Wood W G, Kress M, Meissner D, Hanke R, Reinauer H
Institute for Standardisation and Documentation in the Medical Laboratory (INSTAND), Reference Laboratories, Düsseldorf, Germany.
Clin Lab. 2001;47(5-6):279-88.
The aim of the study was to develop a method for the determination of haemoglobin in plasma suitable for use to set target values for external quality assessment schemes for this analyte using commercially available test kits and equipment. In the early phase of the method development it became clear that the use of a single method, namely HPLC, would not be possible. However, by combining HPLC and absorption spectrophotometry, both qualitative and quantitative rapid determinations of protein-bound and free haemoglobin were able to be performed on equipment present in most routine clinical chemistry laboratories. The separation of protein-bound and free haemoglobin could be carried out using commercial HPLC equipment for the determination of haemoglobin A1c (HbA1c) without modification of the conditions used. Instead of haemolysed blood, the same volume of plasma (10 microl) was injected. The eluate was not discarded, but collected in 1-minute fractions so that the void volume (protein-bound Hb) and the haemoglobin peaks (free Hb) were available for the colorimetric determination of haemoglobin using the pseudoperoxidase activity of the haem moiety on hydrogen peroxide and a chromogen (3,3',5,5'-tetramethylbenzidine) in concentrated acetic acid and optimal determination at 600 nm. (In this publication at 578 nm due to the use of a spectrophotometer with Hg-discharge lamp and filter). The appearance of a blue colour in the reaction tube or cuvette indicated the presence of haemoglobin. The use of the above chromogen, with its absorption maximum around 600 nm excluded interference from serum components such as bilirubin, which may interfere in the conventional method often used to determine plasma haemoglobin. The method can be used quantitatively by including an aqueous human haemoglobin standard in the run. This elutes from the HPLC column only as free haemoglobin in the concentration range from 0.1 to 10 g/l. Addition of human haemoglobin to haemoglobin-free plasma resulted in the binding of all Hb to plasma proteins up to a concentration between 2 and 3 g/l (void-volume fraction). At higher concentrations free Hb appeared in the 3-5 minute fractions. These observations agree with published data on the scavenging capacity of plasma for Hb released from erythrocytes. The method is rapid, (HPLC-run maximally 6 min, quantitative colorimetric results 5-10 min) precise (inter-assay coefficients of variation < 8%) and suitable for answering the question as to whether the protein-binding (scavenging) system which prevents the nephro- and cerebrotoxic effects of haemoglobin has been saturated or not, an important question in patients with acute haemolysis problems. A qualitative result is obtainable within 10 minutes of injecting the sample into the HPLC-system. The use of this assay in controlling blood transfusion and haemolytic events arising from surgery, intravascular haemolytic bacteria or artificial heart valves can help in rapid corrective action, if needed.
本研究的目的是开发一种测定血浆中血红蛋白的方法,该方法适用于使用市售检测试剂盒和设备为该分析物的外部质量评估计划设定目标值。在方法开发的早期阶段,很明显仅使用单一方法(即高效液相色谱法,HPLC)是不可能的。然而,通过将HPLC与吸收分光光度法相结合,能够在大多数常规临床化学实验室现有的设备上对结合蛋白的血红蛋白和游离血红蛋白进行定性和定量快速测定。结合蛋白的血红蛋白和游离血红蛋白的分离可以使用用于测定糖化血红蛋白A1c(HbA1c)的商用HPLC设备进行,而无需改变所用条件。用相同体积的血浆(10微升)代替溶血的血液进行进样。洗脱液不丢弃,而是按1分钟的馏分收集,这样空体积(结合蛋白的Hb)和血红蛋白峰(游离Hb)可用于利用血红素部分对过氧化氢的假过氧化物酶活性以及在浓乙酸中的显色剂(3,3',5,5'-四甲基联苯胺)对血红蛋白进行比色测定,并在600nm处进行最佳测定。(在本出版物中为578nm,这是由于使用了配备汞放电灯和滤光片的分光光度计)。反应管或比色皿中出现蓝色表明存在血红蛋白。使用上述显色剂,其最大吸收波长在600nm左右,排除了血清成分(如胆红素)的干扰,胆红素可能会干扰常用于测定血浆血红蛋白的传统方法。通过在测定过程中加入人血红蛋白水溶液标准品,该方法可进行定量测定。人血红蛋白在HPLC柱上仅以游离血红蛋白的形式洗脱,浓度范围为0.1至10g/l。向无血红蛋白的血浆中加入人血红蛋白会导致所有Hb与血浆蛋白结合,直至浓度达到2至3g/l(空体积馏分)。在更高浓度下,游离Hb出现在3至5分钟的馏分中。这些观察结果与已发表的关于血浆对红细胞释放的Hb清除能力的数据一致。该方法快速(HPLC运行最长6分钟,比色法定量结果5至10分钟)、精确(批间变异系数<8%),适用于回答防止血红蛋白产生肾毒性和脑毒性作用的蛋白结合(清除)系统是否已饱和的问题,这是急性溶血问题患者中的一个重要问题。将样品注入HPLC系统后10分钟内可获得定性结果。在控制输血以及由手术、血管内溶血细菌或人工心脏瓣膜引起的溶血事件中使用该检测方法,如有需要,有助于迅速采取纠正措施。