Analytical interference of HBOC-201 (Hemopure, a synthetic hemoglobin-based oxygen carrier) on four common clinical chemistry platforms

• Published in: Clinica chimica acta 2018-07, Vol.482, p.33-39
• Main Authors: Korte, Erik A., Pozzi, Nicole, Wardrip, Nina, Ayyoubi, M.Tayyeb, Jortani, Saeed A.
• Format: Article
• Language: English
• Subjects: Absorbance; Anemia; Bias; Extracellular hemoglobin; Hemoglobin-based oxygen carrier; Hemopure; Interference; Transfusion
• ISSN: 0009-8981; 1873-3492
• DOI: 10.1016/j.cca.2018.03.017

There are 13 million blood transfusions each year in the US. Limitations in the donor pool, storage capabilities, mass casualties, access in remote locations and reactivity of donors all limit the availability of transfusable blood products to patients. HBOC-201 (Hemopure®) is a second-generation glutaraldehyde-polymer of bovine hemoglobin, which can serve as an “oxygen bridge” to maintain oxygen carrying capacity while transfusion products are unavailable. Hemopure presents the advantages of extended shelf life, ambient storage, and limited reactive potential, but its extracellular location can also cause significant interference in modern laboratory analyzers similar to severe hemolysis. Observed error in 26 commonly measured analytes was determined on 4 different analytical platforms in plasma from a patient therapeutically transfused Hemopure as well as donor blood spiked with Hemopure at a level equivalent to the therapeutic loading dose (10% v/v). Significant negative error ratios >50% of the total allowable error (>0.5tAE) were reported in 23/104 assays (22.1%), positive bias of >0.5tAE in 26/104 assays (25.0%), and acceptable bias between −0.5tAE and 0.5tAE error ratio was reported in 44/104 (42.3%). Analysis failed in the presence of Hemopure in 11/104 (10.6%). Observed error is further subdivided by platform, wavelength, dilution and reaction method. Administration of Hemopure (or other hemoglobin-based oxygen carriers) presents a challenge to laboratorians tasked with analyzing patient specimens. We provide laboratorians with a reference to evaluate patient samples, select optimal analytical platforms for specific analytes, and predict possible bias beyond the 4 analytical platforms included in this study. •Hemoglobin-based oxygen carriers allow oxygenation when transfusion is unavailable.•Cell-free hemoglobin can interfere with many modern laboratory analyzers.•HBOCs cause both positive and negative analytical interference at therapeutic doses.•Published interferences of common analytes and methods can guide laboratorians.