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Stabilization of Glucose in Blood Specimens: Mechanism of Delay in Fluoride Inhibition of Glycolysis

Department of Pathology, University of Virginia, Charlottesville, VA

^aAddress correspondence to this author at: Department of Pathology, P O Box 800168, University of Virginia School of Medicine, Charlottesville, VA 22908, email dbruns@virginia.edu

The first 20% of the full text of this article appears below.

To the Editor:

The recent report by Gambino(1) brought attention to the often overlooked fact that fluoride does not prevent loss of plasma glucose during the first 30–90 min (or longer) after blood collection(2). Although fluoride is effective in preventing later loss of glucose(1)(2), the mechanism of the delay in its action is a matter of some interest.

Fluoride acts primarily by inhibiting enolase in the glycolytic pathway. Fluoride strongly inhibits the enzyme in the presence of inorganic phosphate. The inhibitory species is the fluorophosphate ion, which when bound to magnesium forms a complex with enolase and inactivates the enzyme. The delay in fluoride’s prevention of glucose loss in blood samples is sometimes attributed to a postulated delay in the entry of fluoride ion into the blood cells in which the glycolytic enzymes reside. Several observations cast doubt on this explanation, however.

As part of a project for quality improvement of sample-handling requirements, we collected blood from a volunteer into four . . . [Full Text of this Article]