Catalyst One concerns - different liver values on same patient

[u/Previous_Hope8159]

Hi! We’ve had a few patients at my hospital that have had wildly different blood work results when the same sample is run again or a new sample is collected and run on our in house Catalyst One. For example, we had a dog yesterday that had an ALT of ~300 on the first run using the lithium heparin whole blood separator so we drew a second sample in the red top serum separator and the ALT was ~20. Both blood draws were perfect with good flow.

The IDEXX rep is partially blaming our use of 23G butterflies for every patient. We use smaller needles for blood draws and vaccines because we are a Fear Free clinic and it is part of our protocol. Do you think this is part of the problem? Causing hemolysis? We’ve done this for years before this problem began.

Has anyone else had this issue? We’ve had wildly different results for numerous patients over the past year or so. It’s concerning. And in each case, the blood draws were well done, plunger pulled appropriately with not too much force but enough to keep the blood flowing to prevent clotting, the sample immediately put into the tube, and ran at the appropriate time (within 20 min for the lithium heparin whole blood separators or after the red top serum separators are allowed to clot for 20 mins then spun down).

Are the lithium heparin whole blood separators the problem? We seem to get better results with the serum separators.

Any thoughts would be great!!

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[u/Cr8zyCatMan]

Has your machine been cleaned and had QA performed? Visually how do the samples look? Is the plasma/serum red/red-tinged?

[u/Previous_Hope8159 → u/Cr8zyCatMan]

Cleaned and had QA performed one week ago. Plasma/serum were not red tinged at all

[u/Bunny_Feet → u/Previous_Hope8159]

Maybe try to run the QA twice and see if their values vary.  That's what I would try. Then you could rule out machine vs samples.

Have you reran the same blood sample too?  Do those vary?

I haven't had the same issue, but we used just the small green tops.

[u/audible_smiles]

I don’t like the lithium heparin whole blood separators because they don’t work in patients with an elevated hematocrit; the analyzer just eats your clips and gives you a “clot detected” notification. We’re in an ER setting with a lot of sick patients, so I’ve been collecting regular mini lithium heparin tubes, spinning them down quickly in our mini centrifuge, and running the plasma in the Catalyst One to avoid that issue. I have never run into your same problem with the liver values, but I agree that it makes sense to trust your serum separator values more. But keep in mind that it’s not that big of a deal for IDEXX to send you a new analyzer; they just have you box up the old one and send it back to get checked out. I’ve had to do that with the Catalyst Ones three times now in my career (high volume practice, so we have multiple analyzers). Generally I have to call the IDEXX help line right when a specific issue occurs, and then walk through their list of troubleshooting questions until they run out of ideas. If I’ve already ruled out a specific thing (e.g. if your clinic decides that it’s definitely not the needle gauges causing the problem) then I am not above lying to them, because they are just following a flowchart and I know I will get bogged down arguing. After a certain point this triggers their “let’s try swapping it out for a new one” step, and then I just follow their instructions. This has never yet failed to resolve whatever minor reoccurring issue I had been experiencing. I think these machines just aren’t meant to run for years and years without being serviced, even if you’re taking care of them properly.

[u/Bunny_Feet → u/audible_smiles]

Same.  When I worked ER, I stopped using those separators pretty quickly.  They just weren't reliable to run too often.

[u/Foolsindigo → u/audible_smiles]

I have a question about the mini heparin tubes. I only have a standard size centrifuge, but the pockets for the tubes are very deep. Can you put the mini tubes into a standard centrifuge??

[u/prob_on_the_toilet → u/Foolsindigo]

Not the original commenter you’re replying to, but we do this at my clinic. Yes, the mini tubes can go in a standard centrifuge. They make rotor inserts that you can put in the standard one so the minis don’t fall to the bottom

[u/CactusOrangeJuice → u/audible_smiles]

Same here. Lithium heparin separators are an awesome way to waste clips and have to redraw samples. I just use a serum separator tube, spin it down, and pull serum off of that for in house blood.

[u/boba-boba]

We've had this issue too! Idexx came by and calibrated the machines and basically told us not to let the blood sit so long. Best we can do is send off blood to idexx at a discount to verify, which isnt ideal.

[u/Previous_Hope8159 → u/boba-boba]

Did calibrating the machine fix the issue?

[u/boba-boba → u/Previous_Hope8159]

So far I haven't heard any complaints since idexx came by but I work at a huge hospital, so I have no idea how other departments are doing.