Perioperative Tracking of Intravenous Iron in Patients Undergoing On-Pump Cardiac Surgery: A Prospective, Single-Center Pilot Trial.

BACKGROUND: Preoperative intravenous iron administration is a frequently used patient blood management procedure. If the timeframe of intravenous iron administration before surgery is short, (1) the concentration of the intravenous iron compound might still be high in patients' plasma when undergoing surgery and (2) this iron in patients' plasma is at risk to be lost due to blood loss. The aim of the current study was, therefore, to track the iron compound ferric carboxymaltose (FCM) before, during, and after cardiac surgery requiring cardiopulmonary bypass, with an emphasis on intraoperative iron losses in shed blood and potential recovery through autologous cell salvage. METHODS: Concentrations of FCM were analyzed in patients' blood using a hyphenation of liquid chromatography and inductively coupled plasma-mass spectrometry to distinguish between pharmaceutical compound FCM and serum iron. In this prospective, single-center pilot trial, 13 anemic and 10 control patients were included. Anemic patients with hemoglobin levels ≤12/13 g/dL in women and men were treated with 500 milligrams (mg) intravenous FCM 12 to 96 hours before elective on-pump cardiac surgery. Patients' blood samples were collected before surgery and at days 0, 1, 3, and 7 after surgery. One sample each was taken of the cardiopulmonary bypass, the autologous red blood cell concentrate generated by cell salvage, and the cell salvage disposal bag. RESULTS: Patients who had received FCM <48 hours before surgery had higher FCM serum levels (median [Q1-Q3], 52.9 [13.0-91.6]) compared to ≥48 hours (2.1 [0.7-5.1] µg/mL, P = .008). Of 500-mg FCM administered <48 hours, 327.37 (257.96-402.48) mg were incorporated compared to administration ≥48 hours with 493.60 (487.78-496.70) mg. After surgery, patients' plasma FCM concentration in the FCM <48 hours group was decreased (-27.1 [-30 to -5.9] µg/mL). Little FCM was found in the cell salvage disposal bag (<48 hours, 4.2 [3.0-25.8] µg/mL, equivalent to 29.0 [19.0-40.7] mg total; equivalent to 5.8% or 1/17th of the 500 mg FCM initially administered), almost none in the autologous red blood cell concentrate (<48 hours, 0.1 [0.0-0.43] µg/mL). CONCLUSIONS: The data generate the hypotheses that nearly all FCM is incorporated into iron stores with administration ≥48 hours before surgery. When FCM is given <48 hours of surgery, the majority is incorporated into iron stores by the time of surgery, although a small amount may be lost during surgical bleeding with limited recovery by cell salvage.

Fast and automated monitoring of gadolinium-based contrast agents in surface waters.

Gadolinium-based contrast agents (GBCAs) are frequently used for magnetic resonance imaging to improve image contrast. These inert complexes are excreted unmetabolized from the human body and pass through wastewater treatment plants almost unaffected, leading to a significant release of anthropogenic Gd into the environment. However, long-term ecotoxicological effects of GBCAs are mainly unknown and thus powerful methods of speciation analysis are required to monitor their distribution and fate in aquatic systems. In this work, a rapid and efficient monitoring method was developed utilizing a fully automated single platform system for total metal analysis and syringe-driven chromatography in combination with inductively coupled plasma-mass spectrometry (ICP-MS). An anion-exchange chromatography (IC) method was developed and applied to achieve a rapid separation and sensitive detection of the five complexes Gd-HP-DO3A, Gd-BT-DO3A, Gd-DOTA, Gd-DTPA, and Gd-BOPTA that are commonly administered in the European Union. Furthermore, the use of an automated inline-dilution function allowed a fast-external calibration from single stock standards. A chromatographic run time of less than 2 min and species-specific detection limits between 11 and 19 pmol L-1 on a quadrupole ICP-MS proved to be competitive compared to previously published methods, but without the use of aerosol desolvation and/or sector field ICP-MS to enhance sensitivity. The automated IC-ICP-MS method was applied for quantitative GBCA monitoring in a multitude of surface water samples that were obtained in the German state of North Rhine-Westphalia. The complexes Gd-HP-DO3A, Gd-BT-DO3A, and Gd-DOTA, were detected and quantified. In addition, the occurrence of an unidentified Gd species was observed for one of the sampled river systems.

