Isotope dilution mass spectrometry alignment of the StatSensor will identify most patients with estimated glomerular filtration rate <60 mL/min, but there will be many falsely low estimated glomerular filtration rate results that require laboratory validation. Creatinine results need improvement.
The NT POCT Program has been operationally effective and well received by staff working as i-STAT POCT operators in remote health centres. Retention of remote health centre staff is the most significant challenge to ensuring the program's long-term viability.
Using a gas-chromatographic method, we examined the effects of phosphate concentration, added calcium chloride, and pH on precipitation of oxalate from urine. All three factors are important, but the pH of precipitation is particularly so, especially in the presence of even normal concentrations of ascorbic acid. At pH 8, increases in measured oxalate ranged from 20% at an ascorbic acid concentration of 1 mmol/L to more than 300% at 15 mmol/L. Ascorbic acid is rapidly converted to oxalate at alkaline pH. We also investigated the stability of both untreated and acidified urine containing ascorbic acid during storage for up to one month at -70, -20, and 4 degrees C, and room temperature. After one month, untreated collections were stable at -70 degrees C and acidified collections at -20 and -70 degrees C. We recommend conditions for assay and storage of urine specimens that are to be assayed for oxalate under which positive interference by ascorbic acid is minimized.
The reliability of a recently released total bilirubin assay for a blood gas analyser was assessed in two Australian hospital laboratories. The instrument computes total bilirubin concentration from multi-wavelength absorbance measurements of undiluted whole blood or plasma. Performance of the Radiometer ABL 735 blood gas analyser bilirubin method (software version 3.6) was compared with a proven Roche diazo method for Hitachi analysers, calibrated using primary standards prepared from NIST SRM 916a bilirubin. Acceptable bilirubin results were found over a wide concentration range for most neonatal samples of whole blood or plasma. For adult specimens, bilirubin results were approximately 10% lower on the blood gas analyser. Within-run imprecision (whole blood) was < 2.5%, between-day imprecision (synthetic controls) < 1.0%, and the bilirubin assay for both whole blood and plasma was linear to 1,000 micromol/L. Using sampling options from 35 microL to 195 microL, bilirubin results differed by less than 3%, with a 95 microL syringe option producing the highest results. We conclude that the Radiometer ABL 735 bilirubin assay is suitable for near-patient assessment of neonatal jaundice using whole blood, thus eliminating the need for sample centrifugation. Verification using laboratory methods can be used when required. A positive correction of approximately 10% is required for adult specimens to conform with Hitachi results (SRM 916a calibration), possibly due to the optical characteristics of the higher proportion of conjugated bilirubin and other substances present in most adult samples.
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