Download presentation
Presentation is loading. Please wait.
Published byAmber Ferguson Modified over 8 years ago
1
1 CALIBRATING THE SYSTEMIC EFFECTS OF INFECTION WITH LABORATORY INVESTIGATIONS Pakistan November 2015
2
2 Greater accuracy in establishment of: Diagnosis of infection Duration of therapy Safety for implantation of prostheses Assessment and classification for clinical trials Establish prognosis in Medico-legal disputes OBJECTIVES
3
3 RBC turnover Iron retention in RES Iron, ferritin Hypochromia, microcytosis Anisocytosis, anisochromia, basophilia ANAEMIA OF CHRONIC INFECTION Pathogenesis
4
4 Malabsorbtion of dietary iron Protein (transferrin-carrier) Renal haemopoietin Marrow activity Result – fewer smaller, paler, red blood cells ANAEMIA OF CHRONIC INFECTION Pathogenisis
5
5 Most often no change Neutrophil leucocytosis Lymphocytosis Thrombocytosis Toxic granulation Shift to left WHITE CELLS IN CHRONIC BONE INFECTION
6
6 C-reactive protein Sedimentation rate Plasma viscosity Mucoproteins Rouleaux formation Transferrin (iron carrier) PROTEIN DISTURBANCE IN CHRONIC INFECTION
7
7 INTERPRETATION OF PROCALCITONIN (PCT) TEST RESULTS S-PCT (ng/ml)INTERPRETATION < 0.5Systemic bacterial infection unlikely 0.5 – 2Local infection possible. Severe sepsis or septic shock unlikely. 2 – 10Systemic (bacterial or fungal) infection likely. 10Severe bacterial infection with systemic inflammation probable (sepsis with organ failure and possible shock). NOTE: PCT HAS A HALF-LIFE OF 24 HOURS PCT DETECTABLE WITHIN 6 HOURS OF ONSET.
8
8 1191 Patients studied and followed as severity of infection eventually subsided or continued to fluctuate
9
9 GRADES OF INFECTION ACUTE Grade - 1 Fulminating 2 Subacute 3 Insidious onset 6/3 Acute on chronic 7/3 exacerbation
10
10 GRADES OF INFECTION CHRONIC Grade - 4 Overwhelming 5 Inflammation 6 Diffuse 7 Localised 8 Not Infected
11
11 GRADE 4 – OVERWHELMING Large necrotic lesions Copious pus (> 10 ml/day) Systemic toxaemia Impaired immunity Cahexia protein deficit Poor containment (scarring) Procalcitonin elevated X-RayBone destruction > sclerosis and callus formation
12
12 GRADE 5 – EXTENSIVE + INFLAMMATION Extensive lesion with oedema Cellulitis and adenopathy Possible low-grade pyrexia Lesion moderately contained Moderate purulence (> 5 ml/day) X-RayFlorid periosteal reaction
13
13 GRADE 6 – EXTENSIVE NOT INFLAMED Extensive lesion (whole bone) No pyrexia Area warm and indurated maybe sinus mild purulence (>2 ml/day) Lesion well contained by scar tissue X-Ray Membranous periosteal reaction
14
14 GRADE 7 – LOCALISED LESION Local Warmth No induration Pinhole sinus at times Spot of discharge Lesion very well contained X-Ray Sclerotic border - normal bone beyond No clear periosteal reaction: fuzzy surface
15
15 GRADE 8 - NOT INFECTED Non infective inflammatory disease Haematoma, Aseptic loosening Tumours, Reflex Sympathetic Dystrophy
16
16
17
17
18
18
19
19
20
20
21
21
22
22
23
23 SERUM FERRITIN : IRON RATIO Grade 453.1 523.8 614.5 7 7.1 8 5.627% Variation
24
24 Grade1 2 3 4 5 6 7 RBC± - - ± - - HB - - ± - PCV - - ± - MCV ± - - ± - MCH ± - - ± - MCHC - - - ± - - RED BLOOD CORPUSCLES
25
25 Grade 1 2 3 4 5 6 7 WBC ± ± - - NEUT ± ± - - LYMPH - - ± - - - TOX GRAN - - ± - - L SHIFT - - ± - - PLATELETS - - ± - - LEUCOCYTES
26
26 Grade 1 2 3 4 5 6 7 ABNORMAL ± - - ± - - ROULEAUX ± - - - SED. RATE ± ± - ABNORMALITIES OF RED CORPUSCLES
27
27 Grade 1 2 3 4 5 6 7 IRON ± - ± TRANSFERRIN - - - - - SATURATION - - - ± TRANSFERRIN - - - - - FERRITIN ± - IRON STUDIES
28
28 Haemoglobin Sedimentation Serum Iron Iron Saturation Ferritin Clinical History Signs & Symptoms X-RAY
29
SLIDING SCALE OF SYSTEMIC RESPONSES TO INCREASING INTENSITY OF SEPSIS No Infection Gr. 8 Grade 7 Grade 6 Grade 5 Grade 4 Ferritin:Iron ratio -------------------------------------------------------------------- Ferritin ------------------------------------------------------------------ Serum Iron --------------------------------------------------- Saturation --------------------------------------------------- CRP ----------------------------------------------------- ESR ------------------------------------------------- Mean Cell Volume ----------------------------- ` Mean Cell Haemoglobin ------------------------- Hematocrit ------------------------------------- Haemoglobin -------------------------------------- PCT 0.5 to 2 ------ PCT above 2 --- Leucocytes ----------------------- Platelets --------------------------- Red Cell Count -------------- Left Shift --------------------- Toxic Granulation ----------- Abnormal Red Cells -------- Transferrin --- MCHC --------
30
LABORATORY CRITERIA Activity tests Sedimentation Rate Plasma viscosity C-Reactive protein (ESR) Neutrophil leucocytosis Red cell morphology Anaemia Iron deficiency Blood ferritin increased 30
31
CLINICAL CRITERIA Pyrexia Exudate Inflammation Induration Oedema Lymphadenopathy Local warmth 31
32
RADIOLOGICAL CRITERIA Further bone destruction Sequestrum formation Periosteal reaction Fuzzy or layered – (onion) Increasing sclerosis Reconstitution of medulla Re-trabeculation Persistent sclerosis 32
33
EVALUATION OF DEGREE OF INFECTION 33 PointsClinicalLaboratoryRadiological 5Pyrexia Exudate Abnormal reds & whites PCT Transferrin MCHC Lymphocytosis New bone lysis New sequestrum Rough periosteum 4Inflammation Oedema Anaemia Neutrophilia Platelets Smooth periosteal Reaction 3Lymphadenopathy MCV MCH Plasma Viscosity No change or Medulla re-opened 2Local warmth Ferritin Iron CRP Sclerosis 1NothingFerritin:Iron Ratio Less than 7:1 Trabecula normal Negative Isotope
34
34 POINTS AWARDED POINTSGROUP 3-4Definitely no Infection 1 5-7Probably no Infection 2 8-10Equivocal3 11-13Probable infection4 14-15Definite infection5
Similar presentations
© 2024 SlidePlayer.com. Inc.
All rights reserved.