Hydroxocobalamin interference in routine laboratory tests: Development of a protocol for identifying samples and reporting results from patients treated with CyanokitTM |
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| Institution: | 1. Medical Laboratory Science Program, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada;2. Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada;3. Alberta Precision Laboratories, North Sector, Edmonton, Alberta, Canada;4. Misericordia Community Hospital, Laboratory Services, Edmonton, Alberta, Canada;5. Misericordia Community Hospital, Respiratory Therapy Program, Edmonton, Alberta, Canada;1. University of Maryland School of Medicine, Baltimore, MD, USA;2. University of Maryland Medical System, Linthicum, MD, USA;1. Division of Hematology/Oncology, Department of Pediatrics, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, China;2. Department of Pediatric Intensive Care Unit, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, China;3. Department of Intensive Care Unit, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou 510000, China;4. Center of Digestive Disease, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, China;1. Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA;2. School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, USA;3. Department of Pathology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA;4. Department of Pediatrics, UPMC Children''s Hospital of Pittsburgh, Pittsburgh PA, USA;5. University of Pittsburgh School of Medicine, Pittsburgh PA, USA;1. Clinical Laboratory, Hospital Universitari de Sant Joan d’Alacant, Sant Joan d’Alacant, Spain;2. Department of Clinical Medicine, Universidad Miguel Hernández, Elche, Spain;3. Department of Biochemistry and Molecular Pathology, Universidad Miguel Hernandez, Elche, Spain;4. CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain;5. Department of Radiology, University of Missouri, Columbia, MO, USA;1. Department of Laboratory Medicine, Son Espases University Hospital, Palma, Spain;2. Institut d’Investigació Sanitària de les Illes Balears (IdISBa), Spain;3. Spanish National Cancer Research Centre (CNIO), Madrid, Spain |
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| Abstract: | ObjectivesHydroxocobalamin (OHCob) is an antidote for cyanide poisoning in patients rescued from house fires and is known to cause interference with certain laboratory tests. Consensus is lacking on the extent of this interference and on how to handle these samples. The objectives of this study were to characterize OHCob interference across a wide range of laboratory tests and to develop protocols for identifying and reporting these samples.Designs & methodsPatient plasma samples (n = 5) were spiked with OHCob (1.5 mg/mL) and compared to controls without this drug. A series of analytes were measured using chemistry, urinalysis, coagulation, hematology, and blood gas instruments. Dose-response testing was performed on a subset of assays that showed interferences ≥10%.ResultsOf the 77 analytes evaluated, 27 (35%) showed interference from OHCob, with chemistry and coagulation analytes showing the greatest effects. Of those affected, 22 analytes had a positive interference, whereas 5 analytes had negative interference. Dose-response studies showed dose-dependent increases and/or decreases consistent with initial spiking studies. Although red in colour, plasma samples with OHCob did not trigger hemolysis index flags, necessitating a special sample identification and reporting protocol.ConclusionOHCob had significant effects on several analytes across different instruments. These findings led to the development of special sample handling and reporting protocols to identify OHCob samples and ensure only accurate results are released. It is vital for emergency departments to document and notify their laboratories whenever blood samples from these patients are drawn. |
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| Keywords: | Hydroxocobalamin Cyanide poisoning Analytical interference Laboratory reporting House fires Spectrophotometry Smoke inhalation |
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