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Sadler W. Methods and reagent-lot comparisons by regression analysis: sample size considerations. Ann Clin Biochem 2024:45632241252006. [PMID: 38631810 DOI: 10.1177/00045632241252006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Parametric regression analysis is widely used in methods comparisons and more recently in checking the concordance of test results following receipt of new reagent lots. The greater frequency of reagent-lot evaluations increases pressure to detect bias with smallest possible sample sizes (i.e. smallest consumption of time and resources). This study revisits bias detection using the joint slope, intercept confidence region as an alternative to slope and intercept confidence intervals. METHODS Four cases were considered representing constant errors, proportional errors (constant CV) and two more complicated error patterns typical of immunoassays. Maximum:minimum range ratios varied from 2:1 to 2000:1. After setting a maximum tolerable difference a series of slope, intercept combinations, each of which predicted the critical difference, were systematically evaluated in simulations which determined the minimum sample size required to detect the difference, firstly using slope, intercept confidence intervals and secondly using the joint slope, intercept confidence region. RESULTS At small to moderate range ratios, bias detection by joint confidence region required greatly reduced sample sizes to the extent that it should encourage reagent-lot evaluations or, alternatively, transform those already routinely performed into considerably less costly exercises. CONCLUSIONS While some software is available to calculate joint confidence regions in real-life analyses, shifting this testing method into the mainstream will require a greater number of software developers incorporating the necessary code into their regression programs. The computer program used to conduct this study is freely available and can be used to model any laboratory test.
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2
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Patel D, Sargur R, Sheldon J, Wheeler RD, Stanley C. Evaluation of cryoprotein investigation using a digital external quality assurance scheme. Ann Clin Biochem 2024:45632241239805. [PMID: 38428927 DOI: 10.1177/00045632241239805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Background: Robust preanalytical and analytical processes are critical for the detection of cryoproteins. There is significant variation in practice in the detection, analysis and reporting. Results: A survey in 2018 of 137 laboratories participating in the UK National External Quality Assessment Service (UK NEQAS) (6) quality control program showed significant variation in the laboratory processes which highlighted the need for standardisation of the detection, analysis and reporting of cryoglobulins.Conclusion: The first available EQA scheme aiming to harmonise practice for cryoprotein testing has been developed by UK NEQAS and laboratories should participate in an appropriate EQA scheme to fulfil requirements for ISO accreditation.
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Affiliation(s)
- Dina Patel
- UK NEQAS Immunology, Immunochemistry & Allergy (IIA), Sheffield, UK
| | | | - Joanna Sheldon
- Protein Reference Unit, St George's Hospital, London, UK
| | | | - Carol Stanley
- UK NEQAS Immunology, Immunochemistry & Allergy (IIA), Sheffield, UK
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3
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Janković Miljuš J, Prosenc Zmrzljak U, Košir R, Jovanović M, Đorić I, Rončević J, Išić Denčić T, Šelemetjev S. Detecting TSHR mRNA from peripheral blood of patients with differentiated thyroid cancer rules out nonaggressive cases. Ann Clin Biochem 2024:45632241228217. [PMID: 38195090 DOI: 10.1177/00045632241228217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Early diagnosis of thyroid cancer is hampered by the inability of fine-needle aspiration biopsy (FNAB) to accurately classify ∼30% of cases while preoperative cancer staging detects lymph nodal involvement in only half of cases. Liquid biopsy may present an accurate, non-invasive alternative for preoperative thyroid nodule assessment. Thyrotropin receptor (TSHR) mRNA, a surrogate marker for circulating cancer cells (CTC), may be an option for early detection of malignancy from peripheral blood, but requires methodological improvements. We aimed to investigate if TSHR mRNA can be detected in low sample volumes by employing an ultrasensitive method - droplet digital PCR (ddPCR). METHODS Less that 5 mL of blood was collected from 47 patients with thyroid nodules (25 benign, 22 malignant). RNA was isolated from the fraction of mononuclear cells where CTCs segregate. Samples were analyzed for the presence of TSHR mRNA by ddPCR. RESULTS TSHR mRNA was detectable in 4 mL sample volumes, with the test having good specificity (80%) but modest diagnostic accuracy (68.1%). Combining TSHR mRNA with ultrasound features and FNAB diagnosis, the test reaches high rule-out performances (sensitivity=90% and NPV=88.2%). Strikingly, TSHR mRNA correctly classified all samples with thyroid capsule invasion, lymph node metastasis and extrathyroidal extension. If aggressiveness is defined using these parameters, TSHR mRNA test reaches 100% sensitivity and 100% NPV for detecting high-risk cases. CONCLUSIONS Employing ddPCR for TSHR mRNA improves its measurement by enabling detection in sample volumes common for laboratory testing. The test displays high prognostic performance, showing potential in preoperative risk assessment.
