Influence of In Vitro Hemolysis on 80 Different Laboratory Tests

Yanagisawa, Yasuhiro; Isobe, Kazumasa; Naito, Asami; Ishijima, Michikuni; Nanmoku, Toru; Yamamoto, Takayuki; Suzuki, Emiko; Kawakami, Yasushi

doi:10.7754/clin.lab.2016.160305

Cited by 9 publications

(15 citation statements)

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“…Therefore, it may be related to false-positive TRAb levels. In addition, hemolysis has been reported to affect electrochemiluminescence immunoassays, which are used in third-generation TRAb test [24][25][26]. Thus, false-positive TRAb levels may also be attributed to cell-free hemoglobin in plasma, even though severe hemolysis was not found in the plasma samples used in the current report.…”

Section: Discussionmentioning

confidence: 39%

False-positive TSH receptor antibody—a pitfall of third-generation TSH receptor antibody measurements in neonates—

et al. 2018

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Abstract. Maternal Graves' disease (GD) during pregnancy may influence thyroid function in fetuses. Neonates born to mothers with high serum TSH receptor antibody (TRAb) levels have been reported to develop 'neonatal GD'. Therefore, evaluations of serum thyroid hormone and TRAb levels in neonates upon birth are crucial for a prompt diagnosis. At delivery, we measured TRAb with third-generation TRAb test using an M22 human monoclonal antibody in neonates by collecting umbilical cord blood in a blood collection tube with lithium-heparin, which provides a whole blood/plasma sample. In recent years, we have encountered positive TRAb levels (more than 2.0 IU/L) in nineteen neonates born to mothers with GD whose thyroid hormone levels were almost within the reference range and serum TRAb levels were less than 10 IU/L. All the neonates with positive TRAb levels did not exhibit thyrotoxicosis. However, when we measured TRAb levels with serum sample in six out of the nineteen cases, their serum TRAb levels were all negative, suggesting a discrepancy of TRAb levels between in lithium-heparin plasma from umbilical cord blood and serum. Moreover, this discrepancy was observed in neonates born to euthyroid mothers, adult active GD patients and healthy volunteers. Since lithium-heparin plasma from umbilical cord blood is widely used in laboratory tests at delivery, we may encounter 'false-positive' TRAb, which may, in turn, lead to a misdiagnosis of neonatal GD. This is a pitfall of third-generation TRAb measurements in neonates, particularly at delivery, and needs to be considered by obstetricians and neonatologists. natal GD'. The prevalence of neonatal GD is varying from 1.5% to 20.0% in observational cohort studies [5][6][7][8][9]. Newborns with neonatal GD are at risk for significant morbidity and mortality and need to be promptly identified and appropriately managed [5]. It has been reported a significant correlation between TRAb levels in cord blood in the newborns and those in their mothers at the third trimester of pregnancy and a good positive correlation between the TRAb levels in cord blood and the development of neonatal hyperthyroidism [10][11][12]. Therefore, evaluations of serum thyroid hormone and TRAb levels in neonates upon birth are crucial for a

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Section: Discussionmentioning

confidence: 39%

False-positive TSH receptor antibody—a pitfall of third-generation TSH receptor antibody measurements in neonates—

et al. 2018

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“…In the clinical laboratory, hemolysis interferes with the measurement of multiple biomarkers [12][13][14][15] for the following main reasons. First, the released intracellular substances from blood cells impact the progress of the assay.…”

Section: Discussionmentioning

confidence: 99%

“…As a key mediator of classic IgE-mediated anaphylaxis, IgE is often used as one of the indicators for the diagnosis of anaphylactic diseases in both clinical and forensic medicine [11]. Clinical studies have demonstrated that hemolysis interferes with the measurement of multiple indicators and that hemolyzed samples are not suitable for biochemical analysis in clinical laboratories [12][13][14][15]. However, in forensic practice, blood samples always suffer from irreversible hemolysis due to postmortem changes, even within a short postmortem interval (PMI) [16], which induces unavailable or unsuitable serum for postmortem biochemical analysis of IgE.…”

