Revised national guidelines for analysis of cerebrospinal fluid for bilirubin in suspected subarachnoid haemorrhage

Ann Clin Biochem 2008;45:238-244
© 2008 Association for Clinical Biochemistry


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Anne Cruickshank1,
Peter Auld2,
Robert Beetham3,
Gillian Burrows4,
William Egner5,
Ian Holbrook6,
Geoff Keir7,
Emma Lewis8,
Dina Patel5,
Ian Watson8 and
Peter White, Produced by the UK NEQAS Specialist Advisory Group for EQA of CSF Proteins and Biochemistry5

1 Department of Biochemistry, Southern General Hospital, Glasgow G51 4TF;
2 Department of Clinical Biochemistry, Belfast Trust Hospital, Belfast BT12 6BA;
3 Department of Clinical Biochemistry, Frenchay Hospital, Bristol BS16 1LE;
4 Department of Biochemistry, Stepping Hill Hospital, Stockport SK2 7JE;
5 Department of Immunology, Northern General Hospital, Sheffield S5 7YT;
6 Department of Clinical Biochemistry, York Hospital, York YO31 8HE;
7 Department of Neuroimmunology, National Hospital for Neurology and Neurosurgery, London, WC1 N 3BG;
8 Department of Clinical Biochemistry, University Hospital, Aintree, Liverpool L9 7AL, UK

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Figure 1(a–e) Representative spectrophotometric scans showing net bilirubin absorbance (NBA) at 476 nm above a tangential baseline as described in the text. 1(a) A normal cerebrospinal fluid with essentially no bilirubin; scan and baseline (not drawn) are superimposable. 1(b) NBA within the reference range. 1(c) Oxyhaemoglobin with zero NBA. 1(d) Oxyhaemoglobin with NBA within the reference range. 1(e) Oxyhaemoglobin with an increased NBA. In practice, such scans are best visualized filling the whole of an A4 page in landscape mode

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Figure 2 Bilirubin absorbance in cerebrospinal fluid for detection of intra-cranial bleed

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