Role of serum lactic dehydrogenase, glutamic oxaloacetic transaminase, creatine phosphokinase, alkaline phospatase, serum phosphorus in the cases of bowel ischemia in acute abdomen

Background: Bowel ischemia is a life-threatening condition which may arise from a number of causes affecting the arterial and venous compartments of the mesenteric circulation. The rapid onset of acute mesenteric ischemia and the potential rapidity with which bowel infarction may occur explain the lethality of this disease. The aim of this study was to evaluate the role of serum lactic dehydrogenase (LDH), glutamic oxaloacetic transaminase (SGOT), creatine phosphokinase (CPK), alkaline phospatase, serum phosphorus in the cases of bowel ischemia in acute abdomen.Methods: Above mentioned serum enzymes were measured preoperatively in the fifty patients of acute abdomen. Biomarker levels were compared in patients between equal two groups on the basis intra operative findings of bowel ischemia and non-bowel ischemia.Results: Preoperative estimated serum levels of all described enzymes found to be significantly elevated in patients of group A (with bowel ischemia) in comparison with group B (with no bowel ischemia). Sensitivity and specificity for elevated levels of S. LDH were 88% and 68%, for SGOT 68% and 80%, for S. ALP 72% and 68%, for S. CPK-MB 76% and 84%, and for S. phosphorus 76% and 68% respectively.Conclusions: Preoperative estimated serum levels of all described enzymes found to be significantly elevated in patients of group A (with bowel ischemia) in comparison with group B (with no bowel ischemia). Sensitivity and specificity for elevated levels of S. LDH were 88% and 68%, for SGOT 68% and 80%, for S. ALP 72% and 68%, for S. CPK-MB 76% and 84%, and for S. phosphorus 76% and 68% respectively.

Vitamin B12 Deficiency and Hemoglobin H Disease Early Misdiagnosed as Thrombotic Thrombocytopenic Purpura: A Series of Unfortunate Events

We herein would like to report an interesting case of a patient who presented with anemia and thrombocytopenia combined with high serum Lactic Dehydrogenase where Thrombotic Thrombocytopenic Purpura was originally considered. As indicated a central venous catheter was inserted in his subclavian vein which led to mediastinal hematoma and finally intubation and Intensive Care Unit (ICU) hospitalization. After further examination patient was finally diagnosed with B12 deficiency in a setting of H hemoglobinopathy. There have been previous reports where pernicious anemia was originally diagnosed and treated as Thrombotic Thrombocytopenic Purpura but there has been none to our knowledge that was implicated with hemothorax and ICU hospitalization or correlated with thalassemia and we discuss the significance of accurate diagnosis in order to avoid adverse reactions and therapy implications.