respondents used the QC material manufacturer’s recommendations to set the mean and SD. There were also differences in the way means and SDs were set for multiple instruments using the same analyte and how laboratories assessed comparability of analytes from different analysers. QC targets for means and SDs were reassessed at different time periods. Discussion: Despite the importance of quality assurance there are still inconsistencies in the way laboratories deal with internal QC processes in term of frequency of QC, interpretation and dealing with out of control results and setting QC material targets. There is an argument to harmonise many of these aspects of QC policy.
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.