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Oak Ridge Conference |
Departments of
1
Pathology, Box 8118, and
2
Anesthesiology, Box 8054, Washington University School of Medicine, and
3
Department of Laboratories, Barnes-Jewish Hospital, 660 S. Euclid Ave., St. Louis, MO 63110.
4
Biopure Corp., Cambridge, MA.
5
Alliance Pharmaceutical Corp., San Diego, CA.
a Author for correspondence. Fax 314-362-1461; e-mail mscott{at}labmed.wustl.edu
Abstract
Polymerized hemoglobin solutions (Hb-based oxygen carriers; HBOCs) and a second-generation perfluorocarbon (PFC) emulsion (Perflubron) are in clinical trials as temporary oxygen carriers ("blood substitutes"). Plasma and serum samples from patients receiving HBOCs look markedly red, whereas those from patients receiving PFC appear to be lipemic. Because hemolysis and lipemia are well-known interferents in many assays, we examined the effects of these substances on clinical chemistry, immunoassay, therapeutic drug, and coagulation tests. HBOC concentrations up to 50 g/L caused essentially no interference for Na, K, Cl, urea, total CO2, P, uric acid, Mg, creatinine, and glucose values determined by the Hitachi 747 or Vitros 750 analyzers (or both) or for immunoassays of lidocaine, N-acetylprocainamide, procainamide, digoxin, phenytoin, quinidine, or theophylline performed on the Abbott AxSym or TDx. Gentamycin and vancomycin assays on the AxSym exhibited a significant positive and negative interference, respectively. Immunoassays for TSH on the Abbott IMx and for troponin I on the Dade Stratus were unaffected by HBOC at this concentration. Tests for total protein, albumin, LDH, AST, ALT, GGT, amylase, lipase, and cholesterol were significantly affected to various extents at different HBOC concentrations on the Hitachi 747 and Vitros 750. The CK-MB assay on the Stratus exhibited a negative interference at 5 g/L HBOC. HBOC interference in coagulation tests was method-dependent—fibrometer-based methods on the BBL Fibro System were free from interference, but optical-based methods on the MLA 1000C exhibited interferences at 20 g/L HBOC. A 1:20 dilution of the PFC-based oxygen carrier (600 g/L) caused no interference on any of these chemistry or immunoassay tests except for amylase and ammonia on the Vitros 750 and plasma iron on the Hitachi 747.
The following articles in journals at HighWire Press have cited this article:
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  S. Neragi-Miandoab and G.J. Vlahakes Elevated troponin I level with hemoglobin based oxygen carrying solutions (HBOCs) as a priming solution despite improved left ventricular function Interactive CardioVascular and Thoracic Surgery, April 1, 2006; 5(2): 135 - 138. [Abstract] [Full Text] [PDF]
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 J. S. Jahr, S. Osgood, S. J. Rothenberg, Q.-L. Li, A. W. Butch, R. Gunther, A. Cheung, and B. Driessen Lactate Measurement Interference by Hemoglobin-Based Oxygen Carriers (Oxyglobin(R), Hemopure(R), and HemolinkTM) Anesth. Analg., February 1, 2005; 100(2): 431 - 436. [Abstract] [Full Text] [PDF]
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M. F. James, H. E. Potgieter, and P. Ellis The Effect of Hemopure(R) on Coagulation in Clinically Relevant Concentrations Anesth. Analg., December 1, 2004; 99(6): 1593 - 1597. [Abstract] [Full Text] [PDF]
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A. A. Ali, G. S. Ali, J. M. Steinke, and A. P. Shepherd Co-Oximetry Interference by Hemoglobin-Based Blood Substitutes Anesth. Analg., April 1, 2001; 92(4): 863 - 869. [Abstract] [Full Text] [PDF]
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 M. F. O'Connor and J. L. Apfelbaum Update on Transfusion Therapy Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 2000; 4(4): 236 - 243. [Abstract] [PDF]
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P. T. Leese, R. J. Noveck, J. S. Shorr, C. M. Woods, K. E. Flaim, and P. E. Keipert Randomized Safety Studies of Intravenous Perflubron Emulsion. I. Effects on Coagulation Function in Healthy Volunteers Anesth. Analg., October 1, 2000; 91(4): 804 - 811. [Abstract] [Full Text] [PDF]
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 J. J. Chance, E. J. Norris, and M. H. Kroll Mechanism of Interference of a Polymerized Hemoglobin Blood Substitute in an Alkaline Phosphatase Method Clin. Chem., September 1, 2000; 46(9): 1331 - 1337. [Abstract] [Full Text] [PDF]
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 J. Mullon, G. Giacoppe, C. Clagett, D. McCune, and T. Dillard Transfusions of Polymerized Bovine Hemoglobin in a Patient with Severe Autoimmune Hemolytic Anemia N. Engl. J. Med., June 1, 2000; 342(22): 1638 - 1643. [Full Text] [PDF]
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O. Y. Cuignet, B. L. Wood, W. L. Chandler, and B. D. Spiess A Second-Generation Blood Substitute (Perfluorodichlorooctane Emulsion) Generates Spurious Elevations in Platelet Counts from Automated Hematology Analyzers Anesth. Analg., March 1, 2000; 90(3): 517 - 522. [Abstract] [Full Text] [PDF]
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L. T. Goodnough, M. E. Brecher, M. H. Kanter, and J. P. AuBuchon Transfusion Medicine -- Blood Conservation- Second of Two Parts N. Engl. J. Med., February 18, 1999; 340(7): 525 - 533. [Full Text] [PDF]
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S. C. Kazmierczak, P. G. Catrou, and D. Boudreau Simplified interpretative format for assessing test interference: studies with hemoglobin-based oxygen carrier solutions Clin. Chem., November 1, 1998; 44(11): 2347 - 2352. [Abstract] [Full Text] [PDF]
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A. P. Shepherd and J. M. Steinke CO-Oximetry interference by perflubron emulsion: comparison of hemolyzing and nonhemolyzing instruments Clin. Chem., October 1, 1998; 44(10): 2183 - 2190. [Abstract] [Full Text] [PDF]
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M. G. Scott, D. F. Kucik, L. T. Goodnough, and T. G. Monk Blood substitutes: evolution and future applications Clin. Chem., September 1, 1997; 43(9): 1724 - 1731. [Abstract] [Full Text] [PDF]
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