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Sheerin S. Verifying the nonreporting hemolysis index for potassium, phosphate, magnesium, AST, LDH, iron, CA 19-9, and vitamin D, using Beckman Coulter AU5800 and DxI800 automated analyzers. Lab Med 2024:lmae027. [PMID: 38639324 DOI: 10.1093/labmed/lmae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Hemolysis is a common reason for nonreporting results in biochemistry and is measured using the hemolysis index (HI), with nonreporting limits set for analytes by manufacturers. OBJECTIVE To verify the nonreporting HI limit for potassium, phosphate, magnesium, aspartate aminotransferase (AST), lactate dehydrogenase (LDH), iron, CA19-9, and vitamin D on the Beckman Coulter AU5800/DxI800 analyzers. METHOD Hemolysate was created from EDTA-lined tubes of whole blood using an osmotic shock procedure. The hemolysate underwent serial dilutions with saline and was spiked in paired serum. The delta changes in HI and analyte concentration were measured, assessed using regression analysis, and compared against calculated reference change values. RESULTS A linear relationship between increasing HI and increasing analyte concentration (R2 > 0.9) was observed for potassium (y = 0.8864x), phosphate (y = 0.1079x), magnesium (y = 0.0678x), AST (y = 29.035x), and LDH (y = 350x). Increasing HI values did not have a linear effect on iron (y = -0.2544x), CA19-9 (y = 2.7019x), or vitamin D (y = 8.036x) concentrations. CONCLUSION The results from this experiment support increasing the HI nonreporting limit to 100 mg/dL for potassium; 200 mg/dL for magnesium; and 300 mg/dL for phosphate, CA19-9, and vitamin D. The iron assay is not affected by hemolysis as high as 500 mg/dL. The current HI nonreporting limit of 50 mg/dL is appropriate for LDH.
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Affiliation(s)
- Samuel Sheerin
- Department of Clinical Biochemistry, North Bristol NHS Trust-Southmead Hospital, Bristol, UK
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Zapletal B, Zimpfer D, Schlöglhofer T, Fritzer-Szekeres M, Szekeres T, Bernardi MH, Geilen J, Schultz MJ, Tschernko EM. Hemolysis Index Correlations with Plasma-Free Hemoglobin and Plasma Lactate Dehydrogenase in Critically Ill Patients under Extracorporeal Membrane Oxygenation or Mechanical Circulatory Support-A Single-Center Study. Diagnostics (Basel) 2024; 14:680. [PMID: 38611592 PMCID: PMC11011733 DOI: 10.3390/diagnostics14070680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
Monitoring for thrombosis and hemolysis is crucial for patients under extracorporeal or mechanical circulatory support, but it can be costly. We investigated correlations between hemolysis index (HI) and plasma-free hemoglobin (PFH) levels on one hand, and between the HI and plasma lactate dehydrogenase (LDH) levels on the other, in critically ill patients with and without extracorporeal or mechanical circulatory support. Additionally, we calculated the cost reductions if monitoring through HI were to replace monitoring through PFH or plasma LDH. In a single-center study, HI was compared with PFH and plasma LDH levels in blood samples taken for routine purposes in critically ill patients with and without extracorporeal or mechanical circulatory support. A cost analysis, restricted to direct costs associated with each measurement, was made for an average 10-bed ICU. This study included 147 patients: 56 patients with extracorporeal or mechanical circulatory support (450 measurements) and 91 patients without extracorporeal or mechanical circulatory support (562 measurements). The HI correlated well with PFH levels (r = 0.96; p < 0.01) and poorly with plasma LDH levels (r = 0.07; p < 0.01) in patients with extracorporeal or mechanical circulatory support. Similarly, HI correlated well with PFH levels (r = 0.97; p < 0.01) and poorly with plasma LDH levels (r = -0.04; p = 0.39) in patients without extracorporeal or mechanical circulatory support. ROC analyses demonstrated a strong performance of HI, with the curve indicating excellent discrimination in the whole cohort (area under the ROC of 0.969) as well as in patients under ECMO or mechanical circulatory support (area under the ROC of 0.988). Although the negative predictive value of HI for predicting PFH levels > 10 mg/dL was high, its positive predictive value was found to be poor at various cutoffs. A simple cost analysis showed substantial cost reduction if HI were to replace PFH or plasma LDH for hemolysis monitoring. In conclusion, in this cohort of critically ill patients with and without extracorporeal or mechanical circulatory support, HI correlated well with PFH levels, but poorly with plasma LDH levels. Given the high correlation and substantial cost reductions, a strategy utilizing HI may be preferable for monitoring for hemolysis compared to monitoring strategies based on PFH or plasma LDH. The PPV of HI, however, is unacceptably low to be used as a diagnostic test.
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Affiliation(s)
- Bernhard Zapletal
- Department of Anaesthesiology, General Intensive Care and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria; (B.Z.); (M.H.B.); (J.G.); (E.M.T.)
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (D.Z.); (T.S.)
| | - Thomas Schlöglhofer
- Department of Cardiac Surgery, Medical University Vienna, 1090 Vienna, Austria; (D.Z.); (T.S.)
