hydroxocobalamin and Hemolysis

Protein electrophoresis and immunofixation are subject to a variety of analytical interferences that may affect monoclonal protein diagnostics performed in the context of monoclonal gammopathies. Interferences include endogenous substances, such as hemoglobin and fibrinogen, and exogenous compounds, such as radiocontrast dyes, antibiotics, and monoclonal antibody therapies. General approaches to managing interferences begin with recognition of the problem. Provided herein are examples of common, rare, and novel interferences with the goal of providing a comprehensive overview. With each example, specific methods and strategies are provided to manage analytical interferences to ensure that interpretative reports are accurate. Longstanding and newer technologies are also described to contextualize where interferences may be identified and avoided.

Topics: Animals; Anti-Bacterial Agents; Antibodies; Antifungal Agents; Artifacts; Blood Protein Electrophoresis; Blood Proteins; Contrast Media; Fibrinogen; Hemolysis; Humans; Hydroxocobalamin

Topics: Graft Rejection; Heart Transplantation; Hemolysis; Humans; Hydroxocobalamin; Male; Middle Aged; Plasma Exchange; Vasoplegia

Cyanokit. Several pools of plasma samples spiked with increasing concentrations of OHCo were prepared. Each one was compared to the pool without interferent. Interference was considered when the bias was more than 10%. An interferograph was developed for those analytes with significant interference. The correlation between interference agent concentration and HI was calculated by Spearman correlation coefficient. We used multiple regression analysis to determine the mathematical correction for amylase, creatinine, and lactate.. We detected significant interference in the amylase, carboxyhemoglobin, creatinine, creatine kinase, bilirubin, lactate, and total protein measurement. The HI was positively correlated with OHCo concentration. Corresponding equations for estimating lactate and creatinine concentrations were obtained.. OHCo interferes with many laboratory assays in an unpredictable way making some results invalid and confounding clinical decision making. We can detect and evaluate the degree of interference with the HI. We can still estimate real creatinine and lactate levels using the regression equation obtained in this study.

Topics: Blood Chemical Analysis; Hemolysis; Humans; Hydroxocobalamin; Reproducibility of Results

Two siblings, a boy age 12 and his sister age 4 years, presented with proteinuria and hematuria, hypertension, and chronic hemolytic anemia. At age 13 years, the boy developed an episode of severe hypertensive encephalopathy and transient renal failure. Both children are attending normal school, have no neurologic symptoms, and only minimal pigmentary retinal abnormalities. Renal biopsy showed a chronic thrombotic microangiopathic nephropathy. Both patients had hyperhomocysteinemia and mild methylmalonic aciduria. Fibroblasts showed decreased cobalamin uptake, reduced methyl- and adenosyl-cobalamin formation, and deficient incorporation of formate and propionate, compatible with the Cbl-C complementation group, but milder than that found in cells from most patients. Both patients and their father carry a balanced reciprocal translocation. Parenteral hydroxycobalamin treatment reduced the homocysteine levels, and methylmalonic acid disappeared. Increasing the dosage of hydroxycobalamin from 1 to 2.5, then 5 mg daily together with betaine, further reduced homocysteine levels (boy from 118 to 23 microM and girl from 59 to 14 microM). With this treatment, hemolysis has stopped, hematuria has disappeared, proteinuria has almost normalized, and creatinine clearance has been stable. Investigations for chronic thrombotic microangiopathy should include testing for this unusual but treatable disorder, regardless of age of presentation.

Topics: Age of Onset; Child; Child, Preschool; Female; Hematinics; Hematuria; Hemolysis; Hemolytic-Uremic Syndrome; Homocysteine; Humans; Hydroxocobalamin; Kidney; Male; Methylmalonic Acid; Microcirculation; Proteinuria; Thrombosis; Vitamin B 12 Deficiency

Topics: Aerobiosis; Anaerobiosis; Bacillus cereus; Carbon Monoxide; Hemolysis; Hydroxocobalamin; Spectrophotometry; Streptococcus; Time Factors; Vitamin B 12