Erroneous determination of hyperphosphatemia ('pseudohyperphosphatemia') in sera of patients that have been treated with liposomal amphotericin B (AmBisome)

Clinica Chimica Acta; International Journal of Clinical Chemistry
Gerard M JensenStefanie Laybourne

Abstract

Hyperphosphatemia is not an expected consequence of dosing with amphotericin B formulations. However, hyperphosphatemia or pseudohyperphosphatemia (erroneously high phosphorous measurements) has been variously reported in a number of recent case studies associated with liposomal amphotericin B (L-AmB, AmBisome®). In some of these cases, hyperphosphatemia was assumed to obtain, and direct treatment or alterations to antifungal therapy were carried out. In other cases, pseudohyperphosphatemia was assumed to obtain. Using two different Beckman-Coulter measurement platforms (Synchron® LX20 with PHOSm or PHS chemistry systems) phosphorus values were obtained in human serum titrated with L-AmB or L-AmB placebo (identical composition to L-AmB, but without the drug molecule present). We demonstrate an L-AmB specific assay interference with the PHOSm chemistry system resulting in a linear (in amphotericin B) upward shift in phosphorus values (pseudohyperphosphatemia) and owing to an L-AmB specific interference with the mannitol containing assay system. Interference is not seen with L-AmB placebo. The PHS chemistry exhibits a minor interference from L-AmB, and it is in the form of lower assay values. L-AmB spiked sera treated with LipoCl...Continue Reading

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Citations

Aug 19, 2015·Antimicrobial Agents and Chemotherapy·Nicole M BohmJuan Carlos Q Velez
Aug 26, 2014·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Misty M MillerJamie L Miller
Aug 30, 2014·Clinical Chemistry·D Robert Dufour
Oct 7, 2018·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Monique AlbersenStephanie Smetsers
Apr 6, 2012·The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG·Chad A Knoderer, Holly M Knoderer
Jun 19, 2020·Clinical Chemistry and Laboratory Medicine : CCLM·Valentina MolinarisPietro B Faré
Mar 4, 2014·Annals of Clinical Biochemistry·P ManghatR Swaminathan

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