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, 1090 Vienna, Austria
| | - Monika Fritzer-Szekeres
- Department of Laboratory Medicine, Medical University Vienna, 1090 Vienna, Austria; (M.F.-S.); (T.S.)
| | - Thomas Szekeres
- Department of Laboratory Medicine, Medical University Vienna, 1090 Vienna, Austria; (M.F.-S.); (T.S.)
| | - Martin H. Bernardi
- Department of Anaesthesiology, General Intensive Care and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria; (B.Z.); (M.H.B.); (J.G.); (E.M.T.)
| | - Johannes Geilen
- Department of Anaesthesiology, General Intensive Care and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria; (B.Z.); (M.H.B.); (J.G.); (E.M.T.)
| | - Marcus J. Schultz
- Department of Anaesthesiology, General Intensive Care and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria; (B.Z.); (M.H.B.); (J.G.); (E.M.T.)
- Department of Intensive Care, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Edda M. Tschernko
- Department of Anaesthesiology, General Intensive Care and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University Vienna, 1090 Vienna, Austria; (B.Z.); (M.H.B.); (J.G.); (E.M.T.)
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Li Y, Li C, Zhang L, Li J, Li Q, Ouyang H, Luo J, Zhu L, Cai K. Long-term storage protocol of reagent red blood cells treated with 0.01M dithiothreitol (DTT) for pre-transfusion testing of patients receiving anti-CD38 therapy, daratumumab. Hematology 2023; 28:2186037. [PMID: 36892250 DOI: 10.1080/16078454.2023.2186037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVE Use red blood cell stabilizer to store the antibody screening and antibody identification reagent red blood cells (RBCs) treated with 0.01 mol/L DTT and investigate its value in the pre-transfusion examinations of patients treated with daratumumab. METHOD Determined the optimal incubation time for the 0.01 mol/L DTT-treated RBCs method by evaluating the effect of treatment at different time points. Added ID-CellStab to store DTT-treated RBCs, determined the maximum shelf life of reagent RBCs by monitoring the hemolysis index, and assessed changes in the antigenicity of blood group antigens on the surface of RBCs during storage with antibody reagents. RESULT A protocol for long-term storage of reagent red blood cells treated with the 0.01 mol/L DTT method was established. The optimal incubation time was 40-50 min. RBCs could be stored stably for 18 days after adding ID-CellStab. The protocol was able to eliminate pan-agglutination caused by daratumumab, with no significant changes in the antigens of most blood group systems, except for some attenuation of K antigen and Duffy blood group system antigens during the storage period. CONCLUSION The storage protocol of reagent RBCs based on the 0.01 mol/L DTT method does not affect the detection of most blood group antibodies and retains a certain degree of detection ability for anti-K antibodies, allowing patients treated with daratumumab to quickly perform pre-transfusion examinations, making up for the shortcomings of currently commercial reagent RBCs.
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Affiliation(s)
- Yuyuan Li
- Department of Blood Transfusion, The First People's Hospital of Foshan, Foshan, People's Republic of China.,Department of Transfusion Medicine, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, People's Republic of China
| | - Chengyao Li
- Department of Transfusion Medicine, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, People's Republic of China
| | - Ling Zhang
- Department of Transfusion Medicine, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, People's Republic of China
| | - Jiao Li
- Department of Laboratory, Shunde District Central Blood Station, Foshan, People's Republic of China
| | - Qixin Li
- Department of Clinical Laboratory, the First People's Hospital of Foshan, Foshan, People's Republic of China
| | - Haining Ouyang
- Department of Laboratory, Shunde District Central Blood Station, Foshan, People's Republic of China
| | - Jiaona Luo
- Department of Laboratory, Shunde District Central Blood Station, Foshan, People's Republic of China
| | - Linrui Zhu
- Department of Blood Transfusion, The First People's Hospital of Foshan, Foshan, People's Republic of China
| | - Kui Cai
- Department of Blood Transfusion, The First People's Hospital of Foshan, Foshan, People's Republic of China
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Ishiguro A, Nishioka M, Morishige A, Yoneshiro M, Shinkawa K, Fujinaga A, Kobayashi T, Suehiro Y, Yamasaki T. Determination of the Optimal Wavelength of the Hemolysis Index Measurement. J Clin Med 2023; 12:5864. [PMID: 37762805 PMCID: PMC10531830 DOI: 10.3390/jcm12185864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Many biochemical auto-analyzers have methods that measure the hemolysis index (HI) to quantitatively assess the degree of hemolysis. Past reports on HI are mostly in vitro studies. Therefore, we evaluated the optimal wavelength of HI measurement ex vivo using clinical samples. Four different wavelengths (410/451 nm: HI-1, 451/478 nm: HI-2, 545/596 nm: HI-3 and 571/596 nm: HI-4) were selected for HI measurement, and correlations were examined from the measurement results of 3890 clinical samples. Another set of 9446 clinical samples was used to examine the correlation of HI with lactate dehydrogenase (LDH), aspartate aminotransferase (AST) and potassium (K). Strong correlations were found between HI-4 and HI-1 and between HI-4 and HI-3. HI-1 and HI-2 cannot correctly assess hemolysis for high bilirubin samples, and HI-3 cannot correctly assess hemolysis for high triglyceride samples. LDH, AST and K correlated positively with HI-4 in clinical samples. For every 1-unit increase in HI-4, LDH increased by 19.51 U/L, AST by 1.03 U/L and K by 0.061 mmol/L, comparable to reports of other studies. In clinical samples, HI-4 was less susceptible to bilirubin and chyle and reflected well the changes in LDH, AST and K caused by hemolysis. This suggested that the optimal wavelength for HI measurement is 571 nm.
