{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T16:08:07Z","timestamp":1778602087989,"version":"3.51.4"},"reference-count":20,"publisher":"Walter de Gruyter GmbH","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_cclm-2024-1389_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      To study the prevalence of trisodium citrate (Na\n                      <jats:sub>3<\/jats:sub>\n                      Citrate) contamination in hypernatraemic serum samples by direct measurement of citrate and to evaluate the performance of indirect markers for identification of Na\n                      <jats:sub>3<\/jats:sub>\n                      Citrate contamination.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2024-1389_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Serum citrate was measured in all hypernatraemic serum samples (sodium\u00a0\u2265148\u202fmmol\/L) over a three-month period. The performance of serum chloride, sodium-chloride gap, indirect ion selective electrode (ISE)-direct ISE sodium disparity and osmolar gap in identification of Na\n                      <jats:sub>3<\/jats:sub>\n                      Citrate contaminated samples was assessed against the \u2018gold-standard\u2019 direct citrate measurement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2024-1389_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 27 Na\n                      <jats:sub>3<\/jats:sub>\n                      Citrate contaminated samples were identified based on serum citrate concentration\u00a0\u22651.5\u202fmmol\/L. The prevalence of citrate contamination was 3.1\u202f% of hypernatraemic samples (n=875) and 0.017\u202f% of all samples received for urea and electrolyte analysis (n=153,404). Most\u00a0contaminated samples were from patients receiving haemodialysis (59.3\u202f%), and the rest from inpatients. Cut-offs to give 100\u202f% sensitivity were chloride\u00a0\u2264105\u202fnmol\/L (specificity 93.4\u202f%), sodium-chloride gap\u00a0\u226547\u202fmmol\/L (specificity 95.3\u202f%), indirect ISE-direct ISE sodium disparity\u00a0\u22653\u202fmmol\/L (specificity 81.9\u202f%), and osmolar gap \u226539\u00a0mOsm\/kg (specificity 2.8\u202f%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_cclm-2024-1389_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Trisodium citrate contamination is uncommon. Most contaminated samples were from patients receiving haemodialysis, likely because of contamination with citrate catheter locking solution. Screening with serum chloride or sodium-chloride gap can confidently exclude Na\n                      <jats:sub>3<\/jats:sub>\n                      Citrate contamination in over 90\u202f% of hypernatraemic samples, and in nearly all samples with sodium\u00a0\u2265155\u202fmmol\/L if metabolic alkalosis has been excluded. In the remaining samples, Na\n                      <jats:sub>3<\/jats:sub>\n                      Citrate contamination can only be definitively confirmed or excluded by measurement of serum citrate. We propose algorithms to identify spurious hypernatraemia.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/cclm-2024-1389","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T20:40:57Z","timestamp":1738356057000},"page":"1383-1391","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and detection of citrate contamination in clinical laboratory"],"prefix":"10.1515","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3501-7218","authenticated-orcid":false,"given":"Nathan","family":"Lorde","sequence":"first","affiliation":[{"name":"Blood Sciences, Black Country Pathology Services , 8692 The Royal Wolverhampton NHS Trust , Wolverhampton , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7483-9253","authenticated-orcid":false,"given":"Rousseau","family":"Gama","sequence":"additional","affiliation":[{"name":"Blood Sciences, Black Country Pathology Services , 8692 The Royal Wolverhampton NHS Trust , Wolverhampton , UK"},{"name":"School of Medicine and Clinical Practice , University of Wolverhampton , Wolverhampton , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1306-8832","authenticated-orcid":false,"given":"Tejas","family":"Kalaria","sequence":"additional","affiliation":[{"name":"Blood Sciences, Black Country Pathology Services , 8692 The Royal Wolverhampton NHS Trust , Wolverhampton , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2025,2,3]]},"reference":[{"key":"2026051215094489182_j_cclm-2024-1389_ref_001","doi-asserted-by":"crossref","unstructured":"Plebani, M, Aita, A, Sciacovelli, L. 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Clin Chem Lab Med 2017;55:27\u201331. https:\/\/doi.org\/10.1515\/cclm-2016-0426.","DOI":"10.1515\/cclm-2016-0426"},{"key":"2026051215094489182_j_cclm-2024-1389_ref_018","doi-asserted-by":"crossref","unstructured":"Keppel, MH, Auer, S, Lippi, G, Von Meyer, A, Cornes, M, Felder, T, et al.. Heparin and citrate additive carryover during blood collection. Clin Chem Lab Med 2019;57:1888\u201396. https:\/\/doi.org\/10.1515\/cclm-2019-0433.","DOI":"10.1515\/cclm-2019-0433"},{"key":"2026051215094489182_j_cclm-2024-1389_ref_019","doi-asserted-by":"crossref","unstructured":"Kalaria, T, Ford, C, Gama, R. Managing ethylenediaminetetraacetic acid (EDTA) interference in EDTA contaminated samples\u00a0\u2013 selectivity in reporting analytes. 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