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Riabkova NS, Bogomolova AP, Kogan AE, Katrukha IA, Vylegzhanina AV, Pevzner DV, Alieva AK, Bereznikova AV, Katrukha AG. Interaction of heparin with human cardiac troponin complex and its influence on the immunodetection of troponins in human blood samples. Clin Chem Lab Med 2024; 0:cclm-2024-0066. [PMID: 38738903 DOI: 10.1515/cclm-2024-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/17/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVES Heparin is a highly charged polysaccharide used as an anticoagulant to prevent blood coagulation in patients with presumed myocardial infarction and to prepare heparin plasma samples for laboratory tests. There are conflicting data regarding the effects of heparin on the measurement of cardiac isoforms of troponin I (cTnI) and troponin T (cTnT), which are used for the immunodiagnosis of acute myocardial infarction. In this study, we investigated the influence of heparin on the immunodetection of human cardiac troponins. METHODS Gel filtration (GF) techniques and sandwich fluoroimmunoassay were performed. The regions of сTnI and cTnT that are affected by heparin were investigated with a panel of anti-cTnI and anti-cTnT monoclonal antibodies, specific to different epitopes. RESULTS Heparin was shown to bind to the human cardiac full-size ternary troponin complex (ITC-complex) and free cTnT, which increased their apparent molecular weights in GF studies. Heparin did not bind to the low molecular weight ITC-complex and to binary cTnI-troponin С complex. We did not detect any sites on cTnI in the ITC-complex that were specifically affected by heparin. In contrast, cTnT regions limited to approximately 69-99, 119-138 and 145-164 amino acid residues (aar) in the ITC-complex and a region that lies approximately between 236 and 255 aar of free cTnT were prone to heparin influence. CONCLUSIONS Heparin binds to the ITC-complex via cTnT, interacting with several sites on the N-terminal and/or central parts of the cTnT molecule, which might influence the immunodetection of analytes in human blood.
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Affiliation(s)
- Natalia S Riabkova
- HyTest Ltd., Turku, Finland
- Department of Biochemistry, Biological Faculty, Lomonosov Moscow State University, Moscow, Russia
| | - Agnessa P Bogomolova
- HyTest Ltd., Turku, Finland
- Department of Biochemistry, Biological Faculty, Lomonosov Moscow State University, Moscow, Russia
| | - Alexander E Kogan
- HyTest Ltd., Turku, Finland
- Department of Biochemistry, Biological Faculty, Lomonosov Moscow State University, Moscow, Russia
| | - Ivan A Katrukha
- HyTest Ltd., Turku, Finland
- Department of Biochemistry, Biological Faculty, Lomonosov Moscow State University, Moscow, Russia
| | | | - Dmitry V Pevzner
- National Medical Research Centre of Cardiology Named After Academician E.I. Chazov, Moscow, Russia
| | - Amina K Alieva
- National Medical Research Centre of Cardiology Named After Academician E.I. Chazov, Moscow, Russia
| | - Anastasia V Bereznikova
- HyTest Ltd., Turku, Finland
- Department of Biochemistry, Biological Faculty, Lomonosov Moscow State University, Moscow, Russia
| | - Alexey G Katrukha
- HyTest Ltd., Turku, Finland
- Department of Biochemistry, Biological Faculty, Lomonosov Moscow State University, Moscow, Russia
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Malaeb H, Vera MA, Sangal RB, Venkatesh AK, Possick S, Maciejak L, Oberle E, El-Khoury JM. Rapid serum tubes reduce transport hemolysis and false positive rates for high-sensitivity troponin T. Clin Chim Acta 2023; 551:117630. [PMID: 38420909 DOI: 10.1016/j.cca.2023.117630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Hemolysis in the emergency department (ED) can significantly delay results and appropriate action. We evaluated the main sources of hemolysis during sample collection, and to evaluate the use of rapid serum tubes (RST) as a transport hemolysis-mitigating measure for high-sensitivity troponin T (hs-cTnT) testing. METHODS We examined the effect of tube type, tube fill, types of sample draw and collection methods on hemolysis and hs-cTnT in samples (n = 158) from ED patients. We also compared hs-cTnT values in paired RST and plasma separate tube (PST) samples that were hemolysis-free. RESULTS The primary source of hemolysis in samples collected in the ED was underfilling tubes. In both tube types, PST and RST, filled tubes showed a median reduction in hemolysis of 69.1 % (p < 0.0001). Blood collected in RST also experienced less hemolysis compared to PST. In hemolysis-free samples, false positive results in PST were noted in patients with hs-cTnT values < 50 ng/l. CONCLUSION We suggest that proper tube filling during sample collection and use of RST tubes can significantly reduce the effects of hemolysis. In addition, laboratories should be aware that PST tubes have a non-trivial rate of false positives when hs-cTnT < 50 ng/l.
