Lithium heparin interference in the Abbott enzymatic creatinine assay: the significance of under-filled tubes

Abstract

Background Spuriously high results using the Abbott Architect enzymatic creatinine assay were noted to be particularly associated with very small sample volumes. This led us to query the effect of under-filling lithium heparin tubes on the measured enzymatic creatinine result. Methods Blood was provided by 5 laboratory personnel and then decanted into 5 x1.2 mL Sarstedt S-Monovette tubes, giving final blood volumes of 200, 400, 600, 800 and 1200 μL. Plasma was analysed using Abbott Architect Jaffe, enzymatic creatinine, Beckman Coulter (AU500) enzymatic creatinine and Roche (Cobas c702) enzymatic creatinine assays. Saline was also added to Sarstedt 1.2 mL and Teklab 2 mL tubes and analysed using the Abbott Jaffe and enzymatic creatinine methods. Results Increasing degrees of under-fill were associated with greater over-estimation of creatinine using the Abbott enzymatic assay, but no difference was noted using Jaffe methodology on the same platform or enzymatic assays provided by Roche or Beckman. On average, creatinine was 40.6% (+27.7 μmol/L) higher when only 200 μL of blood was present in the tube. Small volumes of saline added to lithium heparin tubes measured significant creatinine concentrations using the Abbott enzymatic method. Conclusions Lithium heparin directly interferes in the Abbott Architect enzymatic creatinine assay. Under-filling lithium heparin tubes can lead to clinically significant over-estimation of creatinine results by this assay. Users of this assay should be aware of the potential for spurious results in small sample volumes collected into lithium heparin tubes and implement robust procedures for identifying and reporting results on these samples.

Variation of eGFR reporting and CKD equations used in the United Kingdom

“…It is worth noting that interferences have been identified for enzymatic creatinine assays, for example negative interference with elevated catecholamines 21 and spuriously high enzymatic creatinine results on the Abbott Architect system with underfilled Lithium Heparin tubes. 22 Individual specimen percentage biases are combined to form a six month average bias score (B-score) with its corresponding six month consistency of bias score (C-score). The C-score is essentially the standard deviation of the individual bias score data.…”