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Prevalence and detection of citrate contamination in clinical laboratory

  • Nathan Lorde ORCID logo EMAIL logo , Rousseau Gama ORCID logo und Tejas Kalaria ORCID logo
Veröffentlicht/Copyright: 3. Februar 2025
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Clinical Chemistry and Laboratory Medicine (CCLM)
Aus der Zeitschrift Clinical Chemistry and Laboratory Medicine (CCLM) Band 63 Heft 7

Abstract

Objectives

To study the prevalence of trisodium citrate (Na3Citrate) contamination in hypernatraemic serum samples by direct measurement of citrate and to evaluate the performance of indirect markers for identification of Na3Citrate contamination.

Methods

Serum citrate was measured in all hypernatraemic serum samples (sodium ≥148 mmol/L) over a three-month period. The performance of serum chloride, sodium-chloride gap, indirect ion selective electrode (ISE)-direct ISE sodium disparity and osmolar gap in identification of Na3Citrate contaminated samples was assessed against the ‘gold-standard’ direct citrate measurement.

Results

In total, 27 Na3Citrate contaminated samples were identified based on serum citrate concentration ≥1.5 mmol/L. The prevalence of citrate contamination was 3.1 % of hypernatraemic samples (n=875) and 0.017 % of all samples received for urea and electrolyte analysis (n=153,404). Most contaminated samples were from patients receiving haemodialysis (59.3 %), and the rest from inpatients. Cut-offs to give 100 % sensitivity were chloride ≤105 nmol/L (specificity 93.4 %), sodium-chloride gap ≥47 mmol/L (specificity 95.3 %), indirect ISE-direct ISE sodium disparity ≥3 mmol/L (specificity 81.9 %), and osmolar gap ≥39 mOsm/kg (specificity 2.8 %).

Conclusions

Trisodium citrate contamination is uncommon. Most contaminated samples were from patients receiving haemodialysis, likely because of contamination with citrate catheter locking solution. Screening with serum chloride or sodium-chloride gap can confidently exclude Na3Citrate contamination in over 90 % of hypernatraemic samples, and in nearly all samples with sodium ≥155 mmol/L if metabolic alkalosis has been excluded. In the remaining samples, Na3Citrate contamination can only be definitively confirmed or excluded by measurement of serum citrate. We propose algorithms to identify spurious hypernatraemia.

Keywords: citrate contamination; trisodium citrate; Citra-lock; citrate lock; sample contamination; error detection
Corresponding author: Dr. Nathan Lorde, Blood Sciences, Black Country Pathology Services, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK, E-mail:

Acknowledgments

Mr Steve Harris for data extraction from the Laboratory Information Management System.

  1. Research ethics: Not applicable.

  2. Informed consent: Not applicable.

  3. Author contributions: NL, TK and RG conceptualised the project. NL conducted the experiments and wrote the first draft. NL, TK and RG edited the manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: The authors state no conflict of interest.

  6. Research funding: None declared.

  7. Data availability: The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/cclm-2024-1389).

Received: 2024-11-27
Accepted: 2025-01-19
Published Online: 2025-02-03
Published in Print: 2025-06-26

© 2025 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2024-1389
Schlagwörter für diesen Artikel
citrate contamination; trisodium citrate; Citra-lock; citrate lock; sample contamination; error detection

Artikel in diesem Heft

  1. Frontmatter
  2. Editorials
  3. The journey to pre-analytical quality
  4. Manual tilt tube method for prothrombin time: a commentary on contemporary relevance
  5. Reviews
  6. From errors to excellence: the pre-analytical journey to improved quality in diagnostics. A scoping review
  7. Advancements and challenges in high-sensitivity cardiac troponin assays: diagnostic, pathophysiological, and clinical perspectives
  8. Opinion Paper
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  10. Perspectives
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  12. Computer simulation approaches to evaluate the interaction between analytical performance characteristics and clinical (mis)classification: a complementary tool for setting indirect outcome-based analytical performance specifications
  13. Genetics and Molecular Diagnostics
  14. Artificial base mismatches-mediated PCR (ABM-PCR) for detecting clinically relevant single-base mutations
  15. Candidate Reference Measurement Procedures and Materials
  16. Antiphospholipid IgG Certified Reference Material ERM®-DA477/IFCC: a tool for aPL harmonization?
  17. General Clinical Chemistry and Laboratory Medicine
  18. External quality assessment of the manual tilt tube technique for prothrombin time testing: a report from the IFCC-SSC/ISTH Working Group on the Standardization of PT/INR
  19. Simple steps to achieve harmonisation and standardisation of dried blood spot phenylalanine measurements and facilitate consistent management of patients with phenylketonuria
  20. Inclusion of pyridoxine dependent epilepsy in expanded newborn screening programs by tandem mass spectrometry: set up of first and second tier tests
  21. Analytical performance evaluation and optimization of serum 25(OH)D LC-MS/MS measurement
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  26. Temporal dynamics in laboratory medicine: cosinor analysis and real-world data (RWD) approaches to population chronobiology
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  40. Reply to “Is this quantitative test fit-for-purpose?”
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  42. The first case of Teclistamab interference with serum electrophoresis and immunofixation
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