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Affiliation(s)
- Hind Malaeb
- Departments of Laboratory Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Michael A Vera
- Departments of Laboratory Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Rohit B Sangal
- Departments of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Arjun K Venkatesh
- Departments of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Stephen Possick
- Departments of Cardiology, Yale School of Medicine, New Haven, CT, United States
| | - Lisa Maciejak
- Departments of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Erica Oberle
- Departments of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Joe M El-Khoury
- Departments of Laboratory Medicine, Yale School of Medicine, New Haven, CT, United States.
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Cembrowski G, Qiu Y, Sherazi A, Shea JL. Retrospective analysis of intra-patient laboratory variation demonstrates that the BD Vacutainer® Barricor™ blood collection tube reduces troponin variation. Clin Biochem 2023; 114:24-29. [PMID: 36706798 DOI: 10.1016/j.clinbiochem.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/14/2022] [Accepted: 01/23/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The BD Vacutainer® Barricor™ plasma blood collection tube uses a mechanical separator during centrifugation to separate plasma from the cellular elements of blood. Compared to use of plasma separator tubes (PST™) with gel, Barricor™ produces a cleaner sample with less residual cellular content. We sought to determine if Barricor™ reduces pre-analytical error compared to PST™. DESIGN & METHODS We used a model previously published that utilizes serial differences between intra-patient measurements transformed into a Taylor series of variation vs time with the y-intercept equal to the sum of short-term analytic variation, preanalytic variation and biologic variation. The intra-patient variation of chloride, sodium, potassium, and troponin-T (hs-TnT) obtained from the Emergency Department of a large tertiary care center sampled with PST™ (May 2015-April 2018, n = 59,762 specimens) or Barricor™ (May 2018-May 2021, n = 61,512 specimens) was evaluated. All specimens were analyzed on either Roche Modular or Cobas® instruments. For each analyte, pairs of intra-patient results were tabulated and separated by 1 h intervals. The average between-pair variations were then regressed against time. We also determined the number of intra-patient outliers using the reference change value for each analyte. RESULTS The Barricor™ hs-TnT y-intercept (-0.0132) was significantly lower than the PST™ intercept (0.9109; p = 0.022). This was also true for chloride (y-intercept = 1.0067 in Barricor™ and 1.3431 in PST™, p = 0.037). The percentage of hs-TnT outliers was significantly lower in Barricor™ (8.32 %) vs PST™ (12.2 %; p < 0.001). CONCLUSION The analytical and biological variations are assumed to be steady over the study periods; we ascribe the difference in the y-intercept to the preanalytical effect of the Barricor™ tube reducing platelets and other cellular debris.
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Affiliation(s)
- George Cembrowski
- Laboratory Medicine and Pathology, University of Alberta, Cembrowski & Cembrowski Quality Control Consulting, Edmonton, AB, Canada
| | - Yuelin Qiu
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ali Sherazi
- Department of Research Services, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada; Department of Laboratory Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada
| | - Jennifer L Shea
- Department of Laboratory Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada; Department of Pathology, Dalhousie University, Halifax, NS, Canada.
