Abstract
The use of contrast media such as organic iodine molecules and gadolinium contrast agents is commonplace in diagnostic imaging. Although there is widespread perception that side effects and drug interactions may be the leading problems caused by these compounds, various degrees of interference with some laboratory tests have been clearly demonstrated. Overall, the described interference for iodinate contrast media include inappropriate gel barrier formation in blood tubes, the appearance of abnormal peaks in capillary zone electrophoresis of serum proteins, and a positive bias in assessment of cardiac troponin I with one immunoassay. The interference for gadolinium contrast agents include negative bias in calcium assessment with ortho-cresolphthalein colorimetric assays and occasional positive bias using some Arsenazo reagents, negative bias in measurement of angiotensin converting enzyme (ACE) and zinc (colorimetric assay), as well as positive bias in creatinine (Jaffe reaction), total iron binding capacity (TIBC, ferrozine method), magnesium (calmagite reagent) and selenium (mass spectrometry) measurement. Interference has also been reported in assessment of serum indices, pulse oximetry and methaemoglobin in samples of patients receiving Patent Blue V. Under several circumstances the interference was absent from manufacturer-supplied information and limited to certain type of reagents and/or analytes, so that local verification may be advisable to establish whether or not the test in use may be biased. Since the elimination half-life of these compounds is typically lower than 2 h, blood collection after this period may be a safer alternative in patients who have received contrast media for diagnostic purposes.
Highlights
Total quality in laboratory diagnostics is a multifaceted and challenging enterprise, which entails standardization and monitoring of a number of activities throughout the total testing process [1]
The use of contrast media is commonplace in diagnostic imaging
A wrong test result may jeopardize patient safety to a similar extent than a mishandled therapeutic act [51], and so every possible effort should be put in place for preventing or identifying potential sources of errors throughout the total testing process
Summary
Total quality in laboratory diagnostics is a multifaceted and challenging enterprise, which entails standardization and monitoring of a number of activities throughout the total testing process [1]. Several lines of evidence attest that most laboratory errors emerge from manually intensive steps of the preanalytical phase [2,3], a variety of analytical errors may still occur in the analytical phase, which basically entail random errors during measurements, inappropriate calibration of methods, volume displacement, matrix effects, instrument carryover as well as analytical interfere nce(s) [4]. Analytical inaccuracy not recognized (e.g., release of results despite unacceptable internal quality control data due to problems in calibration-verification procedure) and instrument-caused random errors (e.g., pipetting problems, presence of interfering substances or short sampling) were found to be the most frequent mistakes in this phase of total testing process. The aim of this review is to provide an overview about the interference of medical contrast media on laboratory testing
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