Posted on Authorea 30 Dec 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160936528.80879431/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. Buysschaert Collot Julia Polystyrene Kayexalate Sodium Sodium receiving ( patient sulfonate hemodialysis a in ulcer Rectal etlucri eoilssptetrciigSdu oytrn ufnt (Kayexalate sulfonate Polystyrene Sodium receiving patient hemodialysis a in ulcer Rectal who pathologist, page the Title to given material biopsy the follow should Kayexalate history for medication look and will data Clinical therapy. this prescribing Kayexalate Abstract 2020 30, December 3 2 1 ehooyadDayi lnc,Cnr optle einld u u Belgium , M Huy Mesquita , Huy de Regional Hospitalier [email protected] Centre , Clinic Dialysis and Nephrology B Belgium Buysschaert , Huy , Huy de albino.fl[email protected] Regional Hospitalier ,Centre Gastroenterology of Department A Floriani Li`ege,[email protected] Belgium Universitaire, Hospitalier Centre Pathology, of Department CHU- Rickaert Universitaire, Fabienne Hospitalier Centre Department [email protected] Medicine Internal , Belgium Brussels, Clinic Brugmann, Dialysis and Nephrology Belgium , Tayeb Huy Salaouatchi , Huy de Regional Hospitalier [email protected] Centre , Clinic Dialysis and Nephrology J Collot H eLi`ege Horta de Victor CHU Site - Brugmann Huy CHU de Regional Hospitalier Centre ¹ . ® ¹ . ² sascae ihgsritsia nuyta a eftl hscasms eaaeo h des vnswhen events adverse the of aware be must Physicians fatal. be can that injury gastrointestinal with associated is 1 1 ¹ oamdSalaouatchi Mohammed , ai Mesquita Maria , ³ ² ® rsas ahlgssadpyiin hudwr adi hand. in hand work should physicians and Pathologists crystals. > > 2 n rcGodon Eric and , 2 aineRickaert Fabienne , ® ) 1 1 3 lioFloriani Albino , 1 Benoit , ® ) Posted on Authorea 30 Dec 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160936528.80879431/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. o hoi yeklma hsptethdas eea pe Ibednspoal u oNAD uo- auto NSAIDs Kayexalate to Sodium due with probably treated bleedings patient GI HD upper a several in also rectum had the patient medication. of SPS This develop ulcer hyperkalemia. circumferential to chronic of susceptible or for case more kidney a are as report patients We These such state. comorbidities (3). postoperative immunosup- injuries with the or GI patients in corticosteroids induced patients with in treated and abdomen chronically dramatically drugs acute transplantation pressive increases with organ with perforation complications patients to lower disease, these bleeding and vascular of GI upper mild the risk from both The range in and occur use, to SPS shown adverse with been (GI) (2). have gastrointestinal association serious sequelae, in with lethal tract associated sometimes be GI may with hyperkalemia effects, of which treatment Side insufficiency the events. in adrenal SPS and of hemolysis use account. The acidosis, into , taken such and glycaemia be insufficiency inhibitors , to renal (ACE) also (ARBs) than have enzyme Blockers other Angiotensin-converting Receptor factors (NSAIDs), II other Angiotensin drugs many ion- anti-inflammatory by an Nonsteroidal with influenced as treatment is require and concentration Kayexalate therapy HD (Sodium plasmatic dietary receiving (SPS) Potassium with sulfonate anuria hyperkalemia polystyrene or from sodium oliguria as death such avoid with resin to patients exchange the possible some In However, is (1). it HD. (HD) HD, adequate hemodialysis receiving maintenance patients undergoing patients of all in majority to arrhythmia fatal available cause be may Hyperkalemia should drugs New hand. in Introduction hand work hyperkaliemia. should treat clinicians to patients and Pathologists important. is Kayexalate Sodium message Clinical Key Kayexalate Kayexalate hand. for Words in look Key hand will work who should pathologist, physicians history the and medication to Pathologists given and material data biopsy Clinical therapy. the this follow prescribing should