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Affiliation(s)
- Akiyo Ishiguro
- Department of Oncology and Laboratory Medicine, Yamaguchi University Graduate School of Medicine, Ube 755-8505, Japan; (A.I.); (Y.S.)
- Division of Laboratory, Yamaguchi University Hospital, Ube 755-8505, Japan; (M.N.); (A.M.); (M.Y.); (K.S.); (A.F.); (T.K.)
| | - Mitsuaki Nishioka
- Division of Laboratory, Yamaguchi University Hospital, Ube 755-8505, Japan; (M.N.); (A.M.); (M.Y.); (K.S.); (A.F.); (T.K.)
| | - Akihiro Morishige
- Division of Laboratory, Yamaguchi University Hospital, Ube 755-8505, Japan; (M.N.); (A.M.); (M.Y.); (K.S.); (A.F.); (T.K.)
| | - Mai Yoneshiro
- Division of Laboratory, Yamaguchi University Hospital, Ube 755-8505, Japan; (M.N.); (A.M.); (M.Y.); (K.S.); (A.F.); (T.K.)
| | - Kanae Shinkawa
- Division of Laboratory, Yamaguchi University Hospital, Ube 755-8505, Japan; (M.N.); (A.M.); (M.Y.); (K.S.); (A.F.); (T.K.)
| | - Aki Fujinaga
- Division of Laboratory, Yamaguchi University Hospital, Ube 755-8505, Japan; (M.N.); (A.M.); (M.Y.); (K.S.); (A.F.); (T.K.)
| | - Toshihiko Kobayashi
- Division of Laboratory, Yamaguchi University Hospital, Ube 755-8505, Japan; (M.N.); (A.M.); (M.Y.); (K.S.); (A.F.); (T.K.)
| | - Yutaka Suehiro
- Department of Oncology and Laboratory Medicine, Yamaguchi University Graduate School of Medicine, Ube 755-8505, Japan; (A.I.); (Y.S.)
- Division of Laboratory, Yamaguchi University Hospital, Ube 755-8505, Japan; (M.N.); (A.M.); (M.Y.); (K.S.); (A.F.); (T.K.)
| | - Takahiro Yamasaki
- Department of Oncology and Laboratory Medicine, Yamaguchi University Graduate School of Medicine, Ube 755-8505, Japan; (A.I.); (Y.S.)
- Division of Laboratory, Yamaguchi University Hospital, Ube 755-8505, Japan; (M.N.); (A.M.); (M.Y.); (K.S.); (A.F.); (T.K.)
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Li S, Jin D, Gui X, Liu G, Jiang X. Numerical analysis of different cardiac functions and support modes on blood damage potential in an axial pump. Int J Artif Organs 2023; 46:215-225. [PMID: 36941753 DOI: 10.1177/03913988231155938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Cardiac functions and support modes of left ventricular assist device (LVAD) will influence the pump inner flow field and blood damage potential. METHODS Computational fluid dynamics (CFD) method and lumped-parameter-model (LPM) were applied to investigate the impacts of cardiac functions under full (9000 rpm) and partial (8000 rpm) support modes in an axial pump. RESULTS The constitution of hemolysis index (HI) in different components of the pump was investigated. HI was found to be more sensitive to positive incidence angles (i) compared with negative incidence angles in rotors. Negative incidence angles had little impact on HI both in rotors and the outlet guide vanes. The improved cardiac function made only a minor difference in HIave (estimated average HI in one cardiac cycle) by 9.88%, as the flow rate expanded mainly to higher flow range. Switching to partial support mode, however, would induce a periodic experience of severe flow separation and recirculation at low flow range. This irregular flow field increased HIave by 47.97%, remarkably increasing the blood damage potential. CONCLUSION This study revealed the relationship between the blade incidence angle i and HI, and recommended negative-incidence-angle blade designs as it yielded lower HI. Moreover, to avoid flow range below 50% of the design point, careful evaluations should be made before switching support modes as weaning procedures in clinical applications.
