IgM paraprotein interference with hemoglobin measurement using the CELL-DYN 3500

A 10-year-old male Labrador Retriever was presented for a 6-week history of polyuria, polydipsia, rear limb weakness, and ocular discharge. The dog had marked hyperproteinemia with an IgM monoclonal gammopathy, as determined by serum protein electrophoresis and immunoelectrophoresis. Cytologic findings in a lymph node aspirate were suggestive for lymphoma, which was confirmed and identified as B cell lineage by immunophenotyping and PCR antigen receptor rearrangement. In the CBC results, marked discrepancy was observed in the hemoglobin (HGB) concentration and MCHC obtained on a CELL-DYN 3500 analyzer (HGB 13.3 g/dL, MCHC 61.4 g/dL) as compared with an IDEXX LaserCyte analyzer (HGB 7.0 g/dL, MCHC 39.2 g/dL). To investigate this discrepancy, plasma was removed from an EDTA-anticoagulated blood sample from the patient, replaced with an equal volume of CELL-DYN diluent, and analyzed on the CELL-DYN. The resulting HGB (6.72 g/dL) and MCHC (33.5 g/dL) results were similar to those obtained initially on the LaserCyte. We concluded that precipitation of IgM paraprotein by the CELL-DYN lyzing reagent, which contains quaternary ammonium salts, falsely increased the spectrophotometric measurement of HGB on the CELL-DYN. The high MCHC was attributed to the false increase in HGB concentration. No interference with HGB measurement occurred with the LaserCyte, which uses a hypotonic solution to lyse RBCs before HGB determination. Paraprotein interference should be considered in veterinary patients with monoclonal gammopathy and unexpectedly high HGB and MCHC values.