when events adverse the of aware Kayexalate Sodium Abstract [email protected] Mesquita Maria author Corresponding Belgium , Huy [email protected] , Huy de Regional Hospitalier Centre E CHU- Godon Universitaire, Hospitalier Centre chu-brugmann.be , mesquita@ maria. Department Medicine Internal Belgium , Brussels, Clinic Brugmann, Dialysis and Nephrology ¹ . ® yeklei,Hmdayi,Rca le,Sdu oytrn ufnt (Sodium Sulfonate Polystyrene Sodium ulcer, Rectal Hemodialysis, Hyperkaliemia, aeaaecrystals. Kayexalate , ) ® ® sascae ihgsritsia nuyta a eftl hscasms be must Physicians fatal. be can that injury gastrointestinal with associated is a as eeeG ein.Dansso aeaaecytl nG ipysamples biopsy GI in crystals Kayexalate of Diagnosis lesions. GI severe cause can : 2 ® opeethyperkalemia. prevent to ) ® crystals. ® Posted on Authorea 30 Dec 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160936528.80879431/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. n ersshsas enrpre 1) etlucr n etlseoi a ecue yfrinbody foreign by caused be can stenosis rectal and ulcers Rectal ischemia (19). Intestinal patients(18). reported some in been diagnosed also be has can ulcer necrosis emergency. colonic clinical and simple a a early, as diagnosed present if inflam- Probably, may post which and complications perforation wall serious including the 17). ulceration among mucosal (11- authors are SPS, of formation 10). some effects stricture However, - side matory (8 (7). common drug the disease to this to kidney addition of In chronic helped safety patients it and in effectiveness (6).Moreover, hyperkalemia the diarrhea about of or doubt management constipation, term to vomiting, levels long nausea, the for blood stomach, maintain potassium to upset her prescribed appetite, reduce was of SPS levels loss and as (blood ESRD hyperkaliemia of persistent setting Kayexalate the had and in patient hyperkaliemia medication levels uncontrolled Our auto blood complications of arrhythmias. GI NSAIDs potassium because related of cardiac prescribed SPS because develop fatal was /L) to drug of risk this high risk Nevertheless, at drugs the ESRD. was immunosuppressive stage had patient end or and our she corticosteroids chronic Hence, are because with use (3). treated SPS status. with patients common post-operative associated transplantation a injury and GI organ is to solid It contribute or that disease, impaction. factors or orally fecal renal risk prevent the administrated acute that to (5). known be mild Sorbitol patients is can It with treat hemodialysis It associated and to sometimes stool. ESRD used is in in it commonly prescribed potassium and drug resin of enema binding an excretion as potassium the locally increasing a by is hyperkaliemia (SPS) chronic sulfonate (4). patients. polystyrene failure (TaxolSodium renal paclitaxel pills, in iron used NSAIDs, sevelamer including pays drugs and medical (SPS) she of types NSAIDs, several (Cellcept no of more Mofetil target Mycophenolate has any the patient is take tract the GI not months The 6 does Since she binder. week, potassium observed. a a was Discussion anymore bleeding thrice digestive require HD no not on and does complaints is and resin GI diet patient medication her other the to any being, attention take time not hyperkaliemia. the did non-controlled For she of Kayexalate that because sequestrants. noted time duct some be bile for to continued or a is sevelamer with It as ulceration records. such mucosal medication colon and and history Kayexalate 2) clinical of Fig diagnosis ( the epithelium So, 3). surface (Fig basophilic the rectangular exudate. and to the ulcerations in adherent mucosal crystal scales” rectal third “fish showed lower like biopsies the rectal crystals in the of ulcer examination circumferential Histological a 1). pump revealed (Fig rectoscopy proton rectum the with the and successfully of hematochezia time hemorrhagic presented every large consumption. patient a treated NSAIDs on The ulcer to First, antral bleedings. linked GI serpiginous