BLOOD SCIENCES
Respiratory: shortness of breath, hypoxia Cardiovascular: hypotension, weak pulse Renal: decreased urine output (<0.5 mL/kg/h) Skin: warm flushed skin (early stage), cold clammy skin (late stage) Gastro: nausea, vomiting.
In some cases, there may be symptoms related to a particular condition such as: cough in chest infection, pneumonia painful or frequent urination, in the case of a urinary tract infection redness, warmth, swelling, pain in cellulitis following a skin breach.
People most at risk are the very young, the elderly, patients on immunosuppressant drugs and neutropenic patients, though it must be stressed that sepsis can present at any age.
The National Institute for Health and
Care Excellence (NICE) advises suspecting sepsis if a patient has any of the following high-risk features:11 motled or ashen skin cyanosis (blue lips, tongue, or skin) a non-blanching petechial or purpuric rash any break in skin integrity.
Be aware, sepsis may present differently: in young children in the elderly during pregnancy in immunocompromised patients in patients with meningitis or septicaemia.
Diagnosis regime Delays in diagnosis will be critical and certainly life-threatening; therefore, prompt and accurate identification of sepsis is essential. In sepsis, diagnosis requires a comprehensive and systematic approach, integrating a detailed patient
Factors Normal range is consistent across different ages and genders
ESR CRP PV 7 3 3
Unaffected by physiological stimuli: lifestyle, smoking, weight, blood pressure 7 7 3 Anaemia and polycythaemia do not interfere with the result Testing can be performed on a sample up to seven days old Aspirin and steroids have no effect on the result
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Can be a diagnostic test for: multiple myeloma, hyperviscosity,
temporal arteritis and Waldenström’s macroglobulinaemia Reliable, repeatable and reproducible test results
Comparison of inflammatory markers ESR, CRP and PV.
history, careful clinical assessment, and prompt pathological investigations to ensure early recognition and immediate intervention. Established blood tests in suspected
sepsis are:12
Blood gas analysis including glucose and lactate Blood culture Inflammatory markers, white cell count, plasma viscosity (PV) or C- reactive protein (CRP) Urea and electrolytes Creatinine Liver function Lactate : albumin ratio13 Cloting screen.
Inflammatory markers Inflammatory markers are blood tests used by healthcare professionals to detect inflammation, which aid in the diagnosis and monitor the progression of many diseases including sepsis.14
with many factors to consider. The plasma viscosity test will have a considerably greater validity due to its superior accuracy and sensitivity when investigating sepsis compared with the CRP and the ESR tests.15 Plasma viscosity is acknowledged as a
superior marker of inflammation which truly reflects the changes in blood plasma proteins.
The
three most commonly used general inflammation markers to screen the wide range of diseases are CRP, erythrocyte sedimentation rate (ESR) and PV. The decision to commit to a particular test can therefore be an important one for clinicians and laboratory scientists,
The plasma viscosity gives a measure of the acute phase response, which will increase as part of the body’s natural response to infection, inflammation, and the severe autoimmune reaction caused by sepsis. The viscosity of plasma also changes more reliably and consistently in proportion to the concentration and molecular size of plasma proteins such as fibrinogen, immunoglobulins and paraproteins. Therefore, changes in plasma viscosity correlate directly with disease severity and the response to treatment, which is unequivocally displayed in a clear, numerical, easily interpreted result. The PV test has advantages in terms
of stability, direct measurement with no external factor interference.16-19 This makes it an exceptional choice in the detection of elevated proteins and abnormal paraproteins in sepsis.
The viscosity of plasma changes more
reliably and consistently in proportion to the concentration and molecular size of plasma
proteins such as fibrinogen, immunoglobulins and paraproteins. Therefore, changes in plasma
viscosity correlate directly with disease severity and the response to treatment
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Disseminated intravascular coagulation In sepsis the disseminated intravascular coagulation is an acquired condition marked by widespread clot formation in small blood vessels and capillaries, causing the depletion of fibrinogen, platelets and the other clotting factors. This imbalance will lead to both organ failure and severe bleeding and is a major contributor to morbidity and mortality in sepsis and other critical conditions.20 In sepsis-induced DIC, fibrinogen is initially elevated due to its role as an acute-phase reactant but then decreases as coagulation factors are consumed
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