Neonatal hemoglobin affects the accuracy of whole blood bilirubin measurement on GEM Premier 4000 blood gas analyzers

Abstract

Objectives Whole blood bilirubin measured on blood gas analyzers is accepted by physicians in neonatal hyperbilirubinemia management since it requires a small sample volume. The accuracy of bilirubin measurement on blood gas analyzers is instrument dependent and remains controversial. Design and Methods Bilirubin in adult and umbilical cord whole blood samples, spiked with an unconjugated bilirubin standard, and non-spiked adult plasma samples was measured on a blood gas analyzer (GEM 4000) and a Core Laboratory Chemistry analyzer (Architect c16000) respectively. We also investigated the linear regression for neonatal and adult hemoglobin measured on the blood gas analyzer and the Core Laboratory hematology analyzer (Alinity h-Series). Results Plasma bilirubin measured on the blood gas analyzer and the chemistry analyzer was statistically identical. Adult whole blood bilirubin showed slightly increased proportional bias. When umbilical cord whole blood samples were used, the Deming regression showed GEM bilirubin =1.233(Architect) (95% CI 1.199 ~ 1.266)-44.43 ​μmol/L (95% CI -53.6 ​~ ​−35.2). The regression was significantly different from that in plasma (p ​< ​0.001) or adult whole blood (p ​< ​0.001) samples. 36.1% neonatal samples with bilirubin levels >50 ​μmol/L showed that the bias% was above laboratory standards. In addition, the regression of neonatal hemoglobin measurement between the GEM and the Alinity was significantly different from adult hemoglobin (p ​< ​0.01). Conclusions Neonatal whole blood bilirubin measurement on blood gas analyzers may be affected by neonatal hemoglobin. The method should be validated using neonatal whole blood samples or samples with a similar matrix before the analyzers are implemented into neonatal hyperbilirubinemia management.

Accuracy and Reliability of Whole Blood Bilirubin Measurements Using a Roche Blood Gas Analyzer for Neonatal Hyperbilirubinemia Screening and Risk Stratification

“…Unfortunately, the reliability of hemoglobin measurement using a blood gas analyzer remains controversial (12,13). Huang et al (14) found that hemoglobin measurements using a GEM 4000 blood gas analyzer is consistent with the hematology analyzer results in adults, but a significant bias is using neonatal blood. In line with Huang's study, an experience from an NICU in Australia demonstrated that blood gas analyzer (Radiometer ABL 800 flex) results for neonatal bilirubin should be corrected according to fetal hemoglobin (HbF) values rather than adult hemoglobin measurements (15).…”

Investigating Zinc , Iron and 25-hydroxyvitamin D Levels alongside Hemoglobin status in Acute Myocardial Infarction (AMI) Patients

“…Low hemoglobin levels have been independently linked to mortality, cardiovascular events, and major bleeds in individuals with stable coronary artery disease, signifying the prognostic value of hemoglobin and its derivatives in cardiovascular health (Kalra et al, 2017 ). The determination of hemoglobin derivatives through spectrophotometric and multi-component spectrophotometric analysis provides essential insights into the biochemical pathways influencing cardiovascular disease and its outcomes (Kaewprayoon et al, 2020;Huang et al, 2021;Attia et al, 2015) Therefore, this study aims to unravel the complex interplay between electrolytes, vitamin D, and hemoglobin derivatives, shedding light on the multifaceted mechanisms underpinning cardiovascular health and disease. Understanding these intricate relationships offers a promising avenue for developing more effective strategies to combat cardiovascular diseases, enhancing patient care and outcomes in this critically important area of medical research.…”