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Paul HA, Chi Q, Gifford JL, Seiden-Long I. Not T too! False elevations in high-sensitivity cardiac troponin T (hs-TnT) following specimen transport. Clin Biochem 2022; 115:86-91. [PMID: 36027942 DOI: 10.1016/j.clinbiochem.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
Abstract
Though false elevations attributed to preanalytical specimen handling have been widely reported for Troponin I (TnI), Troponin T (TnT) has appeared more robust to falsely elevated Tn. We describe reproducible false elevations in high sensitivity TnT (hs-TnT) in specimens after courier transport in plasma separator tubes (PST) off-site for testing. Hs-TnT was measured under 5 different conditions: 1) at collection location (N=24); 2) after transport upright in racks (N=66); 3) after transport with no control over tube agitation (N=69); 4) on transported aliquots (N=84); or 5) immediately after transport with no control over tube agitation (N=16), followed by keeping the specimen upright and re-measuring at 1hr, 2hr, 4hr, and 20-24hrs (N=6). To assess the degree of discrepancy, plasma from the original PST was aliquotted, re-centrifuged, potential debris removed, and hs-TnT re-measured. 43% of PST specimens collected offsite and transported with no control over tube agitation had clinically significant false elevations of hs-TnT which subsequently decreased following aliquotting and re-centrifugation (median decrease =9.9ng/L). Onsite testing or transported aliquots demonstrated no discrepancy. After being kept upright, discrepant specimens were not different from re-centrifuged aliquots by 4hrs (p=0.6141, repeated measures ANOVA with Dunn's multiple comparisons). Clinically significant false elevations of hs-TnT occurred in approximately 40% of separated PSTs that were transported in containers where specimens are transported with no control over tube agitation. This interference does not occur if plasma is aliquoted or if hs-TnT is tested at the collection site. In order to prevent these false elevations, and their potential patient impact on the diagnosis of acute myocardial infarction, specimens for hs-TnT measurement should be aliquoted at the collection location prior to transport.
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Affiliation(s)
- Heather A Paul
- Alberta Precision Laboratories and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Qingli Chi
- Alberta Precision Laboratories, Calgary, Alberta, Canada
| | - Jessica L Gifford
- Alberta Precision Laboratories and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Isolde Seiden-Long
- Alberta Precision Laboratories and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada; Correspoooonding author at: Foothills Medical Centre, McCaig Tower, Rm 7507, 7(th) Floor, 3134 Hospital Drive NW, Canada.
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5
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Wu AHB. Reduced pre-analytical issues for measuring troponin with use of a high sensitivity assay. Clin Biochem 2021; 95:89-90. [PMID: 33961813 DOI: 10.1016/j.clinbiochem.2021.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/06/2021] [Accepted: 05/02/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Alan H B Wu
- Department of Laboratory Medicine, University of California, San Francisco, CA 94110, USA.
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Wada M, Kita M, Kawasaki K, Kusakabe T, Tagami T, Satoh-Asahara N, Shimatsu A, Hashimoto K. False-positive TSH receptor antibody-a pitfall of third-generation TSH receptor antibody measurements in neonates. Endocr J 2018. [PMID: 29526990 DOI: 10.1507/endocrj.ej17-0426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Maternal Graves' disease (GD) during pregnancy may influence thyroid function in fetuses. Neonates born to mothers with high serum TSH receptor antibody (TRAb) levels have been reported to develop 'neonatal GD'. Therefore, evaluations of serum thyroid hormone and TRAb levels in neonates upon birth are crucial for a prompt diagnosis. At delivery, we measured TRAb with third-generation TRAb test using an M22 human monoclonal antibody in neonates by collecting umbilical cord blood in a blood collection tube with lithium-heparin, which provides a whole blood/plasma sample. In recent years, we have encountered positive TRAb levels (more than 2.0 IU/L) in nineteen neonates born to mothers with GD whose thyroid hormone levels were almost within the reference range and serum TRAb levels were less than 10 IU/L. All the neonates with positive TRAb levels did not exhibit thyrotoxicosis. However, when we measured TRAb levels with serum sample in six out of the nineteen cases, their serum TRAb levels were all negative, suggesting a discrepancy of TRAb levels between in lithium-heparin plasma from umbilical cord blood and serum. Moreover, this discrepancy was observed in neonates born to euthyroid mothers, adult active GD patients and healthy volunteers. Since lithium-heparin plasma from umbilical cord blood is widely used in laboratory tests at delivery, we may encounter 'false-positive' TRAb, which may, in turn, lead to a misdiagnosis of neonatal GD. This is a pitfall of third-generation TRAb measurements in neonates, particularly at delivery, and needs to be considered by obstetricians and neonatologists.