were (ESRD). upper a ulcers disease of (PPI).These on renal episodes stage inhibitor two second end of and of history hy- ulcer setting a mellitus, for the duodenal known in diabetes also NSAIDs was 2 abuse patient chronic by type The to treated of attributed was was history which (COPD), a /L) disease mmol with Kayexalate6 pulmonary (HD) (Sodium obstructive sulfate hemodialysis chronic polystyrene maintenance sodium and on cardiomyopathy women ischemic old pertension, year 69 A Report Case ® a eltlrtdadteptetddnthv h omnsd ffcso hsdu such drug this of effects side common the have not did patient the and tolerated well was < 6mmol/L. ® ® nue etlijr a aeo h ai fmcocpcfaue,her features, microscopic of basis the on made was injury rectal induced - ,bshshnts ociieadoa eissc splsyeesulfonate polystyrene as such resins oral and colchicine bisphosphonates, ), < mo/.Suishv hw h oeaiiyadecc fSPS of efficacy and tolerability the shown have Studies 6mmol/L. ® o ercoyhpraima(oasu lo levels blood (potassium hyperkaliemia refractory a for ) 3 ® oe eefis eue,hwvri a obe to had it however reduced, first were doses > 6mmol ® > ), Posted on Authorea 30 Dec 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160936528.80879431/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. itnus hm cdfs ailsseilsani h otrlal nilr ol tsan aeaaein Kayexalate stains it tool; to ancillary required reliable are most tools the ancillary can is pattern Sometimes stain scale challenge. special fish a and bacillus identification location Acid-fast proper color, (28). them. making but scales distinguish resins, norm, fish the the has identifying from for also deviate benchmark it the edges; to is yellow similar morphology and purple Classic appear center shape, that pink in demarcations with internal rectangular H&E, (Renvela or is Selvelamer on scales” Kayexalate fish. toned “fish follows: a cases has of as and the surface is (H&E) external of crystals staining 75% these eosin the in hematoxylin- diagnose is on roughly to damage pathologist morphology mucosal the classic resin by The of reported resin feature was co- distinctive in ischemic this The seen However, disease, chela- colitis. (28). Lesions bowel crystals. that microscopic injury. inflammatory resin kayexalate as in mucosal of well and seen identification with as sevelamer those colitis associated with are infectious are overlap patients litis, may Both yet renal damage respectively. not in gastro-intestinal are potassium induced (25-27). utilized they , and hyperkaliemia but resins Veltassa) of phosphate SPS, ( causes medication te of all patiromer common that of and most treatment with (ZS-9) the The compared however cyclosilicate for potassium hyperkalemia, and zirconium for countries of sodium selectivity all treatment , binding in available agents the greater binding have for to - prescribed appear potassium commonly new is two (SPS) , sulfonate 24). ( adverse polystyrene GI non-users serious Sodium patients with for in hospitalizations compared of evident users incidence was higher SPS more showed among use SPS were events initiating SPS adults associations older addition, in These In study therapy. Another dispensations. (23). SPS dosages. laxative SPS initiating of increase intes- label patients dependent rate of per CKD dose higher endpoint prescribed a for a combined observed events the with They adverse frequently of use. associated GI product is risk SPS the serious relative for SPS on of increased ulceration/perforation that specified incidence an or than showed observed dosages thrombosis (SRR) lower ischemia, they Registry at tinal non-use, and Renal with chronically Swedish Compared CKD/ESKD the advanced label. with on popu- persons different based by in study used varies cohort sorbitol) prescribed. retrospective without dose or A the (with to SPS according to and arrhythmias. related studies cardiac moment. injuries lation fatal the gastrointestinal to for of Sometimes lead drug incidence complications. Kayexalate could alternating