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Prospective Evaluation of the Rate and Impact of Hemolysis on Intraoperative Parathyroid Hormone (IOPTH) Assay Results

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Intraoperative parathyroid hormone (IOPTH) is commonly used during minimally invasive parathyroidectomy. Retrospective evidence suggested that hemolysis may artificially lower IOPTH results. Falsely decreased IOPTH measurements could result in either failed parathyroidectomy or unnecessary bilateral neck exploration.

Methods

A total of 130 IOPTH specimens from 30 patients were assayed before and after induction of mechanical hemolysis using a vortex and inert sterile glass beads. Free hemoglobin (Hg) was measured as a surrogate for extent of hemolysis. Paired sample t test was used for comparison of matched prehemolysis and posthemolysis specimens.

Results

Of the samples, 16.9% were hemolyzed at the baseline (11 of 72 pre-excision, 11 of 55 postexcision). We successfully induced moderate hemolysis (ΔHg 0.1–1.0 mg/DL) in 66 samples that had minimal hemolysis at baseline. In these, mechanical hemolysis increased free Hg by an average of 0.37 mg/DL (533%; mean posthemolysis free Hg = 0.43; moderate hemolysis) and lowered PTH values by an average of 39% (median = 36%, SD = 11%; P = .002). The decrease in PTH was related to the extent of hemolysis induced (r = 0.51; P < .001), but was unrelated to the specimen’s baseline (true) PTH (P = .24). In 12 of 30 patients, the experimentally hemolyzed pre-excision PTH value would have reduced the 50% threshold sufficiently to cause a false-negative result. In 6 of the 30 parathyroidectomies, a hemolyzed postexcision PTH value would have decreased PTH value sufficiently to cause a false-positive result.

Conclusions

Hemolysis of IOPTH specimens occurs commonly and falsely reduces PTH results. In 18 of 30 patients, this effect was sufficient to have contributed to either a false-positive or false-negative IOPTH result.

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References

  1. Kebebew E, Hwang J, Reiff E, Duh QY, Clark OH. Predictors of single-gland vs multigland parathyroid disease in primary hyperparathyroidism: a simple and accurate scoring model. Arch Surg. 2006;141:777–82; discussion 782.

    Google Scholar 

  2. Lal A, Chen H. The negative sestamibi scan: is a minimally invasive parathyroidectomy still possible? Ann Surg Oncol. 2007;14:2363–6.

    Article  PubMed  Google Scholar 

  3. Clark OH, Duh Q-Y, Kebebew E. Textbook of endocrine surgery. 2nd ed. Philadelphia: W.B. Saunders, 2005.

    Google Scholar 

  4. Nussbaum SR, Thompson AR, Hutcheson KA, Gaz RD, Wang CA. Intraoperative measurement of parathyroid hormone in the surgical management of hyperparathyroidism. Surgery. 1988;104:1121–7.

    CAS  PubMed  Google Scholar 

  5. Irvin GL, III, Dembrow VD, Prudhomme DL. Clinical usefulness of an intraoperative “quick parathyroid hormone” assay. Surgery. 1993;114:1019–22; discussion 1022–3.

    PubMed  Google Scholar 

  6. Jacobson SR, van Heerden JA, Farley DR, Grant CS, Thompson GB, Mullan BP, et al. Focused cervical exploration for primary hyperparathyroidism without intraoperative parathyroid hormone monitoring or use of the gamma probe. World J Surg. 2004;28:1127–31.

    Article  PubMed  Google Scholar 

  7. Irvin GL, III, Solorzano CC, Carneiro DM. Quick intraoperative parathyroid hormone assay: surgical adjunct to allow limited parathyroidectomy, improve success rate, and predict outcome. World J Surg. 2004;28:1287–92.

    Article  PubMed  Google Scholar 

  8. Yang GP, Levine S, Weigel RJ. A spike in parathyroid hormone during neck exploration may cause a false-negative intraoperative assay result. Arch Surg. 2001;136:945–9.

    Article  CAS  PubMed  Google Scholar 

  9. Moalem J, Ruan DT, Farkas RL, Shen WT, Gosnell JE, Miller S, et al. Hemolysis falsely decreases intraoperative parathyroid hormone levels. Am J Surg. 2009;197:222–6.

    Article  CAS  PubMed  Google Scholar 

  10. Dugan L, Leech L, Speroni KG, Corriher J. Factors affecting hemolysis rates in blood samples drawn from newly placed IV sites in the emergency department. J Emerg Nurs. 2005;31:338–45.

    Article  PubMed  Google Scholar 

  11. Hermsen D, Franzson L, Hoffmann JP, Isaksson A, Kaufman JM, Leary E, et al. Multicenter evaluation of a new immunoassay for intact PTH measurement on the Elecsys System 2010 and 1010. Clin Lab. 2002;48:131–41.

    CAS  PubMed  Google Scholar 

  12. Carling T, Udelsman R. Focused approach to parathyroidectomy. World J Surg. 2008;32:1512–7.

    Article  PubMed  Google Scholar 

  13. Gallagher SF, Denham DW, Murr MM, Norman JG. The impact of minimally invasive parathyroidectomy on the way endocrinologists treat primary hyperparathyroidism. Surgery. 2003;134:910–7; discussion 917.

