1
|
Baud B, Dupuy AM, Zozor S, Badiou S, Bargnoux AS, Mathieu O, Cristol JP. Free hemoglobin determination at patients' bedside to evaluate hemolysis. Bioanalysis 2024; 16:65-74. [PMID: 38050368 DOI: 10.4155/bio-2023-0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
Background: The authors report the relevance of using a point of care test (Helge®) for free hemoglobin determination and concordance of the values the with Cobas® 8000 and spectrophotometer methods. Results: The within-run of the point of care test was <3%. Good correlations among the three methods were observed and an acceptable concordance for hemolysis index values from 50 mg/dl. An excellent agreement between the Cobas 8000 and the spectrophotometer was found. Conclusion: Automated methods represent methods of choice for free hemoglobin determination. An advantage of the Helge system is that it can be applied to samples experiencing a delay in evaluation due to the long distance between the collection site and the central laboratory. Another advantage is its use at the bedside, in the monitoring of extracorporeal membrane oxygenation patients.
Collapse
Affiliation(s)
- Bastien Baud
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, Univ Montpellier 1, Montpellier, F-34295, cédex 5, France
| | - Anne Marie Dupuy
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, Univ Montpellier 1, Montpellier, F-34295, cédex 5, France
| | - Samuel Zozor
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, Univ Montpellier 1, Montpellier, F-34295, cédex 5, France
| | - Stéphanie Badiou
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, Univ Montpellier 1, Montpellier, F-34295, cédex 5, France
- Laboratoire de Biochimie et Hormonologie, PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, Montpellier, F-34295, cédex 5, France
| | - Anne Sophie Bargnoux
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, Univ Montpellier 1, Montpellier, F-34295, cédex 5, France
- Laboratoire de Biochimie et Hormonologie, PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, Montpellier, F-34295, cédex 5, France
| | - Olivier Mathieu
- Department of Clinical Pharmacology, University Hospital of Montpellier, Montpellier, F-34295, cédex 5, France
- Hydroscience de Montpellier, UMR 5451, Université de Montpellier, Montpellier, F-34295, cédex 5, France
| | - Jean Paul Cristol
- Laboratoire de Biochimie et Hormonologie, CHU Montpellier, Univ Montpellier 1, Montpellier, F-34295, cédex 5, France
- Laboratoire de Biochimie et Hormonologie, PhyMedExp, Université de Montpellier, INSERM, CNRS, CHU de Montpellier, Montpellier, F-34295, cédex 5, France
| |
Collapse
|
2
|
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] [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.
Collapse
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.)
| |
Collapse
|
3
|
Stickle DF, Rebecca Koob K, McCudden CR. Characterizing ability of serum potassium (K) and the serum K reference interval to flag hypokalemia or hyperkalemia as observed in plasma: a simulation study. Clin Biochem 2023:110606. [PMID: 37391118 DOI: 10.1016/j.clinbiochem.2023.110606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVES Serum potassium (K) exhibits a positive shift relative to plasma K due to a variable amount of K release associated with clotting. Because of this variation, plasma K results outside of the reference interval (RI) for plasma (hypokalemia or hyperkalemia) in individual samples may not produce classification-concordant results in serum according to the serum RI. We examined this premise from a theoretical standpoint by simulation. DESIGN & METHODS We used textbook K reference intervals for plasma (PRI = 3.4-4.5 mmol/L) and serum (SRI = 3.5-5.1 mmol/L). The difference between PRI and SRI is characterized by a normal distribution: serum K = plasma K + 0.35 ± 0.308 mmol/L. This transformation was applied by simulation to an observed patient data distribution for plasma K to generate a corresponding theoretical serum K distribution. Individual samples were tracked for comparison with respect to classification (below, within, above RI) for plasma and serum. RESULTS Primary data were an all-comers plasma K patient distribution (n = 41,768; median = 4.1 mmol/L; 7.1% below PRI (hypokalemia); 15.5% above PRI (hyperkalemia)). Simulation to obtain the associated serum K yielded a right-shifted distribution (median = 4.4 mmol/L; 4.8% below SRI; 10.8% above SRI). Sensitivity for detection in serum (flagged below SRI) for samples originating as hypokalemic in plasma was 45.7% (specificity = 98.3%). Sensitivity for detection in serum (flagged above SRI) for samples originating as hyperkalemic in plasma was 56.6% (specificity = 97.6%). CONCLUSIONS Simulation results indicate that serum K should best be thought of as an inferior substitute marker for plasma K. These results follow simply from the variable component of serum K compared to plasma K. Plasma should be the preferred specimen type for K assessment.