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Affiliation(s)
- Shulei Li
- School of Energy and Power Engineering, Beihang University, Beijing, China
| | - Donghai Jin
- School of Energy and Power Engineering, Beihang University, Beijing, China
| | - Xingmin Gui
- School of Energy and Power Engineering, Beihang University, Beijing, China
| | - Guangmao Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xihang Jiang
- Beijing Power Machinery Research Institute, Beijing, China
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Schapira AJ, Lunte K, Hennequin C, Vicca S, Beaudeux JL, Alkoury R, Nivet-Antoine V, Raynor A, Cottart CH. Analytical performance of Abbott C-16000 analyser haemolysis index and its potential use in measuring plasma cell-free haemoglobin. Ann Biol Clin (Paris) 2023; 81:44-51. [PMID: 36762454 DOI: 10.1684/abc.2023.1785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Purpose Measurement of the haemolysis index (HI) is usually performed in clinical chemistry laboratories in order to inform about whether biological analyses are influenced by in vivo or in vitro haemolysis of the specimen. Our aim was to evaluate the analytical performance of Abbott C-16000 analyser HI measurement in order to determine whether this could be used to reliably measure cell-free haemoglobin (fHB) in plasma samples. Methods The repeatability, reproducibility, lower limit of detection (LLOD) and lower limit of quantification (LLOQ) of C-16000 HI measurement were determined as well as the potential interference of bilirubin, triglycerides and myoglobin. C-16000 HI values of biological samples with various ranges of fHB were compared to those measured using the established reference method, second-derivate spectroscopy. Results Results: C-16000 HI determination showed excellent linear correlation with the reference method (y = 1.0043x – 1.248, R² = 0.998), a broad analytical measurement range (400-20,000 mg/L; y = 0.9904x + 72.972, R² = 0.999), clinically relevant LLOD (56 mg/L) and LLOQ (84 mg/L), good repeatability (coefficient of variation (CV) = 1-15%) and good reproducibility (CV = 5-7%). No interference was observed with myoglobin at concentrations as high as 35,447 mg/L, unconjugated and conjugated bilirubin (at concentrations up to 500 mg/L and 375 mg/L, respectively) or triglycerides up to 6.8 mmol/L. However, a significant underestimation of fHB concentrations was observed at higher triglyceride levels. Conclusion This study demonstrates that Abbott C-16000 analyser HI is reliable and accurately measures plasma fHB concentrations under pathophysiological conditions except when there are high blood concentrations of triglycerides.
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Affiliation(s)
- Anne-Julie Schapira
- Service de biochimie générale, APHP, Hôpital Necker Enfants-Malades, F-75015 Paris, France
| | - Klara Lunte
- Service de biochimie générale, APHP, Hôpital Necker Enfants-Malades, F-75015 Paris, France
| | - Carole Hennequin
- Service de biochimie générale, APHP, Hôpital Necker Enfants-Malades, F-75015 Paris, France
| | - Stéphanie Vicca
- Service de biochimie générale, APHP, Hôpital Necker Enfants-Malades, F-75015 Paris, France
| | - Jean-Louis Beaudeux
- Service de biochimie générale, APHP, Hôpital Necker Enfants-Malades, F-75015 Paris, France, Université Paris Cité, Faculté de Pharmacie de Paris, F-75006 Paris, France
| | - Rana Alkoury
- Service de biochimie, APHP, Hôpital Pitié-Salpêtrière, F-75013, Paris, France
| | - Valérie Nivet-Antoine
- Service de biochimie générale, APHP, Hôpital Necker Enfants-Malades, F-75015 Paris, France, Université Paris Cité, Faculté de Pharmacie de Paris, F-75006 Paris, France
| | - Alexandre Raynor
- Service de biochimie générale, APHP, Hôpital Necker Enfants-Malades, F-75015 Paris, France
| | - Charles-Henry Cottart
- Service de biochimie générale, APHP, Hôpital Necker Enfants-Malades, F-75015 Paris, France, Université Paris Cité, Faculté de Pharmacie de Paris, F-75006 Paris, France
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Bounouib M, Benakrach H, Taha-Janan M, Maazouzi W. Analysis of shear stress related hemolysis in a ventricular assist device. Biomed Mater Eng 2023; 34:51-66. [PMID: 35988210 DOI: 10.3233/bme-221401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Implantable devices such as ventricular assist devices provide appropriate treatment for patients with advanced heart failure. Unfortunately, these devices still have many problems, particularly related to blood damage. OBJECTIVE The aim of this research is to examine two new ventricular assist devices in terms of induced shear stress, exposure time, and induced hemolysis. METHOD Reverse engineering was used on multiple axial flow ventricular assist devices to collect all the details related to the designs (diameters, lengths, blade angles…), which were used to build two prototypes: Model A and Model B. RESULTS The obtained results were close to a large extent, except for static pressure rise, where the difference was clear. CONCLUSION Compared with what has been published in other studies, the overall performance of both models was excellent.