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Affiliation(s)
| | | | | | - Milan Jovanović
- Center for Endocrine SurgeryUniversity Clinical Center of Serbia
| | - Ilona Đorić
- University of Belgrade Institute for the Application of Nuclear Energy
| | - Jelena Rončević
- University of Belgrade Institute for the Application of Nuclear Energy
| | | | - Sonja Šelemetjev
- University of Belgrade Institute for the Application of Nuclear Energy
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Khare R, Brown-Elliott BA. Culture, Identification, and Antimicrobial Susceptibility Testing of Pulmonary Nontuberculous Mycobacteria. Clin Chest Med 2023; 44:743-755. [PMID: 37890913 DOI: 10.1016/j.ccm.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Nontuberculous mycobacteria (NTM) typically cause opportunistic pulmonary infections and reliable laboratory results can assist with diagnosis of disease. Microscopy can detect acid-fast bacilli from specimens though it has poor sensitivity. Solid and liquid culture are used to grow NTM, which are identified by molecular or protein-based assays. Because culture has a long turnaround time, some assays are designed to identify NTM directly from sputum specimens. When indicated, phenotypic susceptibility testing should be performed by broth microdilution as per the guidelines from the Clinical Laboratory Standards Institute. Genotypic susceptibility methods may be used to decrease the turnaround time for some antimicrobials.
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Affiliation(s)
- Reeti Khare
- Mycobacteriology Laboratory, 1400 Jackson Street, National Jewish Health, Denver, CO 80238, USA.
| | - Barbara A Brown-Elliott
- The University of TX Health Science Center at Tyler, Mycobacteria/Nocardia Laboratory, 11937 US Highway 271, Tyler, TX 75708, USA
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Giralt M, Díaz-Troyano N, Comas I, Blanco A, Conesa L, Mendoza M, Zafon C, Goya M, Ferrer R. Reference ranges of thyroid hormones during the first trimester in Catalan women using the Atellica® IM Solution Immunoassay Analyzer. Ann Clin Biochem 2023:45632231219387. [PMID: 37996255 DOI: 10.1177/00045632231219387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
BACKGROUND Gestational hypothyroidism has been shown to be associated with adverse pregnancy outcomes as well as adverse outcomes for the child. Thyroid hormones concentrations change in gestation, especially within the first trimester, so the results of thyroid function test often are outside non-pregnant reference ranges. The objective of this study was to establish the first trimester reference ranges for thyroid stimulating hormone (TSH) and free thyroxine (FT4) for pregnant women in Barcelona (Spain). METHODS It was a prospective study in which 673 women were recruited during their first trimester of gestation (8-13 weeks). Serum TSH, FT4 and antithyroid peroxidase antibodies (TPOAb) were measured with Atellica® IM 1600 (Siemens Healthineers). After excluding 418 women, the reference ranges for TSH and FT4 were calculated by the 2.5th and 97.5th percentiles. Potential variables examined in this study were age, body mass index (BMI), ethnicity, iodine supplementation and smoking habit. RESULTS The reference ranges established on the Atellica® IM 1600 for the first trimester pregnancy in our population were 0.111 to 4.291 mIU/L for TSH and 11.45 to 17.76 pmol/L for FT4. No significant differences were found in thyroid hormones concentrations regarding maternal age (≤30 years versus >30 years) (p=0.117), iodine supplementation (p=0.683) and smoking habit (p=0.363). The prevalence of TPOAb was estimated at 10.0%. CONCLUSIONS We found that in our local population the optimal TSH upper reference limit in the first trimester of gestation was 4.3 mIU/L, similar to that proposed by de ATA-2017 guideline (4.0 mIU/L).
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Affiliation(s)
| | | | | | - Albert Blanco
- Department of BiochemistryVall d'Hebron University Hospital
| | - Laura Conesa
- Department of BiochemistryVall d'Hebron University Hospital
| | - Manel Mendoza
- Department of Obstetrics and Reproductive Medicine, Maternal-Fetal Medicine Unit.Vall d'Hebron University Hospital
| | - Carles Zafon
- Diabetes and Metabolism Research Unit (VHIR) and Department of EndocrinologyVall d'Hebron University Hospital
| | - María Goya
- Department of Obstetrics and Reproductive Medicine, Maternal-Fetal Medicine UnitVall d'Hebron University Hospital
| | - Roser Ferrer
- Department of BiochemistryVall d'Hebron University Hospital
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Fujihara J, Nishimoto N, Takeshita H. Plasma cell-free DNA in patients with acute promyelocytic leukemia treated with arsenic trioxide. Ann Clin Biochem 2023:45632231216596. [PMID: 37944991 DOI: 10.1177/00045632231216596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Cell-free DNA (cfDNA) is free DNA found in circulating blood that originates from apoptosis or necrosis, and elevated cfDNA concentrations have been reported in cancers and other diseases. METHODS In this study, the concentrations and fragment distributions of plasma cfDNA were preliminary investigated in elderly (n = 1) and pediatric (n = 1) patients with acute promyelocytic leukemia (APL) treated with arsenic trioxide (ATO). RESULTS A slight increase in cfDNA concentrations was observed in the APL patients compared with healthy controls. The change in plasma cfDNA concentrations corresponded to the change in plasma arsenic concentrations during ATO treatment. The fragment distribution pattern did not differ before and during treatment. Three ladder fragments were observed in part of the cfDNA in the second consolidation therapy in an elderly APL patient and the first consolidation therapy of a pediatric APL patient, while two fragments were observed in all other treatment periods. Moreover, APL-related gene mutations were successfully genotyped from plasma cfDNA by using polymerase chain reaction-based methods and these results are consistent with those from leukocytes. CONCLUSION This study is the first to report the concentrations and fragment patterns of cfDNA from APL patients treated with ATO. The results suggested that plasma cfDNA concentration in APL patients increased with ATO treatment and that cfDNA is released mainly via neutrophil extracellular traps (and/or necrosis) in addition to apoptosis. To confirm whether cfDNA concentrations and fragment patterns can be used as a biomarker for APL treated with ATO, further accumulative data are needed.