The fatal Sodium that of as hyperkaliemia further ( lack non-controlled avoid soon SPS of of to As free because because order sorbitol complications. drug doses a in life-threatening this had stopped its prescribing patient be continue of Our aware to should obliged drug be use are the should routinely clinicians done sorbitol who is without Physicians not diagnosis mortality. or is the and sorbitol patients easily dialysis morbidity in recognized, and significant agent under CKD an this with in remains associated ischemia SPS intestinal complication, free SPS-induced Nevertheless, avoidable sorbitol low. of very seems because but injuries known tract gastro-intestinal estimated of been Incidence been leading has has , injury (19)(22). intestinal component sorbitol 1.8% SPS-mediated sorbitol in of to the SPS incidence 0.27% by the sorbitol. as mediated and use in mortality primarily and SPS the necrosis, morbidity of intestinal to significant to administration of related development the complication the with a in biopsy. damage rectum, implicated the colonic the of describe examination of authors histopathological third Some the lower at the drug. shown in this as ulcer of SPS circumferential because of a injured ulcers, had rectal be and patient also colonic can Our intestinal, tract only gastrointestinal not upper induce the can (22). resin that (11) this but that perforations shows and literature necrosis the of review fact, In (21). (20) crystals SPS to reaction ® n Renagel and 4 ® n ecniudti rgpeciiglower prescribing drug this continued we and ) ® sas etnua nsaeaduuly2- usually and shape in rectangular also is ) Posted on Authorea 30 Dec 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160936528.80879431/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. mgs A BadG eie h aucit l uhr aera n prvdtefia eso fthe of version final the the obtained approved and and read content References have pathology authors the All wrote manuscript. the RF paper. revised manuscript, revised GE the and writing BB FA, in images. contributed also and articles contributions: Author’s consent Patient approval Ethical Acknowledgements pathologist serious support and more resins, Financial clinicians of medication interest avoidance Hence of of saving. and conflict presentations – medication and life of atypical Disclosures cease be and hand. the can typical in to diagnosis hand the lead timely work of should can and aware clinician Recognition be patients. the outcomes. in adverse to to tract feedback pathologists GI early the for show because of should critical protection studies controlled is the randomized in It Moreover, drugs countries. new all these in armamentarium available of yet advantage new not the the are are drugs cyclosilicate ESRD new zirconium / SPS. These sodium CKD prescribing observation and when Our in patiromer a events hyperkaliemia drug. binders: adverse this exposing of potassium these of management be of of effects is the may risk side it in medication patients, lethal the treatments fragile this possible of Alternative to aware as of given much be often use as must is spread reduce the physicians it As to wide that Although patients. cautiously re-evaluated. suggests the risk it be high high, use to in be to especially needs important risks, not SPS potential may of to patient role population large individual therapeutic the an complications, to GI risk of severity consumption. the NSAIDs Given again to once due search be in could duodenal samples ulcers and Conclusions biopsy GI antral duodenal upper presented and these patient gastric that our the suggested in was ESRD, look Hence, of second outcomes. because kayexalate a adverse for treatment took serious dialysis pathologist more for Our of ulcers. taken avoidance was and hand. she in medication Before hand to of work feedback cease should early the pathologist because pathologists, to and important, For the clinicians is lead (3)(29). tissue and appearance. can gastrointestinal scale” necrosis clinician