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Affiliation(s)
- Mohamed Bounouib
- Laboratory of Applied Mechanics and Technologies, ENSAM, Mohammed V University, Rabat, Morocco
| | - Hind Benakrach
- Laboratory of Applied Mechanics and Technologies, ENSAM, Mohammed V University, Rabat, Morocco
| | - Mourad Taha-Janan
- Laboratory of Applied Mechanics and Technologies, ENSAM, Mohammed V University, Rabat, Morocco
| | - Wajih Maazouzi
- Industrial and Health Science and Technology Research Center (STIS), ENSAM, Mohammed V University, Rabat, Morocco
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Li C, Qiu H, Ma J, Wang Y. Numerical study on the performance of centrifugal blood pump with superhydrophobic surface. Int J Artif Organs 2022; 45:1028-1036. [PMID: 36028949 DOI: 10.1177/03913988221114156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM In order to reduce the blood damage of an artificial heart pump and optimize its hydraulic performance, a centrifugal blood pump with superhydrophobic characteristics is proposed in this study. METHODS To study the influence of superhydrophobic surface characteristics on the performance of centrifugal blood pumps, the Navier slip model is used to simulate the slip characteristics of superhydrophobic surfaces, which is realized by the user defined function of ANSYS fluent. The user defined functions with different values of slip length are verified by two benchmark solutions of laminar flow and turbulence in the pipeline. The blood pump model adopts the designed centrifugal blood pump, and its head, hydraulic efficiency and hemolysis index are calculated. The Navier slip boundary condition (a constant slip-length of 50 μm) is applied to the walls of the blood pump impeller and a volute at different positions, and the influence of the superhydrophobic surface on the performance of the blood pump at the design point Q = 6 L/min was compared and analyzed. RESULTS The results show that the centrifugal blood pump model used in this paper has good blood compatibility and meets the design requirements; the superhydrophobic surface can significantly reduce the scalar shear stress in the blood pump. At the design point, when the slip length is 50 μm, the mass-average scalar shear stress in the impeller area and the volute area reduction rate is about 5.9%, the hydraulic efficiency growth rate is about 3.8%, the hemolysis index reduction rate is about 18.4%, and the pressure head changes little with a growth rate of 0.3%. CONCLUSIONS Centrifugal blood pumps with superhydrophobic surfaces can improve the efficiency of blood pumps and reduce hemolysis. Based on these encouraging results, vitro investigations for actual blood damage would be practicable.
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Affiliation(s)
- Chengcheng Li
- Shanghai Key Laboratory of Multiphase Flow and Heat Transfer in Power Engineering, School of Energy and Power Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Huihe Qiu
- Department of Mechanical and Aerospace Engineering, The Hong Kong University of Science and Technology, Hong Kong
| | - Jianying Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Ying Wang
- Shanghai Key Laboratory of Multiphase Flow and Heat Transfer in Power Engineering, School of Energy and Power Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Department of Mechanical and Aerospace Engineering, The Hong Kong University of Science and Technology, Hong Kong
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Capoferri A, Aloisio E, Pasqualetti S, Panteghini M. More about the random uncertainty of photometric determination of hemolysis index on the Abbott Alinity c platform. Clin Biochem 2022; 105-106:94-95. [PMID: 35460611 DOI: 10.1016/j.clinbiochem.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Alessia Capoferri
- Clinical Pathology Unit, 'Luigi Sacco' University Hospital, Milan, Italy.
| | - Elena Aloisio
- Clinical Pathology Unit, 'Luigi Sacco' University Hospital, Milan, Italy
| | - Sara Pasqualetti
- Clinical Pathology Unit, 'Luigi Sacco' University Hospital, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, 'Luigi Sacco' University Hospital, Milan, Italy
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Barbhuiya MA, Pederson EC, Straub ML, Neibauer TL, Salter WF, Saylor EL, Scott SC, Zhu Y. Automated Measurement of Plasma Cell-Free Hemoglobin Using the Hemolysis Index Check Function. J Appl Lab Med 2021; 5:281-289. [PMID: 32445381 DOI: 10.1093/jalm/jfz006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/17/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND The Roche Cobas chemistry analyzer's hemolysis index (HI) check function can directly report hemoglobin (Hb) concentrations. We aimed to validate the HI check function for the measurement of plasma cell-free Hb. METHODS Plasma samples (6 μl) were taken by the analyzer and diluted in normal saline to measure the absorbance for Hb at 570 and 600 nm. Hb concentrations were calculated based on the molar extinction coefficient. Imprecision, lower limit of quantification (LLOQ), and analytical measurement range (AMR) of the assay were evaluated. The accuracy was determined by comparing the results between the new method and an existing spectrophotometric method. We further studied interference of icterus and lipemia and carryover. The performance of the assay in proficiency testing was also evaluated. The reference range was transferred from the existing method. RESULTS Within-run and total CVs were 1.7%-4.2% and 2.1%-7.0%, respectively (n = 20). The LLOQ was 11 mg/dL (CV = 8.1%) with the upper limit of AMR of 506 mg/dL. The results of the new method correlated well with the existing reference assay: Y (new method) = 0.974 x (reference method) + 4.9, r = 0.9990, n = 52. Bilirubin with a concentration up to 60 mg/dL and lipemic index up to 389 did not show significant interference. No significant carryover was detected. The average standard deviation index in proficiency testing was 0.03 ± 0.29. The reference range was <22 mg/dL. CONCLUSIONS Plasma cell-free Hb measurement using the HI check function meets the analytical requirements of the plasma cell-free Hb assays. It is simple and cost-effective.