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Affiliation(s)
- Junko Fujihara
- Shimane University Faculty of Medicine Graduate School of Medicine
| | | | - Haruo Takeshita
- Shimane University Faculty of Medicine Graduate School of Medicine
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7
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van Duijl TT, Ruhaak R, Hoogeveen E, de Mutsert RE, Rosendaal F, le Cessie S, de Fijter J, Cobbaert C. Reference intervals of urinary kidney injury biomarkers for middle-aged men and women determined by quantitative protein mass spectrometry. Ann Clin Biochem 2022; 59:420-432. [PMID: 35957618 DOI: 10.1177/00045632221121780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS There is an ongoing need to recognize early kidney injury and its progression in structural chronic pathologies. The proteins NGAL, IGFBP7, TIMP2, KIM-1, CXCL9, TGF-β1, SLC22A2, nephrin, cubilin and uromodulin have been proposed as early kidney injury biomarkers. To guide clinical interpretation, their urinary concentrations should be accompanied by reference intervals, which we here establish in a representative Dutch middle-aged population. MATERIALS AND METHODS The 24-h urine samples from 1443 Caucasian middle-aged men and women, were analyzed for the biomarkers by quantitative LC-MS/MS. Biomarker excretion per 24-h were calculated, and urine creatinine and osmolality were measured for dilution normalization. This population was characterized by demographic and anthropometric parameters, comorbid conditions, and conventional kidney function measures. RESULTS NGAL, IGFBP7, TIMP2, KIM-1 and uromodulin could be quantified in this population, whereas nephrin, SLC22A2 and CXCL9 were below their detection limits. Urine creatinine and osmolality ( r= -were correlated to urine volume (r = -0.71; -0.74) and to IGFBP7 (r = 0.73; 0.71) and TIMP2 (r = 0.71; 0.69). Crude and normalized biomarker concentrations were affected by sex, but not by age, BMI, smoking, kidney function or common comorbid conditions. The reference intervals (men; women) were 18-108; 21-131 pmol IGFBP7/mmol creatinine, 1- 63; 4-224 pmol NGAL/mmol creatinine, 7-48; 7- 59 pmol TIMP2/mmol creatinine, <1-9; <1-12 pmol KIM-1/mmol creatinine and 0.1-1.2; 0.1-1.7 mg uromodulin/mmol creatinine. CONCLUSION We present dilution-normalized and sex-stratified urinary reference intervals of kidney injury biomarkers in a middle-aged Caucasian population.
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Affiliation(s)
| | | | - Ellen Hoogeveen
- Department of Clinical Epidemiology4501Leiden University Medical Center
| | - Renà E de Mutsert
- Department of Clinical Epidemiology4501Leiden University Medical Center
| | - Frits Rosendaal
- Department of Clinical Epidemiology4501Leiden University Medical Center
| | - Saskia le Cessie
- Department of Clinical Epidemiology4501Leiden University Medical Center
| | - Johan de Fijter
- Department of Nephrology4501Leiden University Medical Center
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Morris TG, Layley J, Geevarghese R, Steele L, Ssali J, Mirzazadeh M. Adult and neonate TSH blood spot reference intervals. Ann Clin Biochem 2022; 59:363-372. [PMID: 35751155 DOI: 10.1177/00045632221112654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neonatal congenital hypothyroidism screening is performed by measuring thyroid-stimulating hormone (TSH) in a dried blood spot (DBS) sample, whereas acquired hypothyroidism uses serum TSH. There is no established DBS TSH reference interval, but knowing this is useful, as some patients cannot tolerate venepuncture, so DBS collection is seen as an acceptable alternative. The aim of this study was to establish DBS TSH reference intervals in adults and neonates (day 5-8), and determine the relationship between serum and DBS TSH. METHODS Euthyroid adults, not on thyroid medication and with a normal haematocrit, were selected. If they had a paired lithium heparin sample, DBS were prepared by spotting 50 µl of whole blood onto filter paper. DBS TSH was measured using the PerkinElmer Neonatal hTSH kit on the GSP instrument and serum using the Abbott Architect assay. The relationship between DBS and serum TSH was analysed using Passing-Bablok regression and the adult DBS TSH reference interval calculated using transformed data. The neonatal reference interval was calculated from screening results using the non-parametric method. RESULTS 109 adult samples were included in the study (61 female). The Passing-Bablok regression was: DBS TSH = 0.68 x serum TSH + 0.07, and reference interval was 0.49-3.07 mU/L. The neonatal DBS reference interval was 0.40-4.10 mU/L from 8,351 results. CONCLUSION This study derived adult and neonate TSH DBS reference intervals using the GSP analyser and established the relationship between serum and DBS TSH. Knowing this information will allow for improved interpretation of DBS TSH results.
