title: Lactate measurement interference by hemoglobin-based oxygen carriers (Oxyglobin, Hemopure, and Hemolink).
abstract: We sought to determine whether hemoglobin-based oxygen carriers (HBOCs), hemoglobin glutamer-200 [bovine] (HBOC-200, Oxyglobin), hemoglobin glutamer-250 [bovine] (HBOC-201, Hemopure), and hemoglobin raffimer (Hemolink) interfere with the accuracy of lactate measurements. Combinations of concentrated L-lactate solution, HBOC, and blood or plasma with added PlasmaLyte-A were added to sample tubes to make a linear and constant increase in lactate concentration in consecutive samples. Sample lactate concentrations ranged from 5-110 mg/dL (0.6-12 mm) (physiological reference range: 5-20 mg/dL [0.56-2.2 mm]). Comparisons were made between machine measured lactate concentrations and calculated lactate concentrations. For Hb glutamer-250, the average difference between measured and calculated lactate concentrations was -5.1 mg/dL (-0.57 mm) (LX-20), with greater underestimation at larger lactate concentrations. For Hb raffimer, the average difference was -2.2 mg/dL (-0.24 mm) (LX-20). The veterinary product, Hb glutamer-200, was tested on 3 analyzers (LX-20(R), YSI 1500, and YSI 2300). The YSI 1500 was the most accurate instrument with the mean difference between measured minus calculated lactate being +1.3 mg/dL versus -2.6 mg/dL (YSI 2300) and -8.4 mg/dL (LX-20). The clinical implications of this study are that with increasing levels of an HBOC in plasma, lactate interpretation may become inaccurate, especially at larger lactate concentrations, causing underestimation of measured lactate values and possible under-treatment of the patient. Therefore, caution must be exercised when interpreting lactate results when a HBOC is present in plasma.
authors.affiliation: Departments of Anesthesiology and Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, and Department of Anesthesiology, Charles R. Drew University of Medicine and Science, Martin Luther King, Jr./Drew Medical Center, Los Angeles, California; Johns Hopkins University School of Medicine, Baltimore, Maryland; National Institute of Public Health, Cuernavaca, Mexico; Departments of Surgery and Medical Pathology, UC Davis School of Medicine; and Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Jahr
authors.forename: Stephen
authors.initials: S
authors.lastname: Osgood
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Rothenberg
authors.forename: Qiao-Ling
authors.initials: QL
authors.lastname: Li
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Butch
authors.forename: Robert
authors.initials: R
authors.lastname: Gunther
authors.forename: Anthony
authors.initials: A
authors.lastname: Cheung
authors.forename: Bernd
authors.initials: B
authors.lastname: Driessen
mesh_terms: D000818:Animals; D001802:Blood Substitutes / Q000737:chemistry*; D002417:Cattle; D006454:Hemoglobins / Q000737:chemistry; D006801:Humans; D006861:Hydrogen Peroxide / Q000737:chemistry; D019344:Lactic Acid / Q000097:blood*; D011887:Raffinose / Q000031:analogs & derivatives* / Q000737:chemistry; D019155:Veterinary Drugs
chemical_list: D001802:Blood Substitutes; D006454:Hemoglobins; C097124:O-raffinose cross-linked human hemoglobin; D019155:Veterinary Drugs; D019344:Lactic Acid; D006861:Hydrogen Peroxide; D011887:Raffinose