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Affiliation(s)
- Michiko Wada
- Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
| | - Makoto Kita
- Department of Pediatrics, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
| | - Kaoru Kawasaki
- Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
| | - Toru Kusakabe
- Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
| | - Tetsuya Tagami
- Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
- Division of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
| | - Noriko Satoh-Asahara
- Department of Endocrinology, Metabolism, and Hypertension, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
| | - Akira Shimatsu
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
| | - Koshi Hashimoto
- Department of Preemptive Medicine and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
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7
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Herman DS, Kavsak PA, Greene DN. Variability and Error in Cardiac Troponin Testing: An ACLPS Critical Review. Am J Clin Pathol 2017; 148:281-295. [PMID: 28967956 DOI: 10.1093/ajcp/aqx066] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To provide a comprehensive overview of the complexities associated with cardiac troponin (cTn) testing. An emphasis is placed on the sources of error, organized into the preanalytical, analytical, and postanalytical phases of the testing pathway. Controversial areas are also explored. METHODS A case scenario and review of the relevant literature describing laboratory considerations involving cTn testing are described. RESULTS Advanced comprehension of the specific assay used in a given laboratory is necessary for optimal reporting, utilization, and quality monitoring of cTn. CONCLUSIONS cTn assays are reliable diagnostic tests for acute myocardial infarction, but understanding their limitations is required for appropriate result interpretation.
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Affiliation(s)
- Daniel S Herman
- Department of Pathology and Laboratory Medicine, University of Pennsylvania,Philadelphia
| | - Peter A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University,Hamilton, Canada
| | - Dina N Greene
- Department of Laboratory Medicine, University of Washington, Seattle
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Dimeski G, Johnston J, Masci PP, Zhao KN, Brown N. Evaluation of the Greiner Bio-One serum separator BCA Fast Clot tube. ACTA ACUST UNITED AC 2017; 55:1135-1141. [DOI: 10.1515/cclm-2016-0806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/23/2016] [Indexed: 11/15/2022]
Abstract
Abstract
Background:
Current commercial tubes have difficulties in producing “true” serum from all blood samples even within the recommended clotting times. Hence, Becton Dickinson (BD) and now Greiner have produced tubes containing thrombin as the procoagulant to reduce the clotting time and increase the possibility of producing serum from anticoagulated blood samples.
Methods:
The Greiner BCA Fast Clot (GBBCAFC) tube was evaluated in a hospital environment using 40 participants, (30 healthy and 10 undergoing renal dialysis) for 32 analytes against the Greiner lithium heparin tube and the BD Rapid Serum Tubes (BD RST) tube measured on Beckman DxC 800 and DxI 800 analyzers. Clotting strength was also examined using thromboelastography (TEG).
Results:
The analytes results showed there was a very close agreement between the BD RST tube and GBBCAFC tube in comparison with lithium heparin plasma. The result comparison data showed equivalent performance with lower levels of hemolysis. The prolonged storage study also showed very similar agreement between the BD RST and the GBBCAFC tubes. Likewise, the TEG data showed there was very little difference in clotting ability between the tubes, and neither was capable of producing true serum from blood spiked with 2 U heparin/mL of blood.