A fast and automated separation and quantification method for bromine speciation analyzing bromide and 5-bromo-2'-deoxyuridine in enzymatically digested DNA samples via ion chromatography-inductively coupled plasma-mass spectrometry.

A fast and automated separation and quantification method for bromide and the artificial nucleoside 5-bromo-2'-deoxyuridine (5-BrdU) via hyphenation of ion exchange chromatography (IC) and inductively coupled plasma-mass spectrometry (ICP-MS) is presented. The analysis of these two species is relevant to monitor the transfer of electrons along metal-mediated DNA base pairs. Charge transfer in DNA is of high interest for the implementation in nanotechnological applications like molecular wires. 5-BrdU as part of the DNA sequence releases bromide upon one electron reduction after efficient electron transfer along the DNA. The concentrations of 5-BrdU and bromide in enzymatically digested DNA samples can therefore be used as a marker for the efficiency of electron transfer along the DNA helix. A large number of samples was analyzed using an automated IC system. This platform enables time-efficient external calibration by inline dilution of a stock solution. Due to the fast separation of the two bromine species in less than 90 s, the developed method is suitable for screening applications with a multitude of samples. Despite the isobaric interferences and a low degree of ionization for bromine detection via ICP-MS the method has a limit of detection (LOD) of 30 ng/L which is approximately an order of magnitude lower than a comparable method using reversed phase high performance liquid chromatography (RP-HPLC) and ICP-MS.

Automated Chiral Analysis of Amino Acids Based on Chiral Derivatization and Trapped Ion Mobility-Mass Spectrometry.

A fast and fully automated method for chiral analysis has been developed by combining a chiral derivatization approach with high-resolution trapped ion mobility separation. Although the presented approach can be potentially applied to diverse types of chiral compounds, several benchmark amino acids were used as model compounds, focusing on the smallest amino acid alanine. An autosampler with an integrated chromatography system was used for inline chiral derivatization with (S)-naproxen chloride and subsequent preseparation. Afterwards, derivatized amino acids were directly introduced into the electrospray interface of a trapped ion mobility-mass spectrometer for rapid diastereomer separation in the gas phase. This unique combination of preseparation and trapped ion mobility spectrometry separation in the negative ion mode enabled rapid chiral analysis within 3 min per sample. Furthermore, the diastereomer separation proved to be independent of alkali salts or other metal ions, offering robustness with regard to samples containing high amounts of salts. Highly sensitive detection of amino acid diastereomers was possible down to the lower nanomolar concentration range, and enantiomeric ratios could be readily determined from the recorded mobilograms with excellent reproducibility and precision. To demonstrate the general applicability of our method, alanine and other amino acids were analyzed from soy sauces and seasonings, which revealed extraordinarily high d-Ala contents of up to 99% in all samples.

LC-ICP-MS method for the determination of "extractable copper" in serum.

Copper is an essential element for biological functions within humans and animals. There are several known diseases associated with Cu deficiency or overload, such as Menkes disease and Wilson disease, respectively. A common clinical method for determining extractable Cu levels in serum, which is thought to be potentially dangerous if in excess, is to subtract the value of tightly incorporated Cu in ceruloplasmin from total serum Cu. In this work, an automated sample preparation and liquid chromatography (LC) system was combined with inductively coupled plasma-mass spectrometry (ICP-MS) to determine bound Cu and extractable Cu in serum. This LC-ICP-MS method took 250 s for sample preparation and analysis, followed by a column recondition/system reset, thus, a 6 minute sample-to-sample time including sample preparation. The method was validated using serum collected from either control (Atp7b+/-) or Wilson disease rats (Atp7b-/-). The extractable Cu was found to be 4.0 ± 2.3 µM Cu in healthy control rats, but 2.1 ± 0.6 µM Cu in healthy Wilson rats, and 27 ± 16 µM Cu in diseased Wilson rats, respectively. In addition, the extractable Cu/bound Cu ratio was found to be 6.4 ± 3.5%, 38 ± 29%, and 34 ± 22%, respectively. These results suggest that the developed method could be of diagnostic value for Wilson disease, and possibly other copper related diseases.