Hemolysis Index to Detect Degree of Hydroxocobalamin Interference with Common Laboratory Tests

Overview

Journal J Clin Lab Anal

Publisher Wiley

Specialties Biomedical Engineering
Biotechnology
Pathology

Date 2016 Nov 19

PMID 27859624

Citations 2

Authors

Laura Fueyo

Juan Robles

Irene Aguilar

Aina M Yanez

Magdalena Socias

Magdalena Parera

Affiliations

Soon will be listed here.

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.

Citing Articles

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References

Curry S, Connor D, Raschke R . Effect of the cyanide antidote hydroxocobalamin on commonly ordered serum chemistry studies. Ann Emerg Med. 1994; 24(1):65-7. DOI: 10.1016/s0196-0644(94)70164-4. View

Borron S, Baud F, Barriot P, Imbert M, Bismuth C . Prospective study of hydroxocobalamin for acute cyanide poisoning in smoke inhalation. Ann Emerg Med. 2007; 49(6):794-801, 801.e1-2. DOI: 10.1016/j.annemergmed.2007.01.026. View

Gourlain H, Caliez C, Laforge M, Buneaux F, P Levillain . Study of the mechanisms involved in hydroxocobalamin interference with determination of some biochemical parameters. Ann Biol Clin (Paris). 1994; 52(2):121-4. View

Forsyth J, Mueller P, Becker C, Osterloh J, Benowitz N, Rumack B . Hydroxocobalamin as a cyanide antidote: safety, efficacy and pharmacokinetics in heavily smoking normal volunteers. J Toxicol Clin Toxicol. 1993; 31(2):277-94. DOI: 10.3109/15563659309000395. View

Vest P, Renaudeau C, Tellal S, Ragot C, Renard C . [Interference of hydroxocobalamine treatment on commun biochemical determinations]. Ann Biol Clin (Paris). 2002; 60(1):57-64. View

Benner J, Lawrence D, Brady W . Smoke signals. Recognition and treatment of combustion-induced cyanide toxicity. JEMS. 2009; 34(10):56-63. DOI: 10.1016/S0197-2510(09)70242-6. View

Houeto P, Buneaux F, Galliot-Guilley M, Baud F, P Levillain . Determination of hydroxocobalamin and cyanocobalamin by derivative spectrophotometry in cyanide poisoning. J Anal Toxicol. 1994; 18(3):154-8. DOI: 10.1093/jat/18.3.154. View

Carlsson C, Hansen H, Hilsted L, Malm J, Odum L, Szecsi P . An evaluation of the interference of hydroxycobalamin with chemistry and co-oximetry tests on nine commonly used instruments. Scand J Clin Lab Invest. 2011; 71(5):378-86. DOI: 10.3109/00365513.2011.573573. View

Borron S . Recognition and treatment of acute cyanide poisoning. J Emerg Nurs. 2006; 32(4 Suppl):S12-8. DOI: 10.1016/j.jen.2006.05.011. View

10.

Ranjitkar P, Greene D . Therapeutic concentrations of hydroxocobalamin interferes with several spectrophotometric assays on the Beckman Coulter DxC and AU680 chemistry analyzers. Clin Chim Acta. 2015; 450:110-4. DOI: 10.1016/j.cca.2015.07.024. View

11.

Baud F, Borron S, Megarbane B, Trout H, Lapostolle F, Vicaut E . Value of lactic acidosis in the assessment of the severity of acute cyanide poisoning. Crit Care Med. 2002; 30(9):2044-50. DOI: 10.1097/00003246-200209000-00015. View

12.

Beckerman N, Leikin S, Aitchinson R, Yen M, Wills B . Laboratory interferences with the newer cyanide antidote: hydroxocobalamin. Semin Diagn Pathol. 2009; 26(1):49-52. DOI: 10.1053/j.semdp.2008.12.008. View

13.

Lippi G, Salvagno G, Blanckaert N, Giavarina D, Green S, Kitchen S . Multicenter evaluation of the hemolysis index in automated clinical chemistry systems. Clin Chem Lab Med. 2009; 47(8):934-9. DOI: 10.1515/CCLM.2009.218. View

14.

Lee J, Mukai D, Kreuter K, Mahon S, Tromberg B, Brenner M . Potential interference by hydroxocobalamin on cooximetry hemoglobin measurements during cyanide and smoke inhalation treatments. Ann Emerg Med. 2007; 49(6):802-5. DOI: 10.1016/j.annemergmed.2006.11.016. View

15.

Kroll M, Ruddel M, Blank D, Elin R . A model for assessing interference. Clin Chem. 1987; 33(7):1121-3. View