Evaluation of Methaemalbumin in Acute Pancreatitis

Abstract

Methaemalbumin (MHA) was measured in 62 patients with acute pancreatitis. In 26 MHA-positive patients the occurrence of renal and pulmonary complications was 65% and 58%, respectively, compared with 3% and 6% in 36 MHA-negative patients. Fatality rate was 54% in MHA-positive and 6% in MHA-negative patients. In 17 MHA-positive cases haemorrhagic pancreatitis was proven at laparotomy or postmortem examination. Thus MHA determination proved to be a valuable diagnostic and prognostic parameter in acute pancreatitis.

Assessment of Severity in Acute Pancreatitis: Use of Prognostic Factors

“…Since the description by Ranson et al [2] of the 11 prognostic factors, several studies have been carried out to modify and improve the accuracy of these scoring systems [3][4][5]. Other studies have attempted to evaluate the value of a single factor such as plasma fibrinogen level [7], total compliment activity [12], hypocalcemia [9] and serum methemalbumin [13] estimation to identify severe pancreatitis. Subsequent studies have failed to confirm the value of some of these factors in predicting severity [7,14].…”

Protection against Heme Toxicity: Hemopexin Rules, OK?

“…49 Moreover, the presence of methemalbumin that occurs when HPX is depleted is significantly is associated with increased morbidity in clinical sepsis 14 and in patients with acute pancreatitis. 170 In this latter study, more than ~60% of patients had renal and pulmonary complication when methemalbumin was detected in plasma compared with ~5% that lacked detectable methemalbumin. Significantly, the fatality rate was 54% and 6% in these two groups.…”

“…170 The low free heme and iron levels in plasma and other biological fluids, due in part to HPX, Hp, and transferrin, collectively provide individual signals that stimulate the production of a variety of metal sequestering systems by human pathogens. These systems have been well characterized in both Gram-negative and Gram-positive bacteria (Fournier et al 136 and references therein).…”

“…A similar situation has been documented in SCD, 171 in hemorrhagic shock, 49 and in acute pancreatitis. 170 The roles of two other heme-binding proteins on heme clearance, for example, lipocalin (α-1 acid microglobulin, present at 1-2 µM in plasma but likely more important extracellularly [addreview]) and the α-1 proteinase inhibitor, 69 both of which bind heme with affinity similar to the tight binding site on human serum albumin in human diseases, remain to be fully defined. The respective K d s are 10 −6 M and 2 × 10 −8 M with a K d of 6.93 × 10 −6 M for albumin.…”

Acute Pancreatitis

“…α 2 Microglobulin, α 1 antitrypsin, and methemalbumin have been extensively investigated but have not been found to confer any additional benefit over clinical assessment or multiple scoring systems. 38,39 More recently, PMN elastase, an acute phase reactant released by granulocytes during inflammatory processes, has been explored for its potential to identify those patients at risk of developing severe pancreatitis. It has shown the most promise in this regard with sensitivity and specificity in the range of 82-93% and 82-99%, respectively when measured 24 hours after the onset of the disease.…”