Blood samples for ammonia analysis do not require transport to the laboratory on ice: a study of ammonia stability and cause of in vitro ammonia increase in samples from patients with hyperammonaemia
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Gavin W. Mercer-Smith
Abstract
Objectives
Prompt recognition of hyperammonaemia can avoid severe consequences of delayed treatment. Strict sample transport requirements present barriers to requesting and, if not achieved, rejection by the laboratory. Evidence is sparse on in vitro ammonia stability from studies using modern techniques or based in clinical settings. Stability in hyperammonaemic samples is unknown. This study aimed to examine ammonia stability and its source in samples from hyperammonaemic patients and to determine a clinically significant change to establish acceptable sample requirements for ammonia analysis.
Methods
Blood samples were taken from 19 hyperammonaemic patients and placed either on ice or kept at room temperature. Plasma ammonia was measured every 10 min for 2 h. Haemolysis index (HI), full blood count, liver enzymes and amino acids were analysed. Expert physicians were surveyed on a clinically significant ammonia change. Stability was assessed using the reference change value (RCV).
Results
Ammonia increased with time [peak value 14.9 % (8.4–17.1), median (95 % confidence interval)], and was predominately of cellular origin. Ice did not improve stability and increased HI. Survey results found a significantly increased ammonia between 39 % (30–48) at 50 μmol/L and 21 % (15–28) at 1,000 μmol/L. Ammonia RCV was 40.8 %.
Conclusions
Chilling samples did not improve blood ammonia stability. The increase in blood ammonia from patients with hyperammonaemia over 2 h was lower than that considered clinically significant and the calculated RCV. Transport of samples for ammonia analysis does not require ice and laboratories should accept samples if received within 2 h of venepuncture.
Acknowledgments
The authors would like to thank the patients who participated in the study and the laboratory staff in the Department of Blood Sciences, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK, for their valuable help.
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Research ethics: Research was carried out in accordance with the Declaration of Helsinki and in accordance with the terms of the relevant local legislation. The study was reviewed and approved by the London-Bromley Research Ethics Committee (reference 22/LO/0628, 21st November 2022) and the Newcastle Joint Research Office (reference 10206).
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Informed consent: Informed consent was obtained from all individuals included in the study, or their legal guardians or wards.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approve its submission.
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Use of Large Language Models, AI and Machine Learning Tools: None declared.
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Conflict of interest: The authors state no conflict of interest.
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Research funding: None declared.
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Data availability: Not applicable.
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© 2024 Walter de Gruyter GmbH, Berlin/Boston
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Artikel in diesem Heft
- Frontmatter
- Editorials
- The Friedewald formula strikes back
- Liquid biopsy in oncology: navigating technical hurdles and future transition for precision medicine
- The neglected issue of pyridoxal- 5′ phosphate
- Reviews
- Health literacy: a new challenge for laboratory medicine
- Clinical applications of circulating tumor cell detection: challenges and strategies
- Opinion Papers
- Pleural effusion as a sample matrix for laboratory analyses in cancer management: a perspective
- Interest of hair tests to discriminate a tail end of a doping regimen from a possible unpredictable source of a prohibited substance in case of challenging an anti-doping rule violation
- Perspectives
- Sigma Metrics misconceptions and limitations
- EN ISO 15189 revision: EFLM Committee Accreditation and ISO/CEN standards (C: A/ISO) analysis and general remarks on the changes
- General Clinical Chemistry and Laboratory Medicine
- Evaluation of current indirect methods for measuring LDL-cholesterol
- Verification of automated review, release and reporting of results with assessment of the risk of harm for patients: the procedure algorithm proposal for clinical laboratories
- Progranulin measurement with a new automated method: a step forward in the diagnostic approach to neurodegenerative disorders
- A comparative analysis of current С-peptide assays compared to a reference method: can we overcome inertia to standardization?
- Blood samples for ammonia analysis do not require transport to the laboratory on ice: a study of ammonia stability and cause of in vitro ammonia increase in samples from patients with hyperammonaemia
- A physio-chemical mathematical model of the effects of blood analysis delay on acid-base, metabolite and electrolyte status: evaluation in blood from critical care patients
- Evolution of autoimmune diagnostics over the past 10 years: lessons learned from the UK NEQAS external quality assessment EQA programs
- Comparison between monotest and traditional batch-based ELISA assays for therapeutic drug monitoring of infliximab and adalimumab levels and anti-drug antibodies
- Evaluation of pre-analytical factors impacting urine test strip and chemistry results
- Evaluation of AUTION EYE AI-4510 flow cell morphology analyzer for counting particles in urine
- Reference Values and Biological Variations
- Estimation of the allowable total error of the absolute CD34+ cell count by flow cytometry using data from UK NEQAS exercises 2004–2024
- Establishment of gender– and age–related reference intervals for serum uric acid in adults based on big data from Zhejiang Province in China
- Cancer Diagnostics
- Tumor specific protein 70 targeted tumor cell isolation technology can improve the accuracy of cytopathological examination
- Cardiovascular Diseases
- Diagnostic performance of Mindray CL1200i high sensitivity cardiac troponin I assay compared to Abbott Alinity cardiac troponin I assay for the diagnosis of type 1 and 2 acute myocardial infarction in females and males: MERITnI study
- Infectious Diseases
- Evidence-based assessment of the application of Six Sigma to infectious disease serology quality control
- Letters to the Editor
- Evaluating the accuracy of ChatGPT in classifying normal and abnormal blood cell morphology
- Refining within-subject biological variation estimation using routine laboratory data: practical applications of the refineR algorithm
- Early rule-out high-sensitivity troponin protocols require continuous analytical robustness: a caution regarding the potential for troponin assay down-calibration
- Biochemical evidence of vitamin B12 deficiency: a crucial issue to address supplementation in pregnant women
- Plasmacytoid dendritic cell proliferation and acute myeloid leukemia with minimal differentiation (AML-M0)
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