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Affiliation(s)
| | - Jonathan Layley
- South West Thames Newborn Screening Laboratory3237Epsom and Saint Helier University Hospitals NHS Trust
| | - Robin Geevarghese
- South West Thames Newborn Screening Laboratory3237Epsom and Saint Helier University Hospitals NHS Trust
| | - Lucille Steele
- South West Thames Newborn Screening Laboratory3237Epsom and Saint Helier University Hospitals NHS Trust
| | - Joshua Ssali
- South West Thames Newborn Screening Laboratory3237Epsom and Saint Helier University Hospitals NHS Trust
| | - Mehdi Mirzazadeh
- Blood Sciences3237Epsom and Saint Helier University Hospitals NHS Trust
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9
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Deville M, Bailly R, Gauthier N, Pitti P, Wachtelaer A, Charlier C. Biochip Array Technology for new psychoactive substances detection in biological samples: evaluation of the specificity of the Randox Evidence Investigator ®. Ann Clin Biochem 2022; 59:357-362. [PMID: 35726604 DOI: 10.1177/00045632221111751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The need to detect new psychoactive substances in biological samples is of crucial interest. In this paper, the specificity of a benchtop immunoanalyzer commercialized by Randox was evaluated on real patient samples. Method The Evidence Investigator was assessed to screen for NPS on 80 serum and urine samples coming from patient admitted to the emergency department. Targeted NPS were included in various categories such as synthetic cannabinoids, opioids and benzodiazepines. Results were compared with a chromatographic technique coupled with mass spectrometry. Results No NPS was detected by the reference technique. Concerning immunoanalysis, some piperazines were positive, caused by the presence of medicine containing this chemical structure. Clonazepam and fentanyl derivatives were confirmed in some cases, but sometimes the positivity was explained by other opiates or benzodiazepines, which also explained 2 samples falsely positive for etizolam. Conclusions The Randox Evidence Investigator was rapid and easy to use. It can be used as a first intention but always followed by a more specific technique in order to detect false positive result.
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Ansari S, Abdel-Malek M, Kenkre J, Choudhury SM, Barnes S, Misra S, Tan T, Cegla J. The use of whole blood capillary samples to measure 15 analytes for a home-collect biochemistry service during the SARS-CoV-2 pandemic: A proposed model from North West London Pathology. Ann Clin Biochem 2021; 58:411-421. [PMID: 33715443 PMCID: PMC8458673 DOI: 10.1177/00045632211004995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The COVID-19 pandemic has drastically changed the delivery of secondary care services. Self-collection of capillary blood at home can facilitate the monitoring of patients with chronic disease to support virtual clinics while mitigating the risk of SARS-CoV-2 infection and transmission. OBJECTIVE To investigate the comparability of whole blood capillary and plasma venous samples for 15 routinely used biochemical analytes and to develop and pilot a user-friendly home-collection kit to support virtual outpatient clinical services. METHODS To investigate the comparability of whole blood capillary and plasma venous samples for 15 routinely requested biochemical analytes, simultaneous samples of venous and capillary blood were collected in EDTA and lithium-heparin plasma separation tubes that were of 4-6 mL and 400-600 µL draw volume, respectively. Venous samples were analysed within 4 h of collection while capillary samples were kept at ambient temperature for three days until centrifugation and analysis. Analyte results that were comparable between the matrices were then piloted in a feasibility study in three outpatient clinical services. RESULTS HbA1c, lipid profile and liver function tests were considered comparable and piloted in the patient feasibility study. The home-collect kit demonstrated good patient usability. CONCLUSION Home collection of capillary blood could be a clinically-useful tool to deliver virtual care to patients with chronic disease.
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Affiliation(s)
- Saleem Ansari
- Blood Sciences, North West London Pathology, London, UK
| | | | - Julia Kenkre
- Blood Sciences, North West London Pathology, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Sirazum M Choudhury
- Blood Sciences, North West London Pathology, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Sophie Barnes
- Blood Sciences, North West London Pathology, London, UK
| | - Shivani Misra
- Blood Sciences, North West London Pathology, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Tricia Tan
- Blood Sciences, North West London Pathology, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Jaimini Cegla
- Blood Sciences, North West London Pathology, London, UK
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
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11
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Sarto C, Intra J, Fania C, Brivio R, Brambilla P, Leoni V. Monoclonal free light chain detection and quantification: Performances and limits of available laboratory assays. Clin Biochem 2021; 95:28-33. [PMID: 33991536 DOI: 10.1016/j.clinbiochem.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/25/2021] [Accepted: 05/10/2021] [Indexed: 11/19/2022]
Abstract
The detection and quantification of immunoglobulin free light chains in serum and urine is recommended for the diagnosis and monitoring of monoclonal gammopathies according to the guidelines of the International Myeloma Working Group (IMWG). Several tests are currently available in the clinical laboratory to detect and quantify free light chains but although quality, efficiency, and effectiveness have been improved, the results are still variable and poorly harmonized and standardized. The present review article wants to analyze these aspects, with a keen eye on techniques, such as mass spectrometry, that could replace in the practical clinical laboratory the current methods including Bence-Jones protein assay and free light chain immunoassays.
