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Falsely elevated lithium levels in plasma samples obtained in lithium containing tubes

D C Lee1, M N Klachko

  • 1Medical College of Pennsylvania, Philadelphia.

Journal of Toxicology. Clinical Toxicology
|January 1, 1996
PubMed
Summary

Factitious lithium elevation in a child was linked to blood collection tubes containing lithium heparin. This method falsely increases lithium levels by approximately 1.5 mEq/L.

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Area of Science:

  • Clinical Chemistry
  • Toxicology
  • Pediatric Medicine

Background:

  • Accurate lithium level monitoring is crucial for managing bipolar disorder and preventing toxicity.
  • Standard blood collection methods are assumed to provide reliable plasma lithium concentrations.

Observation:

  • A 15-month-old child presented with delayed elevation of plasma lithium concentration.
  • This elevation was traced to the use of a speckled green top tube for blood sample collection, which contains lithium heparin.

Findings:

  • The use of lithium heparin anticoagulant in blood collection tubes can lead to factitious elevations in measured plasma lithium concentrations.
  • A follow-up study confirmed that these tubes increase lithium concentrations by approximately 1.5 mEq/L (1.5 mmol/L).

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Implications:

  • This finding highlights a critical pre-analytical variable that can affect lithium toxicity assessment.
  • Clinicians and laboratory personnel must be aware of this potential artifact to avoid misdiagnosis and inappropriate treatment adjustments.
  • Recommendations for blood collection tube selection in patients on lithium therapy may need revision.