False Negative D Vitamin Measurement in LC-MS/MS Method Due to Hyperlipidemia: Case Report

Author(s): Ataman Gonel*, Alparslan Yetisgin.

Journal Name: Combinatorial Chemistry & High Throughput Screening
Accelerated Technologies for Biotechnology, Bioassays, Medicinal Chemistry and Natural Products Research

Volume 22 , Issue 6 , 2019

Become EABM
Become Reviewer

Abstract:

Background: Lipemia can influence laboratory test results by different mechanisms. Although the liquid chromatography–tandem mass spectrometry (LC-MS/MS) is considered the reference method for 25(OH)D3, some compounds (carbohydrate, lipids, proteins, etc.) in the blood may cause a false result indicating a negative or positive deviation rate from the correct blood level of the test.

Case Report: In this paper, we report a case of D vitamin intoxication due to a false negative result caused by lipemia. A young woman with a complaint of pain in multiple joints applied to the physical therapy clinic and was found to have some cystic bone lesions. She was eventually diagnosed with DM tip 1, familial hyperlipidemia, and nephrolithiasis. Although she had D vitamin replacement therapy, low levels of blood 25(OH)D3 concentration, measured by an LC-MS/MS device, were detected. After blood dilution, a high level of 25(OH)D3 and blood intoxication due to lipid interference were indicated.

Conclusion: From this case, we can conclude that analytical errors caused by the ingredients of a blood sample may lead to unnecessary treatment and intoxication. While evaluating the blood 25(OH)D3 levels, clinicians should guard against false-negative results due to interference in patients with familial hyperlipidemia.

Keywords: D vitamin, lipemia, false result, tandem mass spectrometry, blood, case report.

[1]
Gupta, A.; Jamwal, V.; Sakul, A.; Malhotra, P. Hypervitaminosis D and systemic manifestations: A comprehensive review. JIMSA, 2014, 27(4), 236-237.
[2]
Awumey, E.M.; Mitra, D.A.; Hollis, B.W.; Kumar, R.; Bell, N.H. Vitamin D metabolism is altered in Asian Indians in the southern United States: A clinical research center study. J. Clin. Endocrinol. Metab., 1998, 83(1), 169-173.
[http://dx.doi.org/10.1210/jc.83.1.169] [PMID: 9435436]
[3]
Calmarza, P.; Cordero, J. Lipemia interferences in routine clinical biochemical tests. Biochem. Med. (Zagreb), 2011, 21(2), 160-166.
[http://dx.doi.org/10.11613/BM.2011.025] [PMID: 22135856]
[4]
Ozkan, B.; Hatun, S.; Bereket, A. Vitamin D intoxication. Turk. J. Pediatr., 2012, 54(2), 93-98.
[PMID: 22734293]
[5]
Wacker, M.; Holick, M.F.; Vitamin, D. Vitamin D-effects on skeletal and extraskeletal health and the need for supplementation. Nutrients, 2013, 5(1), 111-148.
[http://dx.doi.org/10.3390/nu5010111] [PMID: 23306192]
[6]
Burtis, C.A.; Ashwood, E.R.; Bruns, D.E. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics-e-Book; Elsevier Health Sciences, 2012.
[7]
Binkley, N.; Sempos, C.T.; Program, V.D.S.; Vitamin, D. Standardization Program (VDSP) standardizing vitamin D assays: the way forward. J. Bone Miner. Res., 2014, 29(8), 1709-1714.
[http://dx.doi.org/10.1002/jbmr.2252] [PMID: 24737265]
[8]
Kim, H-J.; Kang, J-S. Matrix effects: Hurdle for development and validation of bioanalytical LC–MS methods in biological samples analyses. Biodesign, 2016, 4(2), 46-58.
[9]
Gröber, U.; Kisters, K. Influence of drugs on vitamin D and calcium metabolism. Dermatoendocrinol, 2012, 4(2), 158-166.
[http://dx.doi.org/10.4161/derm.20731] [PMID: 22928072]
[10]
Yazdanpanah, M.; Bailey, D.; Walsh, W.; Wan, B.; Adeli, K. Analytical measurement of serum 25-OH-vitamin D3, 25-OH-vitamin D2 and their C3-epimers by LC-MS/MS in infant and pediatric specimens. Clin. Biochem., 2013, 46(13-14), 1264-1271.
[http://dx.doi.org/10.1016/j.clinbiochem.2012.11.030] [PMID: 23269360]
[11]
GönelA. 25-OH Vitamin D düzeyi ölçümünde radyoopak madde interferansının deneysel araştırılması. Harran Üniversitesi Tıp Fakültesi Dergisi, 2018, 15(3), 182-185.
[12]
Atabek, M.E.; Pirgon, O.; Sert, A. Oral alendronate therapy for severe vitamin D intoxication of the infant with nephrocalcinosis. J. Pediatr. Endocrinol. Metab., 2006, 19(2), 169-172.
[http://dx.doi.org/10.1515/JPEM.2006.19.2.169] [PMID: 16562591]
[13]
Nikolac, N. Lipemia: causes, interference mechanisms, detection and management. Biochem. Med. (Zagreb), 2014, 24(1), 57-67.
[http://dx.doi.org/10.11613/BM.2014.008] [PMID: 24627715]
[14]
Pérez-Barrios, C.; Hernández-Álvarez, E.; Blanco-Navarro, I.; Pérez-Sacristán, B.; Granado-Lorencio, F. Prevalence of hypercalcemia related to hypervitaminosis D in clinical practice. Clin. Nutr., 2016, 35(6), 1354-1358.
[http://dx.doi.org/10.1016/j.clnu.2016.02.017] [PMID: 26995293]
[15]
Tebben, P.J.; Singh, R.J.; Kumar, R. Vitamin D-mediated hypercalcemia: Mechanisms, diagnosis, and treatment. Endocr. Rev., 2016, 37(5), 521-547.
[http://dx.doi.org/10.1210/er.2016-1070] [PMID: 27588937]
[16]
Lietman, S.A.; Germain-Lee, E.L.; Levine, M.A. Hypercalcemia in children and adolescents. Curr. Opin. Pediatr., 2010, 22(4), 508-515.
[http://dx.doi.org/10.1097/MOP.0b013e32833b7c23] [PMID: 20601885]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 22
ISSUE: 6
Year: 2019
Page: [428 - 430]
Pages: 3
DOI: 10.2174/1386207322666190722155106
Price: $58

Article Metrics

PDF: 35
HTML: 2
EPUB: 1
PRC: 1