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Correction of patient results for Beckman Coulter LX-20 assays affected by interference due to hemoglobin, bilirubin or lipids: a practical approach

  • Henricus J. Vermeer , Gerard Steen , André J.M. Naus , Berrie Goevaerts , Pauline T. Agricola and Christian H.H. Schoenmakers
Published/Copyright: January 24, 2007
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Volume 45 Issue 1

Abstract

The influence of interference by hemolysis, icterus and lipemia on the results of routine chemistries may lead to wrong interpretations. On Synchron LX-20 instruments (Beckman Coulter) serum or plasma indices can be used as reliable semi-quantitative measures of the magnitude of such interference. In an article recently published in this journal, we presented the results of a multicenter study carried out in Dutch hospitals in which we determined cutoff indices for analytes above which analytically significant interference exists. Clinically significant interference cutoff indices were also derived for these analytes. In this article, we describe the handling of patient samples with clinically significant interference by hemolysis, icterus or lipemia. We investigated several possible approaches for correction of the result: dilution of the interference; mathematical correction in the case of hemolysis; treatment with ferrocyanide to destroy bilirubin; and removal of lipids in lipemic patient samples. We concluded, that mathematical correction of potassium or lactate dehydrogenase results in hemolytic samples can only be carried out if intravascular hemolysis is ruled out. Hemoglobin quantification in serial patient samples, combined with measurement of haptoglobin, represents a useful tool to rule out in vivo hemolysis. We derived an algorithm for this situation. We do not simply recommend mathematical correction, unless it is clinically acceptable. We present formulas for potassium and lactate dehydrogenase: corrected potassium=measured potassium–(hemolytic index increment×0.14); corrected lactate dehydrogenase=measured lactate dehydrogenase–(hemolytic index increment×75). The dilution studies indicated that dilution is only applicable for bilirubin, C-reactive protein and iron. The results of treatment with ferrocyanide were poor, and we do not recommend this method. Removal of lipids using high-speed centrifugation or LipoClear (StatSpin Inc.), a non-toxic and non-ionic polymer, is a very effective approach, although C-reactive protein, creatine kinase-MB (CK-MB) and cholesterol cannot be removed using LipoClear. For all interferants (hemoglobin, bilirubin, lipids), relatively simple algorithms are derived that can easily be implemented in the clinical laboratory.

Clin Chem Lab Med 2007;45:114–9.

Keywords: clinically significant interference; hemolysis; icterus; lipemia; Synchon LX-20
:
The author performed the work described in this article in the Department of Clinical Chemistry and Hematology, Haga Hospital, The Hague, The Netherlands Corresponding author: Henricus Jan Vermeer, PhD, Department of Clinical Chemistry and Hematology, Hilversum Hospital, Van Riebeeckweg 212, P.O. Box 10016, 1201 Hilversum, The Netherlands Phone: +31-35-688-7620, Fax: +31-35-688-7381,

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Published Online: 2007-01-24
Published in Print: 2007-01-01

©2007 by Walter de Gruyter Berlin New York

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  10. The effect of homocysteine reduction by B-vitamin supplementation on inflammatory markers
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  23. Correction of patient results for Beckman Coulter LX-20 assays affected by interference due to hemoglobin, bilirubin or lipids: a practical approach
  24. Acquiring a measurement system within the framework of standard ISO 15189
  25. Six Sigma and laboratory consultation
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https://doi.org/10.1515/CCLM.2007.004
Keywords for this article
clinically significant interference; hemolysis; icterus; lipemia; Synchon LX-20

Articles in the same Issue

  1. CCLM: Bringing advances in laboratory medicine to the “New World”
  2. Diagnostic approach to inherited bleeding disorders
  3. Linking laboratory and medication data: new opportunities for pharmacoepidemiological research
  4. Association between polymorphisms of ACE, B2AR, ANP and ENOS and cardiovascular diseases: a community-based study in the Matsu area
  5. Anti-thyroid-stimulating hormone receptor antibodies determined by second-generation assay
  6. Serum levels of granulocyte colony-stimulating factor (G-CSF) and macrophage colony-stimulating factor (M-CSF) in pancreatic cancer patients
  7. Surrogate markers of insulin resistance in assessing individuals with new categories “prehypertension” and “prediabetes”
  8. Evaluation of pre-analytical, demographic, behavioural and metabolic variables on fibrinolysis and haemostasis activation markers utilised to assess hypercoagulability
  9. Hyperhomocysteinaemia and immune activation in patients with cancer
  10. The effect of homocysteine reduction by B-vitamin supplementation on inflammatory markers
  11. Lipid peroxidation in Down syndrome caused by regular trisomy 21, trisomy 21 by Robertsonian translocation and mosaic trisomy 21
  12. Pregnancy-associated plasma protein A in dialysis patients
  13. L-Cysteine supplementation prevents exercise-induced alterations in human erythrocyte membrane acetylcholinesterase and Na+,K+-ATPase activities
  14. Assessment of homocysteine, neopterin and nitric oxide levels in Behcet's disease
  15. Increased adenosine deaminase in hydatidiform mole
  16. Classification tree analysis for the discrimination of pleural exudates and transudates
  17. External quality assessment of hemoglobin A2 measurement: data from an Italian pilot study with fresh whole blood samples and commercial HPLC systems
  18. Comparison of four commercial quantitative HIV-1 assays for viral load monitoring in clinical daily routine
  19. Interchangeability of measurements of CA 19-9 in serum with four frequently used assays: an update
  20. Analytical validation of the new version of the Liaison N-Tact PTH assay
  21. Validation of an automated sensitive immunoassay for quantitation of cytokines in the sputum of cystic fibrosis patients
  22. Strong interference of hemoglobin concentration on CSF total protein measurement using the trichloroacetic acid precipitation method
  23. Correction of patient results for Beckman Coulter LX-20 assays affected by interference due to hemoglobin, bilirubin or lipids: a practical approach
  24. Acquiring a measurement system within the framework of standard ISO 15189
  25. Six Sigma and laboratory consultation
  26. ESR or LSRB, that is the question!
  27. Reply to the Letter written by Hardeman
  28. Natriuretic peptides. The hormones of the heart
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