Sodium Gluconate Containing Parenteral Nutrition Solution as a Cause of False Positive Aspergillus Galactomannan Assay in Paediatric Patients with Hematological Malignancies.

Patricia Ribaud, Annie Sulahian, Sophie Touratier, Benoit Brethon, Regis Peffault de Latour, Gerard Socie, Jean Menotti, and Francis Derouin

Author address: 

1 Department of Hematology, Saint-Louis Hospital, Paris, France; 2 Laboratory of Mycology and Parasitology, Saint-Louis Hospital, Paris, France and 3 Pharmacy, Saint-Louis Hospital, Paris, France.

Abstract: 

Background: The detection of Aspergillus galactomannan antigenemia (GM-Ag) is a contributive method in the diagnosis of invasive aspergillosis (IA). Herein, we report 3 cases of false positive GM-Ag in paediatric patients (pts) receiving NP2 Enfants AP-HP® parenteral nutrition (Fresenius, France), and none of them had or developed IA. Methods: In December 2006, the sera of these 3 pts (1 allogeneic transplant recipient and 2 neutropenic acute leukaemia pts) taken before, during, and after cessation of NP2 solution were tested for the presence of GM-Ag using the Platelia® Aspergillus kit. This solution, its 30 components and 8 other commercially available solutions for parenteral nutrition were tested for the presence of GM. Results: GM became detectable within 1 day after IV administration of NP2 with indices up to 9.25, remained positive throughout treatment, and became negative (0.5) within 48 hours in 2/3 pts. The NP2 solution and a single one of its components, sodium gluconate (SG), tested positive with GM estimated at 55.4ng/ml. No Aspergillus DNA was detected by real-time PCR. Three NP2 and 6 SG batches from different origins yielded similar results. On the other hand, 6 different batches of calcium gluconate and 8 other commercially available SG-free parenteral nutrition solutions tested negative. Conclusions: These results suggest a strong cross reactivity of Platelia® kit with SG-containing NP2, as recently described with Plasma-Lyte® (Baxter Distribution Centre Europe). We estimate that clinicians and biologists should become aware of this problem which might lead to inappropriate invasive investigations and/or treatments.
2007

abstract No: 

4958

Full conference title: 

49th American Society of Haematologists Annual Meeting
    • ASH 49th (2007)