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(Stroke. 2007;38:e86.)
© 2007 American Heart Association, Inc.

Letters to the Editor

Should Spectrophotometry Be Used to Identify Xanthochromia in the Cerebrospinal Fluid of Alert Patients Suspected of Having Subarachnoid Hemorrhage?

Robert Beetham, PhD, FRCPath

Department of Clinical Biochemistry, North Bristol NHS Trust, Frenchay Hospital, Bristol, UK

Samden Lhatoo, MD

Department of Neurology, North Bristol NHS Trust, Frenchay Hospital, Bristol, UK

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

We read with interest the article by Perry and colleagues.¹ There appears to be a reluctance in North America to embrace what we believe to be the most sensitive method for demonstrating bilirubin in cerebrospinal fluid (CSF), spectrophotometry, on the basis that it is not requested, that the equipment does not exist and that it is difficult to interpret.^1,2 It is then somewhat disingenuous to criticize spectrophotometry by using 4 methods, the first of which (‘traditional’) has many deficiencies which have been well documented^3,4; the second of which (‘Chalmers and Kiley’)⁵ has been superseded by the third (‘Chalmers revised’)⁶; this in turn has been incorporated into the fourth method (‘UK NEQAS’) which provides the most up-to-date and evidence-based approach.⁷ As the authors quote a summary of this article in another journal and not the original, it appears as though they have not read and studied the full method and recommendations. Moreover, the authors admit that they have not performed scanning spectrophotometry, substituting the measurement at 4 wavelengths instead, which does not produce correct results. Because the basic method of calculating the key measure, the net bilirubin absorbance at 476 nm, is identical in methods 3 and 4, it is surprising that in the authors’ hands the revised Chalmers method gave poor agreement between fresh and frozen CSF but the UK NEQAS method gave good agreement. This suggests that use of frozen samples further compromises the validity of the study.

It has been previously demonstrated that . . . [Full Text of this Article]

Related Article:

Response to Letter by Beetham and Lhatoo

Jeffrey J. Perry and Marco L.A. Sivilotti
Stroke 2007 38: e87. [Extract] [Full Text] [PDF]