We report two cases of Belgian women diagnose with a lead poisoning. Both patients presented with... more We report two cases of Belgian women diagnose with a lead poisoning. Both patients presented with abdominal pain and a normochromic normocytic anaemia. The diagnosis was based on the clinical symptoms, the anaemia, the basophilic stippling of erythrocytes and the elevated blood lead level Upon further questioning, both patients reported the use of Ayurvedic medications. Toxicological analysis of the different pills revealed that, in both, the same orange-red pills contained a remarkably high amount of lead. Cases of lead poisoning associated with the use ofAyurvedic formulations are emerging around the world. However, to our knowledge, these are the first reported cases in Belgium.
*Corresponding author: Davy M.J. Kieffer, Laboratory Medicine, University Hospitals Leuven, Heres... more *Corresponding author: Davy M.J. Kieffer, Laboratory Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium, Phone: +32 16 34 25 59, Fax: +32 16 34 70 10, E-mail: davy.kieffer@uzleuven.be; and Department of Microbiology and Immunology, KU Leuven – University of Leuven, Leuven, Belgium Cornelis L. Harteveld: Hemoglobinopathies Laboratory, Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands Da Hae Lee and Pieter Gillard: Department of Clinical and Experimental Medicine, KU Leuven – University of Leuven, Leuven, Belgium; and University Hospitals Leuven, Endocrinology, Leuven, Belgium Toon Schiemsky: Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium. http://orcid.org/0000-0002-4409-3769 Koenraad J.O. Desmet: Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Leuven, Belgium; and Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium Letter to the Editor
Suspected hemoglobin (Hb) variants, detected during HbA1C measurements should be further investig... more Suspected hemoglobin (Hb) variants, detected during HbA1C measurements should be further investigated, determining the extent of the interference with each method. This is the first report of Hb Melusine and Hb Athens-Georgia in Caucasian Belgian patients. Intervention & Technique: Since common CE-HPLC methods for HbA1C analysis or Hb variant screening are apparently unable to detect these Hb variants, their presence might be underestimated. HbA1C analysis using CZE, however, alerted for their presence. Moreover, in case of Hb Melusine, even Hb variant screening using CZE was unsuccessful in its detection. Fortunately, carriage of Hb Melusine or Hb Athens-Georgia variants has no clinical implications and, as shown in this report, no apparent difference in HbA1C should be expected.
We describe a 77-year-old cyclosporine-treated renal allograft recipient in whom falsely elevated... more We describe a 77-year-old cyclosporine-treated renal allograft recipient in whom falsely elevated whole blood cyclosporine concentrations were encountered using the antibody conjugated magnetic immunoassay (ACMIA) for therapeutic drug monitoring.
INTRODUCTION Femoral neck narrowing (NN) following Metal-on-Metal Hip Resurfacing Arthroplasty (M... more INTRODUCTION Femoral neck narrowing (NN) following Metal-on-Metal Hip Resurfacing Arthroplasty (MoMHRA) is a well-recognised clinical phenomenon. The incidence of resurfaced hips with NN > 10% is reported to be up to 27%. Its pathogenesis is thought to be multi-factorial secondary to stress shielding, impingement, osteolysis secondary to wear/ion particles and as a result of reduced vascularity and pressure effect on cancellous bone secondary to the presence of a soft-tissue mass around the resurfaced hip. Recognised risk factors for its development include: female gender and the presence of a pseudotumour. Serum Chromium (Cr) and Cobalt (Co) are recognised surrogate markers of in-vivo wear of MoMHRA. The aims of this study were to establish whether NN is associated with increased wear. METHODS A cohort of 214 patients with unilateral MoMHRA (139M: 75F) was included in this study. Primary osteoarthritis was the diagnosis leading to surgery for the majority of patients (208). The ...
Introduction: Hypoglycaemia has been reported as an unusual complication of tramadol use and in a... more Introduction: Hypoglycaemia has been reported as an unusual complication of tramadol use and in a few cases of tramadol poisoning, but the exact mechanism is not known. Case description: An ambulance crew was dispatched to an unconscious 46-year old man. A glucometer point-of-care measurement revealed a profound hypoglycaemia (1.9 mmol/L). Treatment with intravenous glucose was started and the patient was transported to the hospital. The patient had several episodes of pulseless electrical activity requiring cardiopulmonary resuscitation in the ambulance and upon arrival in the hospital. Despite continuous glucose infusion the hypoglycaemia was difficult to correct during the next few hours and the patient developed hypokalaemia. Further investigation to identify the cause of hypoglycaemia revealed that insulin and C-peptide were inappropriately raised. A toxicological investigation revealed the presence of tramadol and its metabolites in lethal concentrations. Also acetaminophen, i...
