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Icteria interference for 34 clinical chemistry analytes on different analytical platforms: Method or analyzer
Alen Vrtaric1, Marijana Miler1, Nora Nikolac Gabaj2
1Working Group for Preanalytical Phase of the Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia; Department of Clinical Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia.
Insights
Icterus interference in clinical chemistry testing varies by analytical platform and method. Some interferences, like those affecting triglycerides, cholesterol, and urate, are more sensitive to bilirubin concentration across analyzers.
Area of Science:
- Clinical Chemistry
- Laboratory Medicine
- Analytical Toxicology
Background:
- Bilirubin, a common byproduct of heme metabolism, can interfere with laboratory assays.
- Icterus, characterized by elevated bilirubin levels, poses a diagnostic challenge in clinical chemistry.
- Understanding interference patterns is crucial for accurate patient results.
Purpose of the Study:
- To evaluate the impact of increasing bilirubin concentrations on 34 clinical chemistry analytes.
- To determine if icterus interference is dependent on the analytical platform and method used.
- To compare interference patterns across four different analytical platforms.
Main Methods:
- A pooled serum sample was spiked with bilirubin to create icteric samples.
- Measurements of 34 analytes were performed in duplicate on four analytical platforms.
- Bias was calculated against non-icteric samples and compared to External Quality Assurance criteria.
Main Results:
- Most analytes showed minimal interference from icterus.
- Triglycerides, cholesterol, and urate exhibited the highest sensitivity to bilirubin interference.
- Interference patterns varied significantly across different analytical platforms.
Conclusions:
- Icterus interference is not uniform across all clinical chemistry assays.
- Analyzer-specific differences in interference were observed, even with identical analytical methods.
- Method and analyzer choice are critical factors in mitigating icterus interference.
Objectives:
In this study, we aimed to investigate the effect of increasing bilirubin concentration on 34 commonly measured clinical chemistry analytes on four different analytical platforms. We hypothesized that differences in icteria interference are not only method dependent, but also analyzer dependent.
Methods:
Serum pool was prepared using leftover samples after routine laboratory blood testing. Serum pool was then spiked with dissolved bilirubin stock. Measurements were performed on all four locations at the same time. All measurements were done in duplicate. Mean value was calculated as: (value1 + value2)/2. Those values were multiplied by corresponding dilution factors obtained during the preparation of icteric samples. For each icteric sample (Ix), bias against native (I0) sample was calculated as ((value Ix- valueI0)/ valueI0) × 100 %. Bias was calculated with actual average values. Obtained bias values were compared against acceptance criteria according to External quality assurance (EQA) providers. Difference in bilirubin concentration across platforms was tested using Friedman ANOVA. P values < 0.05 were considered statistically significant. Data are collected and analyzed in MS Excel 2016 (Microsoft, Redmond, Washington) and MedCalc® Statistical Software version 20.015 (MedCalc Software Ltd, Ostend, Belgium).
Results:
Many of the tested parameters demonstrated low sensitivity to icterus interference. The highest sensitivity to icterus was observed for triglycerides, cholesterol, and urate.
Conclusions:
Our results indicate that while some common icteric interferences were consistent across all tested platforms, others were specific to the analyzer used, even when employing the same analytical methods.
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