    Article  PubMed  Google Scholar 

  14. Carneiro DM, Solorzano CC, Nader MC, Ramirez M, Irvin GL, III. Comparison of intraoperative iPTH assay (QPTH) criteria in guiding parathyroidectomy: which criterion is the most accurate? Surgery. 2003;134:973–9; discussion 979–81.

    Article  PubMed  Google Scholar 

  15. Weber CJ, Ritchie JC. Retrospective analysis of sequential changes in serum intact parathyroid hormone levels during conventional parathyroid exploration. Surgery. 1999;126:1139–43; discussion 1143–4.

    Article  CAS  PubMed  Google Scholar 

  16. Lokey J, Pattou F, Mondragon-Sanchez A, Minuto M, Mullineris B, Wambergue F, et al. Intraoperative decay profile of intact (1–84) parathyroid hormone in surgery for renal hyperparathyroidism—a consecutive series of 80 patients. Surgery. 2000;128:1029–34.

    Article  CAS  PubMed  Google Scholar 

  17. Horanyi J, Duffek L, Szlavik R, Darvas K, Lakatos P, Tóth M, et al. Parathyroid surgical failures with misleading falls of intraoperative parathyroid hormone levels. J Endocrinol Invest. 2003;26:1095–9.

    CAS  PubMed  Google Scholar 

  18. Woodrum DT, Saunders BD, England BG, Burney RE, Doherty GM, Gauger PG. The influence of sample site on intraoperative PTH monitoring during parathyroidectomy. Surgery. 2004;136:1169–75.

    Article  PubMed  Google Scholar 

  19. The hemolyzed specimen: causes, effects, and reduction. 2003. Accessed at http://www.bd.com/vacutainer/labnotes/pdf/Volume13Number1_VS7044.pdf.

  20. Lippi G, Salvagno GL, Montagnana M, Brocco G, Guidi GC. Influence of hemolysis on routine clinical chemistry testing. Clin Chem Lab Med. 2006;44:311–6.

    Article  CAS  PubMed  Google Scholar 

  21. Grant MS. The effect of blood drawing techniques and equipment on the hemolysis of ED laboratory blood samples. J Emerg Nurs. 2003;29:116–21.

    Article  PubMed  Google Scholar 

  22. Kennedy C, Angermuller S, King R, Noviello S, Walker J, Warden J, et al. A comparison of hemolysis rates using intravenous catheters versus venipuncture tubes for obtaining blood samples. J Emerg Nurs. 1996;22:566–9.

    Article  CAS  PubMed  Google Scholar 

  23. Cox SR, Dages JH, Jarjoura D, Hazelett S. Blood samples drawn from IV catheters have less hemolysis when 5-mL (vs 10-mL) collection tubes are used. J Emerg Nurs. 2004;30:529–33.

    Article  PubMed  Google Scholar 

  24. Laga AC, Cheves TA, Sweeney JD. The effect of specimen hemolysis on coagulation test results. Am J Clin Pathol. 2006;126:748–55.

    Article  PubMed  Google Scholar 

  25. Kirschbaumweg LT. Haemolysis as influence & interference factor. eJIFCC vol 13 no 4. Available: http://wwwifccorg/ejifcc/vol13no4/130401002htm.

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ACKNOWLEDGMENT

This study was supported in part by the Mount Zion Health Fund, the Hellen and Sanford Diller Family Foundation, the Gerold Diller Family Foundation, and the Friends of Endocrine Surgery. We would also like to thank Kristin Johansing for her assistance in gathering the clinical data. This project did not receive external financial support.

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Authors and Affiliations

  1. Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA

    Jacob Moalem MD & Rachel L. Farkas MD

  2. Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Daniel T. Ruan MD

  3. Department of Surgery, Mount Zion Medical Center, University of California, San Francisco, San Francisco, CA, USA

    Wen T. Shen MD, Quan-Yang Duh MD, FACS, Orlo H. Clark MD, FACS & Electron Kebebew MD, FACS

  4. Surgical Service, Veterans’ Affairs Medical Center, San Francisco, CA, USA

    Wen T. Shen MD & Quan-Yang Duh MD, FACS

  5. Department of Laboratory Medicine, Mount Zion Medical Center, University of California, San Francisco, San Francisco, CA, USA

    Steve Miller MD, PhD

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  1. Jacob Moalem MD
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  2. Daniel T. Ruan MD
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  3. Rachel L. Farkas MD
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  4. Wen T. Shen MD
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  6. Quan-Yang Duh MD, FACS
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  7. Orlo H. Clark MD, FACS
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  8. Electron Kebebew MD, FACS
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Correspondence to Jacob Moalem MD.

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Moalem, J., Ruan, D.T., Farkas, R.L. et al. Prospective Evaluation of the Rate and Impact of Hemolysis on Intraoperative Parathyroid Hormone (IOPTH) Assay Results. Ann Surg Oncol 17, 2963–2969 (2010). https://doi.org/10.1245/s10434-010-1161-6

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  • DOI: https://doi.org/10.1245/s10434-010-1161-6

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