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Affiliation(s)
- Mustafa A Barbhuiya
- Department of Pathology and Laboratory Medicine, Pennsylvania State University College of Medicine, Hershey, PA
| | - Edward C Pederson
- Department of Pathology and Laboratory Medicine, Pennsylvania State University College of Medicine, Hershey, PA
| | - Monica L Straub
- Department of Pathology and Laboratory Medicine, Pennsylvania State University College of Medicine, Hershey, PA
| | - Terri L Neibauer
- Department of Pathology and Laboratory Medicine, Pennsylvania State University College of Medicine, Hershey, PA
| | - Wayne F Salter
- Department of Pathology and Laboratory Medicine, Pennsylvania State University College of Medicine, Hershey, PA
| | - Eric L Saylor
- Department of Pathology and Laboratory Medicine, Pennsylvania State University College of Medicine, Hershey, PA
| | - Sofia C Scott
- Department of Pathology and Laboratory Medicine, Pennsylvania State University College of Medicine, Hershey, PA
| | - Yusheng Zhu
- Department of Pathology and Laboratory Medicine, Pennsylvania State University College of Medicine, Hershey, PA
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11
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Cheng L, Tan J, Yun Z, Wang S, Yu Z. Analysis of flow field and hemolysis index in axial flow blood pump by computational fluid dynamics-discrete element method. Int J Artif Organs 2020; 44:46-54. [PMID: 32393086 DOI: 10.1177/0391398820917145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To fully study the relationship between the internal flow field and hemolysis index in an axial flow blood pump, a computational fluid dynamics-discrete element method coupled calculation method was used. Through numerical analysis under conditions of 6000, 8000, and 10,000 r/min, it was found that there was flow separation of blood cell particles in the tip of the impeller and the guide vane behind the impeller. The flow field has a larger pressure gradient distribution, which reduces the lift ratio of the blood pump and easily causes blood cell damage. The study shows that the hemolysis index obtained by the computational fluid dynamics-discrete element method is 4.75% higher than that from the traditional computational fluid dynamics method, which indicates the impact of microcollision between erythrocyte particles and walls on hemolysis index and also further verifies the validity of the computational fluid dynamics-discrete element coupling method. Through the hydraulic and particle image velocimetry experiments of the blood pump, the coincidence between numerical calculation and experiment is analyzed from macro and micro aspects, which shows that the numerical calculation method is feasible.
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Affiliation(s)
- Lizhi Cheng
- School of Mechanical and Electrical Engineering, Central South University, Changsha, China.,School of Mechanical and Electrical Engineering, Changsha University, Changsha, China
| | - Jianping Tan
- School of Mechanical and Electrical Engineering, Central South University, Changsha, China
| | - Zhong Yun
- School of Mechanical and Electrical Engineering, Central South University, Changsha, China
| | - Shuai Wang
- School of Mechanical and Electrical Engineering, Central South University, Changsha, China
| | - Zheqin Yu
- School of Mechanical and Electrical Engineering, Central South University, Changsha, China
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12
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Luo J, Huang D, Xu B. [Numerical simulation and performance analysis of mixed flow blood pump]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 2020; 37:296-303. [PMID: 32329282 DOI: 10.7507/1001-5515.01904010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The high rotational speed of the axial flow blood pump and flow separation of the centrifugal blood pump are the main causes for blood damage in blood pump. The mixed flow blood pump can effectively alleviate the high rotational speed and the flow separation. Based on this, the purpose of this study is to explore the performance of the mixed blood pump with a closed impeller. A mixed flow blood pump with closed impeller was studied by numerical simulation in this paper. The flow field characteristics and the pressure distribution of this type of blood pump were analyzed. The hydraulic performance of the blood pump and the possible damages to red blood cells were also discussed. At last, pump performance was compared with the mixed flow blood pump with semi-open impeller. The results show that the mixed flow blood pump with close impeller studied in this paper can operate safely and efficiently with a good performance. The pump can reach the pressure head of 100 mmHg at 5 L/min mass flow rate. Flow in the blood pump is uniform and no obvious separation or vortex occurs. Pressure distribution in and on the impeller is uniform and reasonable, which can effectively avoid the thrombosis of blood. The average mean value of hemolysis index is 4.99 × 10 -4. The pump has a good biocompatibility. Compared with the mixed flow blood pump with semi-open impeller, the mixed flow blood pump with closed impeller has higher head and efficiency, a smaller mean value of hemolysis index prediction, a better hydraulic performance and the ability to avoid blood damage. The results of this study may provide a basis for the performance evaluation of the closed impeller mixed flow blood pump.