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Affiliation(s)
- C Sarto
- Department of Laboratory Medicine, University of Milano-Bicocca, Azienda Socio Sanitaria Territoriale della Brianza ASST-Brianza, Desio Hospital, via Mazzini 1, 20833 Desio, (MB), Italy
| | - J Intra
- Clinical Chemistry Laboratory, University of Milano-Bicocca, Azienda Socio Sanitaria Territoriale di Monza ASST-Monza, St Gerardo Hospital, via Pergolesi 33, 20900 Monza, (MB), Italy.
| | - C Fania
- Clinical Chemistry Unit, "Maggiore della Carità" University Hospital, 28100 Novara, Italy
| | - R Brivio
- Clinical Chemistry Laboratory, University of Milano-Bicocca, Azienda Socio Sanitaria Territoriale di Monza ASST-Monza, St Gerardo Hospital, via Pergolesi 33, 20900 Monza, (MB), Italy
| | - P Brambilla
- Department of Laboratory Medicine, University of Milano-Bicocca, Azienda Socio Sanitaria Territoriale della Brianza ASST-Brianza, Desio Hospital, via Mazzini 1, 20833 Desio, (MB), Italy
| | - V Leoni
- Department of Laboratory Medicine, University of Milano-Bicocca, Azienda Socio Sanitaria Territoriale della Brianza ASST-Brianza, Desio Hospital, via Mazzini 1, 20833 Desio, (MB), Italy
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12
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Sanger M, Natarajan BM, Wang B, Edil T, Ginder-Vogel M. Recycled concrete aggregate in base course applications: Review of field and laboratory investigations of leachate pH. J Hazard Mater 2020; 385:121562. [PMID: 31732334 DOI: 10.1016/j.jhazmat.2019.121562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/27/2019] [Accepted: 10/28/2019] [Indexed: 06/10/2023]
Abstract
The prevalence of construction and demolition (C&D) waste and the concurrent demand for construction aggregate presents the opportunity to recycle C&D waste materials as substitutes for virgin aggregate. Commonly, recycled concrete aggregate (RCA) is used as base course in pavement construction. Environmentally responsible applications of RCA must consider the high pH leachate and trace element leaching risks reported in the literature. This review presents the methodology, results, and limitations of existing laboratory and field investigations of RCA leachate chemistry. Long-term highway field studies of RCA leachate illustrate that an initially high leachate pH approaches neutral within approximately one to two years of construction. Conversely, laboratory investigations of RCA leachate pH using batch reactor leaching tests and column leaching tests measure consistently high leachate pH (pH > 10). The discrepancies between field and laboratory measurements of RCA leachate pH suggest that the current laboratory methodology inadequately describes leachate conditions in the field. The authors recommend that future laboratory investigations consider intermittent wetting and drying cycles, eliminate particle abrasion, employ relevant contact times, and consider additional environmental processes that reduce leachate pH such as soil acidity and carbonation.
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Affiliation(s)
- Morgan Sanger
- Department of Civil and Environmental Engineering, Geological Engineering Program, University of Wisconsin - Madison, United States.
| | - Bharat Madras Natarajan
- Department of Civil and Environmental Engineering, Geological Engineering Program, University of Wisconsin - Madison, United States.
| | - Bu Wang
- Department of Civil and Environmental Engineering, Geological Engineering Program, University of Wisconsin - Madison, United States
| | - Tuncer Edil
- Department of Civil and Environmental Engineering, Geological Engineering Program, University of Wisconsin - Madison, United States
| | - Matthew Ginder-Vogel
- Department of Civil and Environmental Engineering, Geological Engineering Program, University of Wisconsin - Madison, United States; Department of Civil and Environmental Engineering, Environmental Chemistry and Technology Program, University of Wisconsin-Madison, United States.
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13
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Affiliation(s)
- Josef Coresh
- Departments of Epidemiology, Medicine, and Biostatistics, Johns Hopkins University, Baltimore, Maryland
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14
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Price HR, Chehroudi C, Knight SJ, Smith AD, Lai D, Kim H, Wright TE, Coughtrie MW, Collier AC. Umbilical cord as an analytical matrix - A technical note. Placenta 2019; 90:42-44. [PMID: 32056550 DOI: 10.1016/j.placenta.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/26/2019] [Accepted: 12/02/2019] [Indexed: 01/19/2023]
Abstract
The umbilical cord (UC) connects the fetal blood supply to the placenta, so is exposed to all systemic endo- and xenobiotics. We have extensive experience using UC as an analytical matrix for detecting and/or quantitating drugs, chemicals and endogenous compounds. This technical note describes advantages (large amount available, ease of collection, small sample needed for use, rapid availability) and challenges (clinical relationships, processing difficulties, matrix effects on analytes and detection technologies) of UC as an analytical matrix in ELISA and LC/MS platforms, and provides guidance for successfully working with this tissue.