necrotic “fish ulceration, the medication in a mucosal crystals of with kayexalate include crystals presentations the retractile necrosis atypical identifying basophilic and SPS-induced polygonal typical in of patient the findings presence the of histopathologic by aware typical taken be The medication to the pathologists about for clinician critical (28). the resins is with It Discussion useful. magenta. is in Sevelamer and black NzoA,SarCnkr,MiltM,Meabn .Gsrdoea nuyidcdb orally by induced injury tract gastrointestinal Gastroduodenal the M´egarbane in B. injury sodium with , Drug-induced events adverse M C. Gastrointestinal . N Maillet M C.Panarelli C Bell , 4. J, Perl Shaar-Chneker R, , Wald A , Nuzzo P.S Shah 3. , S Harel , Z Harel 2. A.A Yusuf 1. gy diitrdsdu oytrn sulfonate polystyrene sodium administered review. systematic a use: (Kayexalate) sulfonate polystyrene Study. Cohort Retrospective A Patients: Hemodialysis oue3,Ise2 04 165-175 2014, 2, Issue 31, Volume ® , nomdcnetwsotie rmteptetfrtepbiaino hscs report. case this of publication the for patient the from obtained was consent Informed : o applicable not : rsasbtfudnn.Ti ol eaflengtv eutlne obos apig It sampling. biopsy to linked result negative false a be could This none. found but crystals uY ig .Mny ..WtoeJB eu oasu eesadMraiyin Mortality and Levels Potassium Serum J.B. Wetmore J.A. Menoyo B. Singh Y, Hu none : h uhr hn h eoilssnrigteam. nursing hemodialysis the thank authors the : JadM aepiaydsge n rfe h ae.Trvee h related the reviewed paper.ST the drafted and designed primary have MM and CJ none : lnTxcl(Phila) Toxicol Clin 5 mJNephrol J Am mJMed J Am 21;57(1):75-76. .2019; eiasi igotcPatholo- Diagnostic in Seminars 2016;44:179-186 0316(3):264.e9-24. 2013;126 . Posted on Authorea 30 Dec 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160936528.80879431/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. Ne . oaSE,Ptcc ag. arr . ae agiN,ClarkE.G , N of Tangri Management Clinical , the C.J for Meaney Z Agents , Harel Potassium-Binding M.V , Beccari M.B. Bridgeman 26. J.J P Carrero D, Barany Dixit , , GargA.X M.M M, Chaitman Sood , 25. , W R Petrcich Bellocco , , I S.E Bota Mariani , , J.A L Noel Schalin , 24. M Trevisan , due ulcer Y Rectal C. Xu Santos sodium , of , result Lu´ıs a P P.P as Laureati patients , uremic 23. in R.S tract gastrointestinal Almeida the of , Necrosis A.V S;R. Hamilton , cau- , stenosis N A .Rectal Craveiro Rashid , H 22. Sevestre F Pedro J-M, , Regimbeau A.A Oliveira YzetnT, 21. D, polystyrene sodium Manaouil to due M, necrosis Brevet Intestinal SF. Moss , B, M Resnick D Chatelain G, Chu , 20. S ulcer Saha colonic Kayexalate-induced , calcium L Weber of E C administration McGowan following , necrosis 19. V mucosal Gaur Colonic in S.R. kayexalate , Han oral M N.H, receiving Albeldawi Kim patient young 18. WK, a Bae in , necrosis Colonic M. M-S. Joo following Hsieh a 17. perforation administration: kayexalate colon H-Y, after Wang and perforation , Ileum colon Y-H T-W. for Chou colectomy Kao Total 16. , Martinez Ryan T-L , H Mao sulfonate R , polystyrene Dunlap W-C sodium 15. Chiang with associated , perforation Y-C Colonic Tsai , P. C-C Taourel Kao J, injury 14. Ramos tract gastrointestinal Upper , L . Wu Piron T 13. T Rashid, A Lee, Dardik A T 12. L Cessford Bhagavan, S , B S Au-Yeung , C Mui S Hin Abraham , 11. Lin Jane , J Batterink 10. Mln .Tkn eodLo tKayexalate. at Look Second a S Taking Chennupati J. D P, Malone Bernstein 9. M, Rojas , A. R Sterns Kyriakou 8. , I Liampas , J I Doiron Panagiotis , 7. A-C Dufour , L Lepage Yoshihara M. 6. , M Miyazono , T Fujisaki T, Nakamura 5. Hyperkalemia Age Advanced of Patients (8):1025-1033. in 10;179 Use 2019 Sulfonate . Polystyrene Sodium With Associated study. nationwide a disease: kidney chronic advanced Transplant in events adverse gastrointestinal Sj , condition. 60-9. recognized : under an 21(1) sorbitol: in (Kayexalate) sulfonate polystyrene . case unusual an - deposition (Kayexalate). Kayexalate crystals to sulfonate polystyrene sodium to reaction thol body foreign by sed sorbitol. in (Kayexalate) sulfonate (3):235-6. 