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Affiliation(s)
- Jiping Luo
- School of Energy and Power Engineering, University of Shanghai for Science and Technology, Shanghai 200093, P.R.China
| | - Diangui Huang
- School of Energy and Power Engineering, University of Shanghai for Science and Technology, Shanghai 200093, P.R.China
| | - Bin Xu
- School of Energy and Power Engineering, University of Shanghai for Science and Technology, Shanghai 200093, P.R.China
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13
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Liu G, Xi J, Chen H, Zhang Y, Hou J, Zhou J, Sun H, Hu S. [Design of an axial blood pump of diffuser with splitter blades and cantilevered main blades]. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi 2019; 36:379-385. [PMID: 31232539 DOI: 10.7507/1001-5515.201801065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
An implantable axial blood pump was designed according to the circulation assist requirement of severe heart failure patients of China. The design point was chosen at 3 L/min flow rate with 100 mm Hg pressure rise when the blood pump can provide flow rates of 2-7 L/min. The blood pump with good hemolytic and anti-thrombogenic property at widely operating range was designed by developing a structure that including the spindly rotor impeller structure and the diffuser with splitter blades and cantilevered main blades. Numerical simulation and particle image velocimetry (PIV) experiment were conducted to analyze the hydraulic, flow fields and hemolytic performance of the blood pump. The results showed that the blood pump could provide flow rates of 2-7 L/min with pressure rise of 60.0-151.3 mm Hg when the blood pump rotating from 7 000 to 11 000 r/min. After adding the splitter blades, the separation flow at the suction surface of the diffuser has been reduced efficiently. The cantilever structure changed the blade gap from shroud to hub that reduced the tangential velocity from 6.2 m/s to 4.3-1.1 m/s in blade gap. Moreover, the maximum scalar shear stress of the blood pump was 897.3 Pa, and the averaged scalar shear stress was 37.7 Pa. The hemolysis index of the blood pump was 0.168% calculated with Heuser's hemolysis model. The PIV and simulated results showed the overall agreement of flow field distribution in diffuser region. The blood damage caused by higher shear stress would be reduced by adopting the spindle rotor impeller and diffuser with splitter blades and cantilevered main blades. The blood could flow smoothly through the axial blood pump with satisfactory hydraulics performance and without separation flow.
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Affiliation(s)
- Guangmao Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R.China
| | - Jian Xi
- Zhonghang Electronic Measuring Instruments Co., Ltd, Xi'an 710000, P.R.China
| | - Haibo Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R.China
| | - Yan Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R.China
| | - Jianfeng Hou
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R.China
| | - Jianye Zhou
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R.China
| | - Hansong Sun
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R.China
| | - Shengshou Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037,
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14
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Du Z, Liu J, Zhang H, Bao B, Zhao R, Jin Y. Determination of hemolysis index thresholds for biochemical tests on Siemens Advia 2400 chemistry analyzer. J Clin Lab Anal 2019; 33:e22856. [PMID: 30779463 PMCID: PMC6589729 DOI: 10.1002/jcla.22856] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/15/2018] [Accepted: 12/19/2018] [Indexed: 11/23/2022] Open
Abstract
Background In vitro hemolysis is still the most common source of pre‐analytical nonconformities. This study aimed to investigate the hemolytic effects on commonly used biochemical tests as well as to determine the hemolysis index (HI) thresholds on Siemens Advia 2400 chemistry analyzer. Methods Peripheral blood samples were collected from forty healthy volunteers. Hemolysis was achieved using syringes. Five hemolysis levels were produced including the no hemolysis group, slight hemolysis group, mild hemolysis group, moderate hemolysis group, and heavy hemolysis group. We then used the bias from baseline (no hemolysis) and HI to construct regression functions. The HI corresponding to the bias limits was considered as HI thresholds. We chose the total allowable error (TAE) as the bias limit. Results Of the twenty‐eight analytes, ten analytes had clinical significance. Creatine kinase‐MB, creatine kinase, potassium, aspartate aminotransferase, and hydroxybutyrate dehydrogenase were all positively affected; the corresponding HI threshold was 45.2, 99.96, 4.07, 10.16, and 7.94, respectively. Lactate dehydrogenase was also positively interfered, but we failed to calculate the HI threshold. Total bile acid, uric acid, and sodium were all negatively affected, and the HI threshold was 42.23, 500 and 501.8, respectively. Glucose was also negatively interfered, but it failed to achieve the HI threshold. Conclusions When the HI value was higher than its threshold, the corresponding analyte was considered inappropriate for reporting. The implementation of the assay‐specific HI thresholds could provide an accurate method to identify analytes interfered by hemolysis, which would improve clinical interpretations and further boost laboratory quality by reducing errors associated with hemolysis.