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Affiliation(s)
- Hayley R Price
- Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Camron Chehroudi
- Centre for Blood Research, 2350 Health Sciences Mall, The University of British Columbia, Vancouver, BC, V6T 1Z3, Canada; Faculty of Dentistry, 2199 Wesbrook Mall, The University of British Columbia, Vancouver, BC, V6T 1Z3, Canada; Department of Biochemistry and Molecular Biology, 2350 Health Sciences Mall, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Stuart J Knight
- Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Alexander D Smith
- Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Dickson Lai
- Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Hugh Kim
- Centre for Blood Research, 2350 Health Sciences Mall, The University of British Columbia, Vancouver, BC, V6T 1Z3, Canada; Faculty of Dentistry, 2199 Wesbrook Mall, The University of British Columbia, Vancouver, BC, V6T 1Z3, Canada; Department of Biochemistry and Molecular Biology, 2350 Health Sciences Mall, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Tricia E Wright
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, 94115, USA
| | - Michael Wh Coughtrie
- Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Abby C Collier
- Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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15
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Abstract
Anticoagulant drugs directly or indirectly influence coagulation factors preventing fibrin formation, thus preventing blood clotting. They are classified into two groups according to the mode of application, namely parenteral and oral drugs. Among the latter, vitamin K antagonists (most often warfarin) were most widely used for almost a century. In recent years new oral anticoagulant drugs have become available that directly target either factor IIa or Xa (direct oral anticoagulants, DOACs). The proportion of patients to whom DOACs are prescribed is increasing because clinical studies have proved they are at least as effective and safe as vitamin K antagonists. Some of the anticoagulant drugs require regular laboratory monitoring, while others only need assessment of blood drug levels in specific clinical situations. This chapter provides an overview of appropriate laboratory tests used for either regular laboratory monitoring of therapy or occasional assessment of the anticoagulant effect of both parenteral and oral anticoagulant drugs used in clinical practice.
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Affiliation(s)
- Mojca Božič Mijovski
- Department of Vascular Diseases, Laboratory for Haemostasis and Atherothrombosis, University Medical Centre Ljubljana, Ljubljana, Slovenia.
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16
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May K, Marchand-Austin A, Peci A, Jamieson FB. A method for improved fluorescent staining for acid fast smear microscopy by incorporating an acetone rinse step. Diagn Microbiol Infect Dis 2018; 93:329-333. [PMID: 30527784 DOI: 10.1016/j.diagmicrobio.2018.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/25/2018] [Accepted: 11/02/2018] [Indexed: 11/29/2022]
Abstract
Microscopic examination of the specimen smear for acid fast bacilli (AFB) provides a simple and rapid means of detecting AFB using fluorescent stain methods and remains a valuable diagnostic test used worldwide to identify and manage suspect cases of tuberculosis (TB). Methods to improve AFB smear staining protocols could provide better detection of suspect TB cases. In particular, decreasing background debris may improve the detection of smears with low numbers of bacilli. We assessed staining by the standard rack method compared to bulk container staining using an acetone rinse step to decrease background debris. No cross-contamination was observed in the bulk container staining, and higher accuracy with less reading time was achieved with the acetone rinse. Most importantly, more bacilli were detected per positive smear using the acetone rinse method.
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Affiliation(s)
- Kevin May
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Canada
| | | | - Adriana Peci
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Canada
| | - Frances B Jamieson
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Canada.
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17
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Heffler E, Puggioni F, Peveri S, Montagni M, Canonica GW, Melioli G. Extended IgE profile based on an allergen macroarray: a novel tool for precision medicine in allergy diagnosis. World Allergy Organ J 2018; 11:7. [PMID: 29743964 PMCID: PMC5918992 DOI: 10.1186/s40413-018-0186-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/06/2018] [Indexed: 12/17/2022] Open
Abstract
Background Precision medicine (PM) is changing the scope of allergy diagnosis and treatment. An in vitro IgE assay, a prototype PM method, was developed in the sixties and has garnered increasing interest because of the introduction of recombinant components in the test. More recently, microarrays of allergen components have significantly improved the ability to describe the IgE profile. Aim of this study was to evaluate the characteristics of the newly developed Allergy Explorer (ALEX), a macroarray containing both extracted "whole" allergens and molecular components. This method allows the acquisition of an IgE profile comprising 282 reagents (157 allergen extracts and 125 components), resulting in the widest screening of potential allergens available. Methods Sera from 43 patients with allergies were assayed with ALEX and then with ImmunoCAP ISAC. The results of the two tests were compared, and the consistency of the molecular results with the presence of IgE in the relevant extract was also evaluated. Results A good correlation between ISAC and ALEX was observed. The ALEX results for second-level tests (i.e., specific IgE to complete extracted allergens) were consistent with the results obtained for the relevant components. Discussion Despite differences in the methodology, the IgE profiles detected for molecular allergens by ALEX and ISAC were very similar. The differences were mainly related to the lower dynamic range of ALEX and to the use of a CCD inhibitor in the first incubation phase, which reduced the binding of IgE to CCD, as represented in the extracted allergens and components. Conclusion Based on our findings, ALEX is a novel tool for describing the IgE profile in a PM setting, where the IgE assay must be performed on many allergens and components. In particular, polysensitized patients and patients with pollen-food syndrome will have a real advantage due the combination of the second and third levels of allergy diagnostics in the same chip.
