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False decrease of high-sensitivity cardiac troponin T assay in pneumatic tube system samples.

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Pneumatic tube systems (PTS) can increase specimen hemolysis, potentially leading to falsely decreased high-sensitivity cardiac troponin T (hs-cTnT) levels. Clinicians should consider sample hemolysis in hs-cTnT assays when free hemoglobin is 50 mg/dL or higher.

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Area of Science:

  • Clinical Chemistry
  • Laboratory Medicine
  • Biomarker Analysis

Background:

  • Pneumatic tube systems (PTS) are common in clinical laboratories for specimen transport.
  • The impact of PTS on high-sensitivity cardiac troponin T (hs-cTnT) assay accuracy requires evaluation.

Purpose of the Study:

  • To assess the effects of PTS transport on hs-cTnT assay results.
  • To determine the relationship between specimen hemolysis and hs-cTnT measurements.

Main Methods:

  • Hemolysis index (HI) was used to quantify hemolysis in PTS specimens from the emergency department (ED).
  • Samples from healthy volunteers were transported via manual delivery (MD) or PTS.
  • Interference studies evaluated the influence of varying hemolysis levels on hs-cTnT assays.

Main Results:

  • 7.26% of ED PTS specimens exhibited hemolysis.
  • PTS samples showed significantly higher free plasma hemoglobin (Hb) compared to MD samples.
  • Hs-cTnT demonstrated a negative interference with free Hb (R = -0.625, P < .001), confirmed in interference studies (R ≥ -0.820, P ≤ .001).
  • Clinically significant bias in hs-cTnT was observed at 100 mg/dL free Hb (Bias ≥ -13.85%, P < .05).
  • At 50 mg/dL free Hb, hs-cTnT assay bias approached 10%, particularly at 30 ng/L hs-cTnT concentration (Bias: -11.72%, P < .001).

Conclusions:

  • PTS transport can increase specimen hemolysis, potentially causing a false decrease in hs-cTnT assay results.
  • Clinicians must be aware of potential measurement bias in hs-cTnT assays from hemolyzed PTS samples with free Hb ≥ 50 mg/dL.