Conclusions:
The study showed the GBBCAFC tube with the combination of the two procoagulants blood clotting activator and thrombin produced comparable performance with the lithium heparin plasma and the BD RST serum samples.
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The BD Barricor blood collection tube is an acceptable and robust alternative to the PST for use with the Beckman AccuTnI+3 assay. Clin Biochem 2017; 50:851-857. [PMID: 28583435 DOI: 10.1016/j.clinbiochem.2017.05.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/17/2017] [Accepted: 05/23/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVES BD Canada recently released a blood collection tube with a novel mechanical separator called the Barricor. We evaluated this tube as an alternate sample type for cardiac troponin I (cTnI) testing using the Beckman Coulter AccuTnI+3 assay. DESIGN AND METHODS 3014 paired patient specimens (Barricor, plasma separator tube or PST) were obtained from the emergency departments and cardiac care units of nine hospitals in and around Edmonton, Alberta. After centrifugation, each plasma sample was analyzed for cTnI using the Beckman Coulter AccuTnI+3 assay. In addition, selected samples were analyzed multiple times within a single run or over 4-5days to generate imprecision data for the assay. RESULTS Repeatability and within-laboratory studies revealed an imprecision of <10% at concentrations above 0.025μg/L for the Barricor as well as BD's traditional PST. Paired patient sample comparisons over the full range of the assay yielded linear regression slopes ranging from 0.956 to 1.011 and Pearson correlation coefficients ranging from 0.993 to 0.999. At a lower range of results closer to the manufacturer's 99th percentile cutoffs correlation was slightly worse, but still acceptable, with linear regression slopes ranging from 0.967 to 1.211 and Pearson correlation coefficients ranging from 0.983 to 0.987. Notably, at these lower concentrations the agreement between individual PST and Barricor results worsened with decreasing cTnI concentration. Differences between pairs of results became particularly large (-50 to +400%) at PST cTnI concentrations ≤0.015μg/L. Closer inspection of the data around the 0.02 and 0.04μg/L 99th percentile cutoffs revealed a number of discordances between PST and Barricor results, with at least some of these attributable to false elevations in the PST results. CONCLUSIONS Together, our results suggest that the Barricor blood collection tube is good alternative to the traditional PST for cTnI testing using the AccuTnI+3 assay. The Barricor appears to minimize spurious, nonreproducible, and false elevations in cTnI results for a subset of patients but additional studies are needed to determine if it reduces overall false elevations. cTnI results below 0.04μg/L may still be of questionable accuracy even with the use of this new tube.
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10
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Kavsak PA, Saenger AK, Hickman PE. Reality check for cardiac troponin testing - Sometimes the result is wrong. Clin Biochem 2016; 49:1107-1108. [PMID: 27645499 DOI: 10.1016/j.clinbiochem.2016.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 12/11/2022]
Affiliation(s)
| | - Amy K Saenger
- University of Minnesota, Minneapolis, MN, United States
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La'ulu SL, Straseski JA, Schmidt RL, Genzen JR. Thrombin-mediated degradation of parathyroid hormone in serum tubes. Clin Chim Acta 2014; 437:191-6. [PMID: 25086279 DOI: 10.1016/j.cca.2014.07.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/13/2014] [Accepted: 07/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Intact parathyroid hormone (PTH) tests are frequently sandwich immunoassays. Enzymes that cleave PTH may cause falsely lower PTH results. The objective of this study was to determine whether bovine thrombin in Becton Dickinson (BD) Vacutainer rapid serum tubes™ (RSTs) may lead to PTH results that are lower than in plasma separator tube™ (PST) or serum separator tube™ (SST) collections. METHODS Tubes of blood (PST, SST, and RST) were collected from donors. PTH concentrations were measured on a Roche Cobas e602 analyzer in aliquots held at room temperature or 4°C across time. Instrument comparison studies were also conducted on an Abbott Architect i1000SR and a Siemens Immulite 2000 XPi. Previously collected serum specimens were also incubated in exogenous bovine thrombin, the direct thrombin inhibitor hirudin, or both. Freshly collected RST specimens were also spiked with hirudin after clotting and centrifugation. RESULTS Significant decreases in PTH degradation rate constants were observed according to tube type, with degradation rates faster in RSTs than SSTs, and SSTs faster than PSTs. PTH degradation rate was temperature dependent. PTH decreases induced by exogenous bovine thrombin, as well as endogenous human thrombin, were reduced by hirudin. CONCLUSIONS Bovine thrombin is responsible for the decrease in PTH results observed in RSTs. Endogenous human thrombin, activated during clot formation, is likely responsible for the smaller decreases observed in non-RST sera versus plasma.