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Affiliation(s)
- Zhenhua Du
- Department of clinical laboratory, Characteristic Medical center of Chinese People's Armed Police Force, Pingjin Hospital, Tianjin, China
| | - JiQin Liu
- Department of clinical laboratory, Characteristic Medical center of Chinese People's Armed Police Force, Pingjin Hospital, Tianjin, China
| | - Hua Zhang
- Department of clinical laboratory, Characteristic Medical center of Chinese People's Armed Police Force, Pingjin Hospital, Tianjin, China
| | - BuHe Bao
- Department of clinical laboratory, Characteristic Medical center of Chinese People's Armed Police Force, Pingjin Hospital, Tianjin, China
| | - RuiQi Zhao
- Department of clinical laboratory, Characteristic Medical center of Chinese People's Armed Police Force, Pingjin Hospital, Tianjin, China
| | - Ying Jin
- Department of clinical laboratory, Characteristic Medical center of Chinese People's Armed Police Force, Pingjin Hospital, Tianjin, China
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15
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Wolf J, Haendel N, Remmler J, Kutzner CE, Kaiser T, Mothes T. Hemolysis and IgA-antibodies against tissue transglutaminase: When are antibody test results no longer reliable? J Clin Lab Anal 2017; 32:e22360. [PMID: 29168584 DOI: 10.1002/jcla.22360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/23/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Antibodies against tissue transglutaminase (TTG) of isotype IgA (IgA-aTTG) represent reliable diagnostic markers to confirm or exclude celiac disease (CD). Hemolysis (HL) is an important pre-analytical factor. HL can be quantified as HL index (HI) correlating with the concentration of free hemoglobin. TTG is abundant in erythrocytes and released upon HL. In immunoassays, the released TTG may interfere with binding of IgA-aTTG to the coated TTG. METHODS We selected 17 HL-free sera from children with biopsy-confirmed CD: 7 with low-positive (1-5 multiples of upper limit of normal [×ULN]), 5 with intermediate (5-10 × ULN) and 5 with high IgA-aTTG (10-15 × ULN). Sera were spiked with hemolysates resulting in HIs ranging from 12.5 to 800 (12.5-800 mg/dL free hemoglobin). RESULTS IgA-aTTG values were significantly decreased (>10%) after addition of hemolysates even if HL was invisible (HI <50). This effect is diagnosis-relevant if IgA-aTTG values are measured just below the cut-offs: (i) 0.4-1 × ULN at HI ≥25 (CD not excludable) and (ii) 8.5-10 × ULN at HI ≥200 (diagnosis of CD without biopsy not possible). Antibodies against deamidated gliadin were not influenced by HL. CONCLUSIONS IgA-aTTG results in sera with HI ≥25 can yield inconclusive results. Therefore, those antibody results should be assessed only under consideration of the HI.
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Affiliation(s)
- Johannes Wolf
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Medical Faculty of the University and University Hospital, Leipzig, Germany
| | | | - Johannes Remmler
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Medical Faculty of the University and University Hospital, Leipzig, Germany
| | - Carl Elias Kutzner
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Medical Faculty of the University and University Hospital, Leipzig, Germany
| | - Thorsten Kaiser
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Medical Faculty of the University and University Hospital, Leipzig, Germany
| | - Thomas Mothes
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Medical Faculty of the University and University Hospital, Leipzig, Germany
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16
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Fueyo L, Robles J, Aguilar I, Yáñez AM, Socias M, Parera M. Hemolysis index to detect degree of hydroxocobalamin interference with common laboratory tests. J Clin Lab Anal 2016; 31. [PMID: 27859624 DOI: 10.1002/jcla.22089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/07/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Cyanokit® (hydroxocobalamin OHCo) is the recommended treatment for cyanide poisoning. OHCo is a red chromophore and may cause interference with some biochemical measurements. In this study, we assessed the possible interference of Cyanokit on several cooximetric and plasma biochemistry tests and then determined the possible mathematical correction for some analytes. We studied the possibility of detecting and evaluating the degree of interference with the hemolysis index (HI) provided by our autoanalyzer because it is not possible to measure the OHCo concentration in conventional laboratories. METHODS Several pools of plasma samples spiked with increasing concentrations of OHCo were prepared. Each one was compared to the pool without interferent. Interference was considered when the bias was more than 10%. An interferograph was developed for those analytes with significant interference. The correlation between interference agent concentration and HI was calculated by Spearman correlation coefficient. We used multiple regression analysis to determine the mathematical correction for amylase, creatinine, and lactate. RESULTS We detected significant interference in the amylase, carboxyhemoglobin, creatinine, creatine kinase, bilirubin, lactate, and total protein measurement. The HI was positively correlated with OHCo concentration. Corresponding equations for estimating lactate and creatinine concentrations were obtained. CONCLUSIONS OHCo interferes with many laboratory assays in an unpredictable way making some results invalid and confounding clinical decision making. We can detect and evaluate the degree of interference with the HI. We can still estimate real creatinine and lactate levels using the regression equation obtained in this study.
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Affiliation(s)
- Laura Fueyo
- Servicio de Análisis Clínicos, Hospital Universitario Son Espases, Palma, Balearic Islands, Spain
| | - Juan Robles
- Servicio de Análisis Clínicos, Hospital Universitario Son Espases, Palma, Balearic Islands, Spain
| | - Irene Aguilar
- Servicio de Análisis Clínicos, Hospital Universitario Son Espases, Palma, Balearic Islands, Spain
| | - Aina M Yáñez
- Instituto de investigación sanitaria de Palma (IdISPa), Palma, Balearic Islands, Spain
| | - Magdalena Socias
- Servicio de Urgencias, Hospital Universitario Son Espases, Palma, Balearic Islands, Spain
| | - Magdalena Parera
- Servicio de Análisis Clínicos, Hospital Universitario Son Espases, Palma, Balearic Islands, Spain
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