title: Correction of patient results for Beckman Coulter LX-20 assays affected by interference due to hemoglobin, bilirubin or lipids: a practical approach.
abstract: The influence of interference by hemolysis, icterus and lipemia on the results of routine chemistries may lead to wrong interpretations. On Synchron LX-20 instruments (Beckman Coulter) serum or plasma indices can be used as reliable semi-quantitative measures of the magnitude of such interference. In an article recently published in this journal, we presented the results of a multicenter study carried out in Dutch hospitals in which we determined cutoff indices for analytes above which analytically significant interference exists. Clinically significant interference cutoff indices were also derived for these analytes. In this article, we describe the handling of patient samples with clinically significant interference by hemolysis, icterus or lipemia. We investigated several possible approaches for correction of the result: dilution of the interference; mathematical correction in the case of hemolysis; treatment with ferrocyanide to destroy bilirubin; and removal of lipids in lipemic patient samples. We concluded, that mathematical correction of potassium or lactate dehydrogenase results in hemolytic samples can only be carried out if intravascular hemolysis is ruled out. Hemoglobin quantification in serial patient samples, combined with measurement of haptoglobin, represents a useful tool to rule out in vivo hemolysis. We derived an algorithm for this situation. We do not simply recommend mathematical correction, unless it is clinically acceptable. We present formulas for potassium and lactate dehydrogenase: corrected potassium=measured potassium-(hemolytic index increment x 0.14); corrected lactate dehydrogenase=measured lactate dehydrogenase-(hemolytic index increment x 75). The dilution studies indicated that dilution is only applicable for bilirubin, C-reactive protein and iron. The results of treatment with ferrocyanide were poor, and we do not recommend this method. Removal of lipids using high-speed centrifugation or LipoClear (StatSpin Inc.), a non-toxic and non-ionic polymer, is a very effective approach, although C-reactive protein, creatine kinase-MB (CK-MB) and cholesterol cannot be removed using LipoClear. For all interferants (hemoglobin, bilirubin, lipids), relatively simple algorithms are derived that can easily be implemented in the clinical laboratory.
authors.affiliation: Department of Clinical Chemistry and Hematology, Haga Hospital, The Hague, The Netherlands. evermeer@zhh.nl
authors.forename: Henricus J
authors.initials: HJ
authors.lastname: Vermeer
authors.forename: Gerard
authors.initials: G
authors.lastname: Steen
authors.forename: André J M
authors.initials: AJ
authors.lastname: Naus
authors.forename: Berrie
authors.initials: B
authors.lastname: Goevaerts
authors.forename: Pauline T
authors.initials: PT
authors.lastname: Agricola
authors.forename: Christian H H
authors.initials: CH
authors.lastname: Schoenmakers
mesh_terms: D001663:Bilirubin / Q000097:blood*; D001681:Biological Assay; D001774:Blood Chemical Analysis / Q000295:instrumentation / Q000592:standards*; D006454:Hemoglobins / Q000378:metabolism*; D006461:Hemolysis; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood; D007565:Jaundice / Q000097:blood; D008055:Lipids / Q000097:blood*; D015203:Reproducibility of Results
chemical_list: D006454:Hemoglobins; D008055:Lipids; D001663:Bilirubin