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Affiliation(s)
- Sonia L La'ulu
- ARUP Institute for Clinical and Experimental Pathology, 500 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Joely A Straseski
- Department of Pathology, University of Utah School of Medicine, 500 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Robert L Schmidt
- Department of Pathology, University of Utah School of Medicine, 15 N Medical Drive East, Salt Lake City, UT 84132, USA
| | - Jonathan R Genzen
- Department of Pathology, University of Utah School of Medicine, 500 Chipeta Way, Salt Lake City, UT 84108, USA.
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12
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Yan R, Colantonio D, Wong PY, Chen Y. Suitability of Becton Dickinson Vacutainer rapid serum tube for collecting and storing blood samples for antibiotic and anticonvulsant drug monitoring. J Clin Pathol 2014; 67:807-10. [DOI: 10.1136/jclinpath-2014-202466] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AimsTo investigate the suitability of newly developed Becton Dickinson Vacutainer rapid serum tube (RST) for therapeutic drug monitoring of antibiotics and anticonvulsants.MethodsTwo pools of citrated whole blood were created by spiking high and low concentrations of gentamicin, vancomycin, phenytoin, lamotrigine and carbamazepine. After recalcification with 15 mmol/L calcium chloride, spiked whole blood was added into four different Becton Dickinson blood collection tubes: RST, serum separator tube, red top tube and polyethylene plain tube. Serum aliquots were collected at baseline (0 h), 2 h, 24 h, day 3 and day 7. Drug concentrations were measured in batch by HPLC and the Architect c8000.ResultsGentamicin and vancomycin concentrations were stable up to 7 days in all 4 blood collection tubes. Anticonvulsants results for the RST were stable and did not deviate substantially from those of the red top and plain tubes, and demonstrated better performance than the serum separator tubes that showed significant (≥10% bias, p<0.05) decrease in phenytoin and carbamazepine levels after 3 days of storage.ConclusionsThe RST provides acceptable drug stability over the course of 7 days for gentamicin, vancomycin, phenytoin and lamotrigine and over 3 days for carbamazepine.
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13
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Yan R, Lou A, Watts G, Tarr H, Smith H, Kinney L, Chen Y. Comparison of Becton Dickinson Vacutainer rapid serum tube with the serum separator tube for routine chemistry and immunoassay tests. J Clin Pathol 2014; 67:599-604. [PMID: 24687321 DOI: 10.1136/jclinpath-2013-202130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To shorten the clotting time and resolve the delayed clotting or no clotting on specimens from patients on anticoagulant therapy, Becton Dickinson (BD) recently developed the Vacutainer rapid serum tube (RST). The aim of this study was to systematically compare the new RST tube with the widely used serum separator tube (SST) for routine chemistry and immunoassay tests on 3 common analyser platforms. METHODS Blood from 45 people (24 women and 21 men, age 21-77 years) was collected using the SST and RST tubes in sequence. Sera from both tubes were separated and analysed simultaneously for 54, 50, and 10 chemistry and/or immunoassay tests on the Roche Modular, Abbott Architect, and Siemens Centaur analysers, respectively. RESULTS The results from the RST tube were comparable with those from the SST tube on most analytes. Although the results for a few analytes showed statistically significant differences between the two tubes (p<0.05), the differences had no clinical significance for most assays. Only for parathyroid hormone on the Abbott Architect, the RST tube demonstrated clinical significant bias versus the SST tube (-15.3%, p<0.01). CONCLUSIONS The RST tube provides acceptable performance for routine chemistry and immunoassay tests.