We report two cases of Belgian women diagnose with a lead poisoning. Both patients presented with... more We report two cases of Belgian women diagnose with a lead poisoning. Both patients presented with abdominal pain and a normochromic normocytic anaemia. The diagnosis was based on the clinical symptoms, the anaemia, the basophilic stippling of erythrocytes and the elevated blood lead level Upon further questioning, both patients reported the use of Ayurvedic medications. Toxicological analysis of the different pills revealed that, in both, the same orange-red pills contained a remarkably high amount of lead. Cases of lead poisoning associated with the use ofAyurvedic formulations are emerging around the world. However, to our knowledge, these are the first reported cases in Belgium.
*Corresponding author: Davy M.J. Kieffer, Laboratory Medicine, University Hospitals Leuven, Heres... more *Corresponding author: Davy M.J. Kieffer, Laboratory Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium, Phone: +32 16 34 25 59, Fax: +32 16 34 70 10, E-mail: davy.kieffer@uzleuven.be; and Department of Microbiology and Immunology, KU Leuven – University of Leuven, Leuven, Belgium Cornelis L. Harteveld: Hemoglobinopathies Laboratory, Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands Da Hae Lee and Pieter Gillard: Department of Clinical and Experimental Medicine, KU Leuven – University of Leuven, Leuven, Belgium; and University Hospitals Leuven, Endocrinology, Leuven, Belgium Toon Schiemsky: Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium. http://orcid.org/0000-0002-4409-3769 Koenraad J.O. Desmet: Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Leuven, Belgium; and Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium Letter to the Editor
Suspected hemoglobin (Hb) variants, detected during HbA1C measurements should be further investig... more Suspected hemoglobin (Hb) variants, detected during HbA1C measurements should be further investigated, determining the extent of the interference with each method. This is the first report of Hb Melusine and Hb Athens-Georgia in Caucasian Belgian patients. Intervention & Technique: Since common CE-HPLC methods for HbA1C analysis or Hb variant screening are apparently unable to detect these Hb variants, their presence might be underestimated. HbA1C analysis using CZE, however, alerted for their presence. Moreover, in case of Hb Melusine, even Hb variant screening using CZE was unsuccessful in its detection. Fortunately, carriage of Hb Melusine or Hb Athens-Georgia variants has no clinical implications and, as shown in this report, no apparent difference in HbA1C should be expected.
We describe a 77-year-old cyclosporine-treated renal allograft recipient in whom falsely elevated... more We describe a 77-year-old cyclosporine-treated renal allograft recipient in whom falsely elevated whole blood cyclosporine concentrations were encountered using the antibody conjugated magnetic immunoassay (ACMIA) for therapeutic drug monitoring.
INTRODUCTION Femoral neck narrowing (NN) following Metal-on-Metal Hip Resurfacing Arthroplasty (M... more INTRODUCTION Femoral neck narrowing (NN) following Metal-on-Metal Hip Resurfacing Arthroplasty (MoMHRA) is a well-recognised clinical phenomenon. The incidence of resurfaced hips with NN > 10% is reported to be up to 27%. Its pathogenesis is thought to be multi-factorial secondary to stress shielding, impingement, osteolysis secondary to wear/ion particles and as a result of reduced vascularity and pressure effect on cancellous bone secondary to the presence of a soft-tissue mass around the resurfaced hip. Recognised risk factors for its development include: female gender and the presence of a pseudotumour. Serum Chromium (Cr) and Cobalt (Co) are recognised surrogate markers of in-vivo wear of MoMHRA. The aims of this study were to establish whether NN is associated with increased wear. METHODS A cohort of 214 patients with unilateral MoMHRA (139M: 75F) was included in this study. Primary osteoarthritis was the diagnosis leading to surgery for the majority of patients (208). The ...
Introduction: Hypoglycaemia has been reported as an unusual complication of tramadol use and in a... more Introduction: Hypoglycaemia has been reported as an unusual complication of tramadol use and in a few cases of tramadol poisoning, but the exact mechanism is not known. Case description: An ambulance crew was dispatched to an unconscious 46-year old man. A glucometer point-of-care measurement revealed a profound hypoglycaemia (1.9 mmol/L). Treatment with intravenous glucose was started and the patient was transported to the hospital. The patient had several episodes of pulseless electrical activity requiring cardiopulmonary resuscitation in the ambulance and upon arrival in the hospital. Despite continuous glucose infusion the hypoglycaemia was difficult to correct during the next few hours and the patient developed hypokalaemia. Further investigation to identify the cause of hypoglycaemia revealed that insulin and C-peptide were inappropriately raised. A toxicological investigation revealed the presence of tramadol and its metabolites in lethal concentrations. Also acetaminophen, i...
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