Collapse
|
4
|
Marques-Garcia F, Jung DHH, Pérez SE. Impact of Individualized Hemolysis Management Based on Biological Variation Cut-offs in a Clinical Laboratory. Ann Lab Med 2022; 42:169-177. [PMID: 34635610 PMCID: PMC8548235 DOI: 10.3343/alm.2022.42.2.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/11/2021] [Accepted: 09/16/2021] [Indexed: 11/19/2022] Open
Abstract
Background Hemolysis is the most common type of preanalytical interference. Cut-offs based on the hemolysis index level can be established using different approaches. The Working Group for Preanalytical Phase of the European Federation of Laboratory Medicine has developed a protocol for hemolysis management based on cut-offs estimated from biological variation (BV) and the use of interpretative comments. We developed and assessed the implementation of the protocol in our laboratory. Methods Hemolysates from whole blood were prepared following the Meites method, and pooled serum samples with known Hb concentrations were prepared. For each analyte (42 ), interferograms were generated and used to establish cut-offs: desirable analytical quality specification and reference change value. This protocol was assessed, both pre- and post-implementation, according to expert rules in the Laboratory Information System. Results Among the analytes evaluated, we selected those that showed the highest degree of hemolysis interference: lactate dehydrogenase (LDH), aspartate aminotransferase, direct bilirubin, potassium, and folic acid. The cut-offs for LDH and direct bilirubin were the lowest. Only 28.16% of all LDH values were adequately reported in the pre-implantation retrospective study, but this percentage improved in the post-implementation stage. Conclusions The development and implementation of a harmonized protocol for hemolysis management based on BV cut-offs and result reporting significantly improve hemolysis detection and lead to a decrease in the number of hemolyzed samples over time.
Collapse
Affiliation(s)
| | | | - Sandra Elena Pérez
- Department of Clinical Biochemistry, University Hospital of Salamanca, Salamanca, Spain
| |
Collapse
|
5
|
Bargnoux AS, Kuster N, Sutra T, Laroche L, Rodriguez A, Morena M, Chenine L, Chalabi L, Dupuy AM, Badiou S, Cristol JP. Evaluation of a new point-of-care testing for creatinine and urea measurement. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:290-297. [PMID: 33908840 DOI: 10.1080/00365513.2021.1914344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Point of care testing makes it possible to obtain results in an extremely short time. Recently, radiometer has expanded the panel of tests available on its ABL90 FLEX PLUS blood gas analyzer (ABL90) by adding urea and creatinine. The aim of this study was to verify the performance of these new parameters. This included assessment of imprecision, linearity, accuracy by comparison with central laboratory standard assays and interferences. In addition, clinical utility in a dialysis center was evaluated. Within-lab coefficients of variation were close to 2%. The mean and limits of agreement (mean ± 1.96 SD) of the difference between ABL90 and Roche enzymatic assays on cobas 8000 were 0.5 (from -1.4 to 2.3) mmol/L and -0.9 (from -19.5 to 17.8) µmol/L for urea and creatinine, respectively. The ABL90 enzymatic urea and creatinine assays met the acceptance criteria based on biological variation for imprecision and showed good agreement with central laboratory. The two assays were unaffected by hematocrit variation between 20 and 70%, hemolysis and icterus interferences. It should be noted that the relationship between lab methods and ABL90 was conserved even for high pre-dialysis values allowing easy access to dialysis adequacy parameters (Kt/V) and muscle mass evaluation (creatinine index). Rapid measurement of creatinine and urea using whole blood specimens on ABL90 appears as a fast and convenient method. Analytical performances were in accordance with our expectations without any significant interferences by hemolysis or icterus.
