Hydroxocobalamin interference in routine laboratory tests: Development of a protocol for identifying samples and reporting results from patients treated with CyanokitTM

Dang, Steven; Tsui, Albert K.Y.; Herndon, Richard F.; Babiak, Cheryl; Szkotak, Artur; Füzéry, Anna K.; Raizman, Joshua E.

doi:10.1016/j.clinbiochem.2021.01.001

Cited by 7 publications

(3 citation statements)

References 23 publications

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“…The algorithm assumes that the blood sample contains predominantly normal haemoglobin A, although correction for the presence of fetal haemoglobin is possible. Structural haemoglobin variants (eg, haemoglobin M-Boston),15 certain dyshaemoglobins (eg, sulfhaemoglobin)16 and small molecules (eg, hydroxocobalamin,17 methylene blue)18 have all been reported to interfere with the internal algorithm and thereby lead to suppressed co-oximetry results with error flags. The analytical specificity for methaemoglobin is provided in the form of interference testing data but is not reported.…”

Section: Discussionmentioning

confidence: 99%

Methaemalbumin: a diagnostic surrogate for methaemoglobinaemia and treatment with red cell exchange in a patient with thalassaemia

et al. 2023

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A man in his 30s with alpha thalassaemia (four-alpha globin gene deletion) presented with 1 week of shortness of breath and 1 month of general malaise. Pulse oximetry monitoring revealed low peripheral oxygen saturation of approximately 80% despite maximal high-flow nasal cannula oxygen (fractional inspired oxygen 1.0–60 L/min flow). Arterial blood gas samples were chocolate brown in colour, with a low arterial partial pressure of oxygen of 197 mm Hg. This large oxygen saturation gap raised suspicion for methaemoglobinaemia. However, the patient’s co-oximetry results were suppressed by the blood gas analyser and delayed a definitive diagnosis. A methaemalbumin screen was sent instead, which was positive at 65 mg/L (reference interval: <3 mg/L). Treatment with methylene blue was initiated but did not result in complete resolution of cyanosis. This patient had been red cell exchange dependent since childhood for thalassaemia. Therefore, an urgent red cell exchange was initiated overnight, leading to an improvement in symptoms and interpretability of co-oximetry results. This resulted in rapid improvement without residual sequelae or complications. We conclude that a methaemalbumin screen can be used as a surrogate test for prompt confirmation of diagnosis in lieu of co-oximetry in cases of severe methaemoglobinaemia or in cases with underlying haemoglobinopathy. Red cell exchange can allow prompt methaemoglobinaemia reversal, especially if methylene blue is only partially effective.

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Section: Discussionmentioning

confidence: 99%

Methaemalbumin: a diagnostic surrogate for methaemoglobinaemia and treatment with red cell exchange in a patient with thalassaemia

et al. 2023

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“…The colorimetric changes in serum also interfere with the function of hemodialysis machines, as the pigment causes diffraction of light in the effluent path of the blood leak detector, which precludes further dialysis [21]. A recent study by Dang also highlighted the impact of hydroxocobalamin on laboratory chemistry, coagulation, and liver function testing which could adversely impact the patient [19 ▪▪ ]. These alterations are present for 72 h after administration of hydroxocobalamin.…”

Section: Burn Resuscitation: Treatment Of Cyanide Toxicitymentioning

confidence: 99%

“…Despite the paucity of randomized trials supporting its use, the administration of hydroxocobalamin for burn patients with acidosis has increased nationwide. Hydroxocobalamin, however, has several adverse effects which have implications for critical care management [19 ▪▪ ]. First, hydroxocobalamin causes a purplish/reddening of the skin and purple/red urine, making burn depth determination difficult.…”

Section: Burn Resuscitation: Treatment Of Cyanide Toxicitymentioning

confidence: 99%

Acute care for burn patients: fluids, surgery, and what else?

Palmieri

2023

Current Opinion in Critical Care

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Purpose Recently published initiatives spanning the burn care spectrum have substantially changed the standard of care in burn care. The purpose of this article is to describe new impactful concepts in burn first aid, triage, resuscitation, and treatment as well as their impact on future research. Recent findings First aid after burn injury traditionally consists of extinguishing the burn and applying dressings. Recent evidence suggests that applying 20 min of cool tap water to the burn wound in the first 3 h postburn mitigates burn injury extent. National burn center transfer criteria have been updated, impacting patient initial transfer and management. The adverse effects of hydroxocobalamin, a commonly used antidote for cyanide toxicity, have been delineated. Initial burn resuscitation recommendations for both volume and potentially fluid type are being reexamined. The emergence of innovative skin substitutes may improve burn survival by providing a physiologically stabilizing intermediate dressing. Finally, formal clinical practice guidelines for early mobility in the ICU after burn injury have been defined. Summary These changes in burn care, triage, resuscitation, and treatment have challenged traditional burn care standards, created new standards, and are the basis for future prospective randomized trials.

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Hydroxocobalamin does not interfere with high-sensitivity cardiac troponin T assay

Liu

Zha

Chen

et al. 2022

Clinical Biochemistry

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Hydroxocobalamin interference in routine laboratory tests: Development of a protocol for identifying samples and reporting results from patients treated with CyanokitTM

Cited by 7 publications

References 23 publications

Methaemalbumin: a diagnostic surrogate for methaemoglobinaemia and treatment with red cell exchange in a patient with thalassaemia

Methaemalbumin: a diagnostic surrogate for methaemoglobinaemia and treatment with red cell exchange in a patient with thalassaemia

Acute care for burn patients: fluids, surgery, and what else?

Hydroxocobalamin does not interfere with high-sensitivity cardiac troponin T assay

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