Erythrocyte fraction affects red blood cell thiopurine methyltransferase activity

Red blood cell (RBC) thiopurine methyltransferase (TPMT) metabolizes the cytotoxic drugs 6-mercaptopurine and azathioprine. RBC TPMT activity has been reported to predict clinical outcome in children with acute lymphoblastic leukaemia and in kidney transplant patients. We first suspected that the erythrocyte fraction affected the calculated TPMT activity when we examined intraindividual TPMT activities in kidney transplant recipients. We demonstrated that the erythrocyte fraction affected the calculated TPMT activity, thus causing a methodological inaccuracy. A low erythrocyte fraction gave an erroneously low TPMT activity. Mean variation of 7.0% was observed within the normal limits of the haematocrit level in healthy subjects. The slopes of the TPMT activity between erythrocyte fraction 0.1 and 0.5 were all significantly different from zero, and the activity displayed good linearity from erythrocyte fraction 0.2. There was a strong association between TPMT activity and erythrocyte fraction in a population sample of children, but not in two other population samples. We propose that the TPMT assay should be performed in lysates at a standardized erythrocyte fraction to avoid variation in activity due to the range of the haematocrit in a population.