Collapse
Affiliation(s)
- Anne-Sophie Bargnoux
- Département de Biochimie et Hormonologie, PhyMedExp, INSERM, CNRS, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Nils Kuster
- Département de Biochimie et Hormonologie, PhyMedExp, INSERM, CNRS, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Thibault Sutra
- Département de Biochimie et Hormonologie, PhyMedExp, INSERM, CNRS, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Laëtitia Laroche
- Département de Biochimie et Hormonologie, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Annie Rodriguez
- Département de Biochimie et Hormonologie, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Marion Morena
- Département de Biochimie et Hormonologie, PhyMedExp, INSERM, CNRS, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Leila Chenine
- Département de Néphrologie, Dialyse et Transplantation, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | | | - Anne-Marie Dupuy
- Département de Biochimie et Hormonologie, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Stéphanie Badiou
- Département de Biochimie et Hormonologie, PhyMedExp, INSERM, CNRS, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Jean-Paul Cristol
- Département de Biochimie et Hormonologie, PhyMedExp, INSERM, CNRS, CHU de Montpellier, Université de Montpellier, Montpellier, France
| |
Collapse
|
6
|
Dupuy AM, Bargnoux AS, Roubille F, Cristol JP. Letter in reply to the letter to the editor of Geerts N and Schanhorst V with the title "Roche Troponin T hs-STAT meets all expert opinion analytical laboratory practice recommendations for the use of the differential diagnosis of acute coronary syndrome". Clin Chem Lab Med 2021; 59:e125-e127. [PMID: 32739903 DOI: 10.1515/cclm-2020-0469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/13/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Anne Marie Dupuy
- Department of Biochemistry, University Hospital of Montpellier, Montpellier, France
| | - Anne Sophie Bargnoux
- Department of Biochemistry, University Hospital of Montpellier, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - François Roubille
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.,Cardiology Department, University Hospital of Montpellier, Montpellier, Francex
| | - Jean Paul Cristol
- Department of Biochemistry, University Hospital of Montpellier, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| |
Collapse
|
7
|
Calvaresi EC, La'ulu SL, Snow TM, Allison TR, Genzen JR. Plasma hemoglobin: A method comparison of six assays for hemoglobin and hemolysis index measurement. Int J Lab Hematol 2021; 43:1145-1153. [PMID: 33449436 DOI: 10.1111/ijlh.13457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/04/2020] [Accepted: 12/27/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Plasma hemoglobin (Hb) is measured for assessment of in vivo and in vitro hemolysis. The objective of the present investigation was to conduct a method comparison of five quantitative and one semi-quantitative Hb and H-index (hemolysis index) assays to evaluate their performance measuring plasma Hb in clinical specimens. METHODS One hundred and fourteen clinical specimens previously tested for plasma Hb using a laboratory-developed spectrophotometric assay were also tested for Hb using a HemoCue Plasma/Low Hb assay (azide methemoglobin), a laboratory-modified Pointe Scientific Hb assay (cyanmethemoglobin), tested for H-index measurements using a Roche cobas c501, an Abbott Architect c8000, and a semi-quantitative (binned) H-index measurement on a Beckman AU5800. The reference result was defined as the median Hb score (median of all Hb or H-index results). RESULTS The laboratory-developed spectrophotometric Hb assay and Roche H-index methods mostly closely matched the median Hb score across all data, as well as for lower range median Hb score results ≤2.0 g/L. Two-way frequency table analysis using an Hb (or H-index) cutoff of 0.5 g/L (or 0.5 H-index units) was then performed to compare methods to the median Hb score cutoff. The Beckman method had the highest accuracy at this cutoff, the Roche and Abbott methods had the highest positive predictive value (PPV), and the Beckman, HemoCue, and Pointe methods had the highest negative predictive value (NPV). CONCLUSIONS Plasma Hb and H-index results vary by method. Laboratories should evaluate the performance characteristics of their respective assays when considering adoption of spectrophotometric or chemical methods for plasma Hb assessment.
Collapse
Affiliation(s)
| | - Sonia L La'ulu
- ARUP Institute of Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Taylor M Snow
- ARUP Institute of Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Tiffany R Allison
- ARUP Institute of Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Jonathan R Genzen
- Department of Pathology, University of Utah, Salt Lake City, UT, USA.,ARUP Institute of Clinical and Experimental Pathology, Salt Lake City, UT, USA.,ARUP Laboratories, Salt Lake City, UT, USA
| |
Collapse
|