Section: Introductionmentioning

confidence: 99%

Interference of hemolysis on the postmortem biochemical analysis of IgE by ECLIA

Wang

Jia

et al. 2021

Int J Legal Med

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Forensic diagnosis of anaphylactic shock is a challenging task in forensic practice due to the lack of characteristic morphological changes. Postmortem analysis of serum IgE can provide helpful information for determining anaphylaxis. However, postmortem serum always suffers from hemolysis. To investigate the interference of hemolysis on postmortem analysis of total IgE by electrochemiluminescent immunoassay (ECLIA) and verify the suitability of the commercially available ECLIA kit for postmortem hemolyzed blood with the dilution-correction method, different levels of hemolyzed serum were prepared to evaluate the interference of hemolysis. A linear regression analysis was then performed on the concentration of total IgE in the completely hemolyzed blood and the corresponding serum. Our results indicated that hemolysis negatively interfered with the total IgE analysis by ECLIA and the interference (|Bias%|) increased with increasing levels of hemolysis. After controlling for |Bias%| by dilution, the test concentration of total IgE in the completely hemolyzed blood was still significantly lower than that in the serum (P < 0.05) and resulted in eight false-negative cases. A strong correlation was observed between the test concentration of total IgE in the completely hemolyzed blood and that in the serum (r = 0.983). After correction by the regression formula, the corrected concentration revealed no significant differences and exhibited the same diagnostic ability, compared with the serum total IgE concentration. These results indicate that the completely hemolyzed blood is not recommended for postmortem analysis of total IgE directly. The dilution-correction method might have potential utility in forensic practice for evaluating serum total IgE concentrations.

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“…As is well known, hemolysis blood sample may affect the measurement of many tests, such as serum potassium, NSE and lactate dehydrogenase (LDH), etc The hemolytic samples can be regarded as unqualified specimens and rejected. The visible hemolysis samples can be identified by machine or naked eyes easily, but if slight hemolysis could not be identified, erroneous results may lead to wrong clinical decisions.…”

Section: Discussionmentioning

confidence: 99%

Correction of serum NSE reference intervals includes the unidentified hemolysis sample: 1‐year data analysis from healthcare individuals

Xie

Zhang

et al. 2019

Clinical Laboratory Analysis

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Background Reference intervals (RIs) are important for interpretation of laboratory results. Neuron‐specific enolase (NSE) can be utilized to aid the diagnosis of various tumors. However, while red blood cells contain NSE αγ‐isozymes, unrecognized slight hemolysis will result in increasing of NSE levels in serum. The aim of this study was to correct the NSE RIs from healthcare individuals results which may have unidentified microhemolysis. Methods A total of 15 047 healthy individuals undergoing regular health care were recruited to redefine the NSE reference interval according to the CA28‐A3 document. Volunteers with NSE level between 16.3 ng/mL and the upper limit of new RIs were performed venipuncture for NSE retest. Simultaneously, serum free hemoglobin (fHb) was performed with o‐tolidine test. Results Reestablishment of NSE RIs is 0‐18.9 ng/mL, which is wider than 0‐16.3 ng/mL provided by the manufacturer. Seventy‐four volunteers with the NSE level between 16.3 and 18.9 ng/mL were performed venipuncture for NSE retest. The ratio of NSE level drop to normal is 85.1% (63/74) in the subsequent results; there are significant differences between the median NSE of two groups (18.15 vs 14.15 ng/mL). Subsequently, the fHb concentration of 22 healthy individuals from 74 individuals was measured; there are significant differences between the median fHb of two groups (58 vs 30 mg/L). Conclusions Some specimens with slightly elevated NSE may be attributed to the unrecognized slight hemolysis. The correction RIs may be expected to decrease the abnormal NSE results.

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Influence of In Vitro Hemolysis on 80 Different Laboratory Tests

Cited by 9 publications

References 0 publications

False-positive TSH receptor antibody—a pitfall of third-generation TSH receptor antibody measurements in neonates—

False-positive TSH receptor antibody—a pitfall of third-generation TSH receptor antibody measurements in neonates—

Interference of hemolysis on the postmortem biochemical analysis of IgE by ECLIA

Correction of serum NSE reference intervals includes the unidentified hemolysis sample: 1‐year data analysis from healthcare individuals

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