Interference of Methylene Blue with CO-Oximetry of Hemoglobin Derivatives

Gourlain, H.; Buneaux, F; Borron, Stephen W.; Gouget, Bernard; Levillain, P.

doi:10.1093/clinchem/43.6.1078

Cited by 23 publications

(11 citation statements)

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“…It is difficult to extrapolate the result to cases in other institutions because of the differences in the algorithms used by various analysers. A similar interference study performed with methylene blue and various cooximeters demonstrated both positive and negative interference depending on the system used (9). Our findings concerning isosulfan blue are consistent with these earlier findings; one machine reported methemoglobinemia but the other did not.…”

Section: Discussionsupporting

confidence: 91%

“…The visible absorption spectrum for isosulfan blue (50 mg l −1 in a 0.01 m phosphate‐buffered solution, pH = 7) was obtained using a Shimadzu 1601 spectrophotometer (Shimadzu Scientific Instruments, Inc., Columbia, MD, USA). This spectrum was superimposed on a published spectrum for metHb (9), and the comparison clearly demonstrated peaks overlying those that would be used for metHb analysis (Figure 2). The manufacturer of the Bayer Rapidlab 845 analyser declined to report the actual wave lengths used in their software, however after the manufacturer's representatives reviewed the spectrum, they verified that metHb values would probably be falsely elevated if isosulfan blue is present in the sample.…”

Section: Discussionmentioning

confidence: 99%

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Isosulfan blue causes factitious methemoglobinemia in an infant¹

Burgoyne¹,

Jay

Bikhazi³

et al. 2005

Pediatric Anesthesia

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A 9 month-old girl was given subcutaneous isosulfan blue to outline lymphatic channels during surgery for thoracic duct ligation. Her pulse oximetry values rapidly declined to a nadir of 85%, 35 min after dye injection. Arterial blood gases revealed methemoglobinemia ([MetHb] = 6.5%). Although abnormal pulse oximetry has already been reported in association with isosulfan blue, methemoglobinemia has not previously been reported. The absorption spectrum for isosulfan blue was determined and when superimposed on that of methemoglobin it was found to have an overlying peak. Interference by the dye was postulated to have caused the abnormal methemoglobin result. The phenomenon was simulated in vitro by adding isosulfan blue to whole blood, and analysing it in the same blood gas analyser as was used for the case, as well as another for comparison. One blood gas analyser reported elevated methemoglobin concentration and the other did not. The samples were sent to a reference laboratory using a chemical method to detect methemoglobin to confirm that the elevated methemoglobin level was spurious.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Isosulfan blue causes factitious methemoglobinemia in an infant¹

Burgoyne¹,

Jay

Bikhazi³

et al. 2005

Pediatric Anesthesia

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“…Since protein and lipid may have divergent effects on the accuracy of different measurements certain parameters pending the type of blood gas analyzer used should have been performed in order to assess for any contribution to variability between the 3 analyzers. Sample lipemia or the presence of methylene blue in the sample have been demonstrated to potentially influence the measurement of hemoglobin and the percentage saturation of Hb with O 2 [30,31]. Unfortunately, hemoglobin and SO 2 data were not analyzed in the present study.…”

Section: Discussionmentioning

confidence: 99%

Comparison of two portable clinical analyzers to one stationary analyzer for the determination of blood gas partial pressures and blood electrolyte concentrations in horses

et al. 2019

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Portable blood gas analyzers are used to facilitate diagnosis and treatment of disorders related to disturbances of acid-base and electrolyte balance in the ambulatory care of equine patients. The aim of this study was to determine whether 2 portable analyzers produce results in agreement with a stationary analyzer. Blood samples from 23 horses hospitalized for various medical reasons were included in this prospective study. Blood gas analysis and electrolyte concentrations measured by the portable analyzers VetStat and epoc were compared to those produced by the cobas b 123 analyzer via concordance analysis, Passing-Bablok regression and Bland-Altman analysis. Limits of agreement indicated relevant bias between the VetStat and cobas b 123 for partial pressure of oxygen (pO 2 ; 27.5–33.8 mmHg), sodium ([Na + ]; 4.3–21.6 mmol/L) and chloride concentration ([Cl - ]; 0.3–7.9 mmol/L) and between the epoc and cobas b 123 for pH (0.070–0.022), partial pressure of carbon dioxide (pCO 2 ; 3.6–7.3 mmHg), pO 2 (36.2–32.7 mmHg) and [Na + ] (0.38.1 mmol/L). The VetStat analyzer yielded results that were in agreement with the cobas b 123 analyzer for determination of pH, pCO 2 , bicarbonate ([HCO 3 - ]) and potassium concentration [K + ], while the epoc analyzer achieved acceptable agreement for [HCO 3 - ] and [K + ]. The VetStat analyzer may be useful in performing blood gas analysis in equine samples but analysis of [Na + ], [Cl - ] and pO 2 should be interpreted with caution. The epoc delivered reliable results for [HCO 3 - ] and [K + ], while results for pH, pCO2, pO2 and [Na + ] should be interpreted with caution.

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“…the same region as the haemoglobin derivatives). Gourlaine et al 58 evaluated the e¡ect of methylene blue on the measurement of COHb and methaemoglobin in blood by six types of CO-oximeters and concluded that it was not safe to use CO-oximetry to evaluate the e¤cacy of treating methaemoglobinaemia with methylene blue. However, marked di¡erences were also found for COHb measurements.…”

Section: Automated Differential Spectrophotometry: Co-oximetersmentioning

confidence: 99%

Analysis of carbon monoxide

Widdop

2002

Ann Clin Biochem

100

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The degree of exposure to carbon monoxide is most often assessed by measuring the blood carboxyhaemoglobin saturation. This measurement is relevant to investigations of acute accidental or deliberate poisoning and of chronic exposure in a domestic or work place environment. Simple spectrophotometric methods based on differential protein precipitation or dithionite reduction are prone to interference from other haemoglobin pigments and are imprecise for low-level estimations. Automated spectrophotometric devices (CO-oximeters) that estimate simultaneously total haemoglobin, percentage oxyhaemoglobin and percentage carboxyhaemoglobin have acceptable accuracy for carboxyhaemoglobin saturation levels of 45% and are recommended for most clinical purposes. For the investigation of low-level exposure and the detection of increased haemolysis in neonates, more sensitive methods involving the release of carbon monoxide and its measurement by gas chromatography are required. Gas chromatographic methods are also appropriate when examining post-mortem blood samples where putrefaction or heat stress has resulted in a signi cant change in haemoglobin composition.

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Interference of Methylene Blue with CO-Oximetry of Hemoglobin Derivatives

Cited by 23 publications

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Isosulfan blue causes factitious methemoglobinemia in an infant¹

Isosulfan blue causes factitious methemoglobinemia in an infant¹

Comparison of two portable clinical analyzers to one stationary analyzer for the determination of blood gas partial pressures and blood electrolyte concentrations in horses

Analysis of carbon monoxide

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Interference of Methylene Blue with CO-Oximetry of Hemoglobin Derivatives

Cited by 23 publications

References 0 publications

Isosulfan blue causes factitious methemoglobinemia in an infant1

Isosulfan blue causes factitious methemoglobinemia in an infant1

Comparison of two portable clinical analyzers to one stationary analyzer for the determination of blood gas partial pressures and blood electrolyte concentrations in horses

Analysis of carbon monoxide

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Isosulfan blue causes factitious methemoglobinemia in an infant¹

Isosulfan blue causes factitious methemoglobinemia in an infant¹