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Affiliation(s)
- Ronald Yan
- Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, New Brunswick, Canada Dalhousie Medical Program in New Brunswick, Saint John, New Brunswick, Canada
| | - Amy Lou
- Department of Pathology and Laboratory Medicine, Capital Health, Halifax, Nova Scotia, Canada Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gail Watts
- Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, New Brunswick, Canada
| | - Heather Tarr
- Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, New Brunswick, Canada
| | - Hilary Smith
- Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, New Brunswick, Canada
| | - Lois Kinney
- Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, New Brunswick, Canada
| | - Yu Chen
- Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, New Brunswick, Canada Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
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Snyder ML, Wiley C, Molinaro RJ, Ritchie JC, Fantz CR. Falsely Increased hCG in Patients with High Leukocyte Counts. Clin Chem 2013; 59:1127-9. [DOI: 10.1373/clinchem.2013.202911] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marion L Snyder
- Department of Chemistry Greenville Health System Greenville, SC
| | - Carmen Wiley
- Providence Sacred Heart Medical Center Spokane, WA
| | - Ross J Molinaro
- Department of Pathology and Laboratory Medicine Emory University Atlanta, GA
| | - James C Ritchie
- Department of Pathology and Laboratory Medicine Emory University Atlanta, GA
| | - Corinne R Fantz
- Department of Pathology and Laboratory Medicine Emory University Atlanta, GA
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Thrombin-accelerated quick clotting serum tubes: an evaluation with 22 common biochemical analytes. Adv Hematol 2013; 2013:769479. [PMID: 23653649 PMCID: PMC3638693 DOI: 10.1155/2013/769479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 02/21/2013] [Indexed: 11/17/2022] Open
Abstract
Clot activator serum tubes have significantly improved turnaround times for result reporting compared to plain tubes. With increasing workload and service performance expectations confronting clinical laboratories with high-volume testing and with particular emphasis on critical analytes, attention has focussed on preanalytical variables that can be improved. We carried out a field study on the test performance of BD vacutainer rapid serum tubes (RSTs) compared to current institutional issued BD vacutainer serum separator tubes (SSTs) in its test result comparability, clotting time, and stability on serum storage. Data from the study population (n = 160) of patients attending outpatient clinics and healthy subjects showed that results for renal, liver, lipids, cardiac, thyroid, and prostate biochemical markers were comparable between RSTs and SSTs. Clotting times of the RSTs were verified to be quick with a median time of 2.05 min. Analyte stability on serum storage at 4°C showed no statistically significant deterioration except for bicarbonate, electrolytes, and albumin over a period of 4 days. In conclusion, RSTs offered savings in the time required for the clotting process of serum specimens. This should translate to further trimming of the whole process from blood collection to result reporting without too much sacrifice on test accuracy and performance compared to the current widely used SSTs in most clinical laboratories.
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16
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Aw TC. High Sensitivity Troponins — Translating Research into Practice. PROCEEDINGS OF SINGAPORE HEALTHCARE 2012. [DOI: 10.1177/201010581202100415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Troponin is vital in the evaluation of acute coronary syndrome. Decision limits, based on the 99th percentile upper reference limit derived from a sufficiently large normal reference population, must be determined for each specific troponin method. The new troponins exhibit high-sensitivity performance – assay precision at less than 10% coefficient of variation (at the 99th percentile upper reference limit) and ability to detect measurable values in healthy subjects. The troponin literature has reached a tipping point necessitating guidance on its use from specialist societies.
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Affiliation(s)
- Tar Choon Aw
- Department of Lab Medicine, Changi General Hospital, Singapore
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