Effects of lipids on routine coagulation tests: Comparison of Sysmex CA1500 and CS-2100i

Anita Woolley, Steve Kitchen.

Sheffield Haemophilia and Thrombosis Centre, Sheffield, UK.

HIL Estimate Sample Information Results Summary

Background bH value
Prothrombin time
 Some blood samples containing very high levels of  3 of 20 samples failed analysis on CA1500 after
Patients samples Spiked plasma addition of lipids.
lipid cannot be analysed by some coagulation
N= 10 20  All 20 samples were successfully analysed by
analysers which employ optical endpoint detection bH range 254 - 941 635 – 747 CS2100i
 The presence of lipids in a sample increases baseline bH mean 623 706  For samples successfully analysed there were no
light scatter as measured by the CA1500 and significant differences between results before and
after addition of lipid
quantitated as the bH value.
Determination of bH value of plasma during clotting on Sysmex CA series APTT
Lipaemia Check (Chylomicronaemia)
 1 sample failed analysis on CA1500 and 3 samples
Scattered failed on CS2100i
Aim Light
Intensity
Lipaemic plasma
 All successfully analysed samples showed significant
difference
 To measure the effectiveness of the Sysmex CS-2100i 
bH Optically clear
plasma Clauss Fibrinogen
in comparison to the Sysmex CA1500 for routine  bH
 All 20 samples containing lipid failed analysis on
clotting tests in the presence of lipids both in patient CA1500
Time (during clotting measurement)
samples and plasma with lipid added. Tests/Reagents  In contrast, results were obtained for all 20 samples
Spiked samples (mean)
on CS-2100i
Prothrombin Time (PT) Innovin  There was no significant difference in successfully
PT-sec APTT-sec Fbg-g/L TT-sec
(Dade-Behring) analysed samples
Analyzers Activated Partial Actin FS
No Lipid
lipid
No Lipid
lipid
No Lipid
lipid
No Lipid
lipid Thrombin time
CS-2100i (Sysmex Corporation) Thromboplastin Time (APTT) (Dade-Behring) CS2100i 11.4 11.2 29.5 24.1 4.19 4.20 15.6 17.7  14 of 20 samples containing lipid failed analysis on
Thrombin Time (TT) Thromboclotin N= 20 20 20 17 20 20 20 20 CA1500
 A fully automated coagulation analyzer launched in  All 20 samples were successfully analysed on
(Dade-Behring) CA1500 11.4 11.3 28.4 27.1 3.96 n/c 15.0 23.0
2006 with novel features related to processing N= 20 17 20 19 20 0 20 6
CS2100i
Clauss Fibrinogen (Fbg) Thrombin Reagent
samples which contain interfering substances (Dade-Behring)  All successfully analysed samples showed
significant difference
 The instrument automatically checks test plasma Influence of Lipaemia on APTT

for the presence of haemolysis, icterus and

Method/Samples
lipaemia (so called HIL check) and flags results to Conclusion

alert the operator.
 In the presence of a high lipid content the analyser
automatically switches detection from 660 to 880nm
where interference from lipids is reduced.
CA-1500 (Sysmex Corporation)
 A fully automated coagulation analyzer in production
since the late nineties.
APTT (secs)
 Citrate samples (3ml 0.109M Becton Dickinson
Vacutainer Plus) which contained a high degree of
lipaemia visible to the naked eye were retained.
 Lipid in form of ClinOleic 20% intravenous fat
emulsion (Baxter) was added in a 1:40 dilution to a
series of 20 plasma samples. Samples were
analysed before and after lipid addition
 We measured the bH value during prothrombin times
on the Sysmex CA1500 as an indication of the
Thrombin (secs)
 We conclude that the Sysmex CS-2100i is more
tolerant of the presence of lipid than the Sysmex
CA1500 in respect of Prothrombin time and
especially thrombin time and Clauss fibrinogen
Influence of Lipaemia on thrombin times
6 samples where clotting times could be determined in measurements.
presence of gross lipaemia
 APTTs were significantly shorter in the presence
of lipid on both systems although the effect was
more marked on the Sysmex CS-2100i.

 All clotting endpoints detected by change in light
scatter monitored at 660 nm.
degree of lipaemia  In view of the effects of lipid the ability to alert the
analyser operator to the presence of lipid via a
 All samples were tested simultaneously on Sysmex
flag on the results is useful.
CS-2100i and Sysmex CA1500

Acknowledgements Sysmex Corporation for use of HIL Estimation and Lipaemia Check information