Reference values should be produced under standardized conditions. To enable comparison it is desirable to use the same procedure also in other clinical situations. A procedure for the collection of venous blood from children with special reference to production of reference values is recommended. It deals with five items: preparation of the child before specimen collection, preparation of the blood collection site, equipment for specimen collection, the specimen collection itself, and handling and storage of the specimen. Alternative methods are described since no single method is suitable for all paediatric age groups. The problem of adhering to a proposed procedure during routine clinical work is also commented upon. The recommendation has been produced as a joint effort of the Scandinavian Committee on Reference Values and a working group set up by the National Paediatric Societies in the Nordic countries.
Reliable reference values need to be collected under standardized conditions. In order to enable comparison of values observed on patients with reference values, it is also desirable to use the same standardized conditions on patients. The present recommendation was produced as a joint effort of representatives of the clinical chemists and paediatricians of Scandinavia and describes the following details. Preparation of the child before specimen collection (food intake, time of day, physical activity, posture, environment), preparation of skin puncture site (warming, disinfection, ointment), instruments for blood collection (lancet, blood collection vessel), site of puncture (plantar surface of foot, finger, ear lobe), collection of emerging blood and handling and storage of the specimen.
Cholic acid‐24‐14C was injected i.v. into five patients with chronic liver disease (four with Laennec's cirrhosis and one with amyloidosis) and three patients with acute liver failure of different etiology (massive hepatic necrosis of unknown etiology, carbon tetrachloride liver injury, infectious hepatitis). The rate of disappearance of isotope from the blood during the first 60 min was depressed in patients with icterus. An anicteric patient with amyloidosis showed greatly depressed removal rate. Only trace amounts of isotope were excreted in urine during the first hours following injection and only a small fraction of the cholic acid pool was eliminated by urinary excretion, since less than 13% of the administered isotope was excreted in urine during the four days following injection. Similar studies were performed in two patients with interrupted enterohepatic circulation of bile acids due to calculi in the choledochus. Bile was sampled through a T‐tube inserted in the choledochus. These patients had impaired liver function, as indicated by bilirubin concentration above 6.0 mg/100 ml. The injected isotope was rapidly excreted in bile and all isotope was recovered in bile within 24 hours in conjugated form. Chromatographic analysis of urinary labelled metabolites showed that eight of the ten patients mainly excreted labelled conjugated bile acids. In two of the patients, one with Laennec's cirrhosis and one with hepatic necrosis, a constant excretion of 30–40% of unconjugated labelled bile acids was observed.
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