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IgM paraprotein interference with hemoglobin measurement using the CELL-DYN 3500.

Stephanie C Corn¹, Maxey L Wellman, Mary Jo Burkhard

¹Department of Veterinary Biosciences, The Ohio State University, 125 Coffey Road, Columbus, OH 43210, USA.

Veterinary Clinical Pathology

|March 28, 2008

Summary

A Labrador Retriever with lymphoma and IgM monoclonal gammopathy showed falsely high hemoglobin and MCHC values due to paraprotein precipitation in one blood analyzer. This highlights the need to consider paraprotein interference in veterinary diagnostics.

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Area of Science:

Veterinary Hematology
Clinical Pathology
Canine Lymphoma

Background:

Monoclonal gammopathy, characterized by an overproduction of a single immunoglobulin type, can occur in dogs with lymphoid malignancies like lymphoma.
Accurate complete blood count (CBC) parameters, including hemoglobin (HGB) and mean corpuscular hemoglobin concentration (MCHC), are crucial for diagnosis and monitoring.
Different automated hematology analyzers employ varying methodologies for cell lysis and parameter measurement, potentially leading to interferences.

Observation:

A 10-year-old Labrador Retriever with confirmed B-cell lymphoma and IgM monoclonal gammopathy presented with clinical signs including polyuria, polydipsia, and weakness.
A significant discrepancy in HGB and MCHC values was noted between two automated analyzers: CELL-DYN 3500 and IDEXX LaserCyte.
The CELL-DYN 3500 yielded markedly elevated HGB and MCHC, inconsistent with the patient's clinical condition and the LaserCyte's results.

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Findings:

Investigating the HGB/MCHC discrepancy revealed that the CELL-DYN analyzer's lyzing reagent, containing quaternary ammonium salts, caused precipitation of the patient's IgM paraprotein.
This paraprotein precipitation led to a falsely elevated spectrophotometric HGB measurement on the CELL-DYN, consequently inflating the MCHC value.
The IDEXX LaserCyte, using a hypotonic lysis method, did not exhibit this interference, providing more accurate HGB results.

Implications:

Paraprotein interference, specifically IgM precipitation, can significantly artifactually elevate HGB and MCHC readings on certain hematology analyzers.
Veterinary clinicians should be aware of potential analytical interferences in patients with monoclonal gammopathies.
Careful interpretation of CBC results in conjunction with clinical signs and consideration of the analyzer's methodology are essential for accurate diagnosis and patient management.