B-378 Mass Spectrometric Identification of Tranexamic Acid in Cerebrospinal Fluid Following Accidental Intrathecal Administration
Abstract
Tranexamic acid (TXA) is a synthetic lysine analog used for hemostasis. Inadvertent intrathecal injection of tranexamic acid (TXA) is a rare but often fatal medication error (40% mortality) characterized by profound neurotoxicity and refractory seizures. Laboratory detection of TXA in cerebrospinal fluid (CSF) may assist clinical management and toxicologic consultation; however, validated CSF assays are not routinely available. We report the rapid identification of TXA in CSF using a new mass spectrometry platform and broad-spectrum screening library.
A 49-year-old female received intrathecal TXA due to a medication order error and, after consultation with the regional Poison Center, underwent CSF lavage. Four CSF aliquots collected during the lavage procedure were submitted for toxicologic analysis. Each sample (50 µL) was diluted with 10 µL internal standard (proadifen) in 1 mL water and analyzed using a newly acquired mass spectrometer with a broad-spectrum drug screening library (Thermo Scientific Orbitrap Exploris) not previously validated for CSF TXA detection. Chromatographic retention time and mass spectral library match scores were assessed. To confirm compound identity, pharmacy-obtained TXA reference material was prepared at five concentrations (1,000–250,000 ng/mL) and analyzed using the same method for comparative evaluation.
TXA was detected in all four CSF specimens. Patient sample retention times clustered tightly between 0.72–0.74 minutes, with mass spectral…
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