2 patient. uremic a in (Kalimate) sulfonate polystryrene review. J literature Reports and Case report . case complication sorbitol: rare a of review literature and report case sulfonate. polystyrene calcium high-dose and Assoc peritonitis dialysis-related peritoneal use. (Kayexalate) Kayexalate-sorbitol and by endoscopic, induced clinical, necrosis sorbitol: in sulfonate) polystyrene (sodium findings. kayexalate histopathologic receiving patients in Hyperkalemia. of Treatment Short-Term for Sulfonate effective? and safe they are lemia: disease kidney chronic with Nephrol patients Urol in hyperkalemia Int of management long-term for , sulfonate polystyrene CKD in Hyperkalemia Mild of Treatment the for Hemodialysis. Maintenance on Patients in Hyperkalemia for Sulfonate oed odMMRs fHsiaiainfrSrosAvreGsritsia Events Gastrointestinal Adverse Serious for Hospitalization of Risk M.M Sood , P Komenda , 2007;11(3):217-9. lne vn arr..Iiito fsdu oytrn upoaeadters of risk the and sulphonate polystyrene sodium of Initiation CarrerJ.J. , M Evans , A ¨ olander 05;114(10):1008-10. 2015 . A osne C fo ,ABru ,Hrio G ct boe ihcolonic with abdomen Acute MG. Harrison A, Barbul A G, Efron G RC, Moesinger , 09;1-9 ; 2019 . &T P& 07Dc 49(12):2217-2221 Dec; 2017 ig nevImaging Interv Diagn 06,4 (1):43-50. 41 , 2016 . mJSr Pathol Surg J Am . lncluiiyo aioe,sdu icnu ylslct,adsodium and cyclosilicate, zirconium sodium patiromer, of utility Clinical . mScNephrol Soc Am J ot e J Med South tal et ot e J Med South 08 99(7-8):507-509 2018; . Rnoie lnclTilo oimPlsyeeSulfonate Polystyrene Sodium of Trial Clinical .Randomized tal. et ahin e Sci Med J Kaohsiung 01My 25(5):637-44 May; 2001 . e so e Bras Med Assoc Rev 6 09;12(5):493-7. 102 ; 2009 . vlaino h oeaiiyadecc fsodium of efficacy and tolerability the of Evaluation Ion- . opPharm Hosp lnJA o Nephrol Soc Am J Clin 00;93(5):511-3 2000 . 21 21(5):733-5 ; .2010 a opPharm Hosp J Can tal. et oenMdSi. Sci Med Korean J xhnersn o h ramn fhyperka- of treatment the for resins exchange ik n eet fSdu Polystyrene Sodium of Benefits and Risks . 05;50(11):959-60 2015 . ffcieeso oimPolystyrene Sodium of Effectiveness 01 27(4):155-8. 2011; . 08;6 (8):680-683. 64 ; 2018 rg D R Drugs atoneo e (Oxf) Rep Gastroenterol ugCs Rep Case Surg 05 68(4):296-303. 2015; . 09;24(6):1207-1. ; 2009 051 (12):2136-42. 2015;10 . mJSr Pathol Surg J Am 2018;18(3):231-235.. . . AAItr Med Intern JAMA n ig Pa- Diagn Ann omsMed Formos J 06:10;1-3 2016 . eho Dial Nephrol 04; 2014 . 1997; . Posted on Authorea 30 Dec 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160936528.80879431/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. Legends Gnae .,Lgn .,SeoO rodCACalne nDansn eiainRsn nSur- in Resins J.M.A Medication Bogaerts Diagnosing in 29. Challenges C.A Arnold O, Szeto S.M, Lagana R.S, Gonzalez 28. C.J Meaney 27. • • • mg 0 oo uoa leainwt rsa nteexudate the in crystal a with morphology ulceration scales mucosal fish colon rectum typical : the with 003 of crystal Image third basophilic lower refractile the 002: in Image ulcer circumferential 001: Image necrosis. intestinal of cause under-recognized an crystals: Guide. Review Hyperkalemia. Crystal-Clear 1282. of A Treatment Specimens: Pathology the gical for Armamentarium New A Cyclosilicate: Pharmacotherapy Zirconium Sodium and review. evidence-based an hyperkalemia: of treatment 23;12:11-24. the 2017 for sulfonate polystyrene : , ecr . ag hoJ ytmtcRve n eaAayi fPatiromer of Meta-Analysis and Review Systematic J. Zhao , YangY , M.V Beccari , a e ovnJG,At .. a e okB rsn A.Fs scale Fish . LA Brosens , BM Kolk der Van , E.E.A Arts , J.G Hoeven der Van 07;37(4):401-411. ; 2017 7 lnPathol Clin J rhPto a Med Lab Pathol Arch 09;72(8):567 2019 . 07;141(9):1276- 2017 . oeEvidence Core . Posted on Authorea 30 Dec 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.160936528.80879431/v1 — This a preprint and has not been peer reviewed. Data may be preliminary. 8