title: Effect of collection and preprocessing methods on neutrophil elastase plasma concentrations.
abstract: OBJECTIVE
  Elevated plasma levels of the elastase alpha 1-proteinase inhibitor complex (E-alpha 1 PI) have been proposed as a marker of bacterial infection and neutrophil activation. Liberation of elastase from neutrophils after collection of blood may cause falsely elevated results. Collection methods have not been validated for critically ill neonates and children. We evaluated the influence of preanalytical methods on E-alpha 1 PI results including the recommended collection into EDTA tubes.
  
  
  METHODS
  First, we compared varying acceleration speeds and centrifugation times. Centrifugation at 1550 g for 3 min resulted in reliable preparation of leukocyte free plasma. Second, we evaluated all collection tubes under consideration for absorption of E-alpha 1 PI. Finally, 12 sets of samples from healthy adults and 42 sets obtained from critically ill neonates and children were distributed into the various sampling tubes. Samples were centrifuged within 15 min of collection and analyzed with a new turbidimetric assay adapted to routine laboratory analyzers.
  
  
  RESULTS
  One of the two tubes containing a plasma-cell separation gel absorbed 22.1% of the E-alpha 1 PI content. In the remaining tubes without absorption of E-alpha 1 PI no differences were observed for samples from healthy adult patients. However, in samples from critically ill neonates or children, significantly higher results were obtained for plain Li-heparin tubes (mean = 183 micrograms/L), EDTA tubes (mean = 93 micrograms/L), and citrate tubes (mean = 88.5 micrograms/L) than for the Li-hep tube with cell-plasma separation gel and no absorption of E-alpha 1 PI (mean = 62.4 micrograms/L, p < 0.01).
  
  
  CONCLUSIONS
  Contrary to healthy adults, E-alpha 1 PI results in plasma samples from critically ill neonates and children depend on the type of collection tube.
authors.affiliation: Department of Neonatal and Pediatric Intensive Care, University Children's Hospital, Zurich, Switzerland. jfischer@kispi.unizh.ch
authors.forename: J E
authors.initials: JE
authors.lastname: Fischer
authors.forename: M
authors.initials: M
authors.lastname: Janousek
authors.forename: M
authors.initials: M
authors.lastname: Fischer
authors.forename: F G
authors.initials: FG
authors.lastname: Seifarth
authors.forename: N
authors.initials: N
authors.lastname: Blau
authors.forename: S
authors.initials: S
authors.lastname: Fanconi
mesh_terms: D002648:Child; D015331:Cohort Studies; D006801:Humans; D007231:Infant, Newborn; D019272:Leukocyte Elastase / Q000097:blood*; D009504:Neutrophils / Q000201:enzymology*; D011446:Prospective Studies; D015203:Reproducibility of Results; D013048:Specimen Handling / Q000379:methods*
chemical_list: D019272:Leukocyte Elastase