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187 Yasar, Atypic separator gel flotation / doi: 10.14744/ijmb.2020.53824 the bottom (Fig. 1). The sample was re-centrifuged, but this atypical phenomenon did not change. This abnormal gel flotation suggested that the density of the serum may be higher than the gel layer. The appearance of the serum was not hemolytic, lipemic or icteric. The serum was aspirated under the gel layer by a pipette, and biochemical analyses were performed by an auto-analyzer (Roche Diagnostics, Cobas c501, Tokyo, Japan). The results confirmed by re-analysis showed that the total protein concentration markedly elevated (147 g/L; reference interval: 66-87) and the albumin (25 g/L; reference interval: 35-52) and sodium (131 mmol/L; reference interval: 135-145) levels were decreased. The patient's file revealed that she has no history of chronic disease other than chronic obstructive pulmonary disease. However, high total protein and low albumin concentrations were obtained in the biochemical analysis at the previous hospital administrations. A few samples taken from the patient into the gel separation tube were also rejected previously because of unsuitable for the analysis, and the biochemistry tests were not performed. One week later, she presented to the emergency department with chest pain. The blood sample was collected into a gel separation tube (Greiner Bio-One Vacuette) for the routine biochemistry and cardiac marker analysis. The sample arrived at Stat Laboratory of Kars Harakani Public Hospital within only nine minutes and centrifuged at 1500 g for 10 minutes. Contrary to expectations, the serum formed the upmost layer was separated from the cells by the gel. In routine biochemistry analysis, the high total protein (142 g/L) and low albumin (18.3 g/L) and sodium (133 mmol/L) concentration were detected once again. The patient’s consent was obtained for this study.

Atypic separator gel flotation in blood collection tube in a patient with hyperproteinemia