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Affiliation(s)
- Enrico Heffler
- 1Personalized Medicine, Asthma and Allergy Unit, Humanitas Clinical and Research Center, 20089 Rozzano MI, Italy.,2Department of Biomedical Sciences, Humanitas University, Via Manzoni 113, 20089 Rozzano MI, Italy
| | - Francesca Puggioni
- 1Personalized Medicine, Asthma and Allergy Unit, Humanitas Clinical and Research Center, 20089 Rozzano MI, Italy
| | - Silvia Peveri
- Unità Operativa Speciale Dipartimentale di Allergologia, Ospedale G. da Saliceto, Piacenza, Italy
| | - Marcello Montagni
- Unità Operativa Speciale Dipartimentale di Allergologia, Ospedale G. da Saliceto, Piacenza, Italy
| | - Giorgio Walter Canonica
- 1Personalized Medicine, Asthma and Allergy Unit, Humanitas Clinical and Research Center, 20089 Rozzano MI, Italy.,2Department of Biomedical Sciences, Humanitas University, Via Manzoni 113, 20089 Rozzano MI, Italy
| | - Giovanni Melioli
- 1Personalized Medicine, Asthma and Allergy Unit, Humanitas Clinical and Research Center, 20089 Rozzano MI, Italy.,2Department of Biomedical Sciences, Humanitas University, Via Manzoni 113, 20089 Rozzano MI, Italy
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18
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McCann RK, Smith K, Gaya DR. A prospective single centre pilot evaluation of a serum calprotectin assay in unselected GI patients. Clin Biochem 2017; 50:533-536. [PMID: 28093196 PMCID: PMC5480541 DOI: 10.1016/j.clinbiochem.2017.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/15/2016] [Accepted: 01/10/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Whilst C-reactive protein (CRP) is an established serum marker of inflammation, its use in gastroenterology has been limited by its poor sensitivity and specificity for GI disease. Faecal calprotectin (FC) has been adopted into mainstream GI practice as a sensitive but non-specific marker of intestinal inflammation. However, stool samples collection for FC can be challenging and the possibility of utilising a sensitive and specific serum biomarker of intestinal inflammation in luminal gastroenterology is an attractive prospect. This work investigates the performance of serum calprotectin (SC) compared to current biomarkers, FC and CRP, in an unselected cohort of patients attending our GI unit. METHODS Patients attending in and outpatients within an adult GI service who submitted a stool sample for FC analysis were identified. A total of 109 who had a serum sample obtained within one day of stool sample collection had the serum analysed for CRP and SC and the correlation between these biomarkers was investigated. RESULTS The intraclass correlation coefficient (ICC) between SC, FC and CRP was 0.10, 95% CI -0.09-0.28 and 0.18, 95% CI -0.01-0.35, respectively. The ICC between FC and CRP was 0.18, 95% CI -0.01-0.35. CONCLUSIONS Our data reveals that there is no significant correlation between SC and FC, nor between SC and CRP in a large unselected cohort of GI patients. Therefore, as a serum biomarker for intestinal inflammation, SC is unlikely to be of clinical utility and the search for an appropriate serum GI biomarker continues.
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Affiliation(s)
- Rebecca K McCann
- Department of Clinical Biochemistry, Glasgow Royal Infirmary, Glasgow, UK
| | - Karen Smith
- Department of Clinical Biochemistry, Glasgow Royal Infirmary, Glasgow, UK
| | - Daniel R Gaya
- Gastroenterology Unit, Glasgow Royal Infirmary, Glasgow, UK.
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19
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Harenberg J. Laboratory determination of old and new targeted anticoagulant agents for prevention of bleeding and thrombotic events in cancer patients. Thromb Res 2017; 140 Suppl 1:S165-7. [PMID: 27067972 DOI: 10.1016/s0049-3848(16)30117-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A two-fold prolongation of activated partial thromboplastin time (APTT) is established as therapeutic range for therapy with unfractionated heparin, hirudin and argatroban. The international normalized ratio (INR) of 2 to 3 is required to maintain anticoagulation in the therapeutic range of vitamin K antagonists. The therapeutic range of anti-factor Xa activity during therapy with low-molecular weight heparins and danaparoid are less well and of direct oral anticoagulants (DOAC) poorly defined. The relation of aPTT and INR values to thrombotic and bleeding events are well established despite a large variation of values in affected patients. The relation of coagulation values of the other anticoagulants to clinical events is open. The value of determination in cancer patients is higher because of the increased risk for thrombotic and bleeding events of this patient group. Several activities are currently undertaken to certify methods for in vitro diagnostic testing for DAOCs.
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Affiliation(s)
- Job Harenberg
- Medical Faculty Mannheim, University of Heidelberg, Maybachstrasse 14, 68169 Mannheim, Germany.
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20
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Robinson E, Proctor M, Oldham M, Masic U. The effect of heightened awareness of observation on consumption of a multi-item laboratory test meal in females. Physiol Behav 2016; 163:129-135. [PMID: 27137078 PMCID: PMC4959264 DOI: 10.1016/j.physbeh.2016.04.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/18/2016] [Accepted: 04/24/2016] [Indexed: 12/25/2022]
Abstract
Human eating behaviour is often studied in the laboratory, but whether the extent to which a participant believes that their food intake is being measured influences consumption of different meal items is unclear. Our main objective was to examine whether heightened awareness of observation of food intake affects consumption of different food items during a lunchtime meal. One hundred and fourteen female participants were randomly assigned to an experimental condition designed to heighten participant awareness of observation or a condition in which awareness of observation was lower, before consuming an ad libitum multi-item lunchtime meal in a single session study. Under conditions of heightened awareness, participants tended to eat less of an energy dense snack food (cookies) in comparison to the less aware condition. Consumption of other meal items and total energy intake were similar in the heightened awareness vs. less aware condition. Exploratory secondary analyses suggested that the effect heightened awareness had on reduced cookie consumption was dependent on weight status, as well as trait measures of dietary restraint and disinhibition, whereby only participants with overweight/obesity, high disinhibition or low restraint reduced their cookie consumption. Heightened awareness of observation may cause females to reduce their consumption of an energy dense snack food during a test meal in the laboratory and this effect may be moderated by participant individual differences. We examined the effect of heightened awareness of observation on food intake. This caused female participants to eat less of an energy dense snack food. This effect was moderated by weight status and trait eating behaviour measures. Heightened awareness of observation had little effect on intake of other foods.
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21
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McConnell JP, Guadagno PA, Dayspring TD, Hoefner DM, Thiselton DL, Warnick GR, Harris WS. Lipoprotein(a) mass: a massively misunderstood metric. J Clin Lipidol 2014; 8:550-3. [PMID: 25499936 DOI: 10.1016/j.jacl.2014.08.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/11/2014] [Accepted: 08/14/2014] [Indexed: 11/23/2022]
Abstract
The importance of lipoprotein (a)-Lp(a)-as a cardiovascular (CV) risk marker has been underscored by recent findings that CV risk is directly related to baseline Lp(a) levels, even in well-treated patients. Although there is currently little that can be done pharmacologically to lower Lp(a) levels, knowledge of its serum concentration is important in overall risk assessment. This review focuses on 1 aspect of Lp(a) that is rarely discussed directly: how to express its levels in serum. There is considerable confusion on this point, and a fuller understanding of what the concentration units mean will help improve study-to-study comparisons and thereby advance our understanding of the pathobiology of this lipoprotein particle. As discussed here, the term Lp(a) mass refers to the entire mass of the particle: lipids, proteins, and carbohydrates combined. At present, there are no commercially available assays that are completely insensitive to the variability in particle mass, which arises not only from differences in apo(a) isoform mass but also from variations in lipid mass. Because lipoprotein "particle number" (molar concentration) has been found to be superior to component-based metrics (ie, low-density lipoprotein particle vs cholesterol concentrations) for CV disease risk prediction, the development of a mass-insensitive Lp(a) assay should be a high priority.
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22
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Abstract
In the last decade, the introduction of the serum-free light-chain (sFLC) assay has been an important advance in the diagnosis and management of plasma cell dyscrasias, particularly monoclonal light-chain diseases. The immunoassay was developed to detect free light chains in serum by using anti-FLC antibodies which specifically recognised epitopes on light chains that were 'hidden' in intact immunoglobulins. Since its introduction in 2001, there have been several publications in the English language literature discussing the clinical utility as well as analytical limitations of the sFLC assay. These studies have highlighted both positive and negative aspects of the assay particularly with regard to its sensitivity and specificity and the technical challenges that can affect its performance. The contribution and significance of the sFLC assay in the management of light-chain myeloma, primary amyloid light-chain (AL) amyloidosis and non-secretory myeloma are well recognised and will be addressed in this review. The aim of this article is to also review the published literature with a view to providing a clear understanding of its utility and limitations in the diagnosis, prognosis and monitoring of plasma dyscrasias including intact immunoglobulin multiple myeloma (MM) and monoclonal gammopathy of unknown significance (MGUS). The increasing interest in using this assay in other haematological conditions will also be briefly discussed.
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Affiliation(s)
- Malini V Bhole
- Department of Immunology, Russells Hall Hospital, The Dudley Group NHS Foundation Trust, Dudley, UK
| | - Ross Sadler
- Department of Immunology, Churchill Hospital, Oxford Radcliffe NHS Trust, Oxford, UK
| | - Karthik Ramasamy
- Department of Haematology, Churchill Hospital, Oxford Radcliffe NHS Trust, Oxford, UK Department of Haematology, Royal Berkshire Hospital NHS Foundation Trust, Reading, UK National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Headington, UK
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