1
|
Panteghini M. What the Milan conference has taught us about analytical performance specification model definition and measurand allocation. Clin Chem Lab Med 2024; 62:1455-1461. [PMID: 38277658 DOI: 10.1515/cclm-2023-1257] [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: 11/07/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
Analytical performance specifications (APS) represent the criteria that specify the quality required for laboratory test information to satisfy clinical needs. In 2014 the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) considered timely to update the topic of APS by organizing a conference in Milan in which some strategic concepts were proposed. Here I summarize the essential points representing the EFLM Strategic Conference heritage and discuss the approaches that will permit us to become more concrete, including roles and main actions expected from each of involved stakeholders for contributing a quantum leap forward in the way of practicality of Milan consensus about APS.
Collapse
Affiliation(s)
- Mauro Panteghini
- Department of Laboratory Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| |
Collapse
|
2
|
Panteghini M. Analytical performance specifications for combined uncertainty budget in the implementation of metrological traceability. Clin Chem Lab Med 2024; 62:1497-1504. [PMID: 38311825 DOI: 10.1515/cclm-2023-1325] [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: 11/21/2023] [Accepted: 01/23/2024] [Indexed: 02/06/2024]
Abstract
In addition to the correct implementation of calibration traceability, the definition and fulfillment of maximum allowable measurement uncertainty (MAU) are essential in assuring that laboratory measurements are clinically usable. Across the entire calibration hierarchy, three major contributors to the measurement uncertainty (MU) budget are identified, starting with the higher-order reference providers, extending through the in vitro diagnostic (IVD) manufacturers and their processes for assigning calibrator values, and ending with medical laboratories generating the random variability of results reported to clinicians. To understand if it is possible to achieve MAU and, consequently, to fix the possible drawbacks, the definition of combined MU budget limits across the entire calibration hierarchy has a central role. In particular, quality specifications for MU of reference and commercial calibrator materials should be defined according to the MAU on clinical samples. All involved stakeholders (i.e., higher-order reference providers, IVD manufacturers, medical laboratories) should be prepared to improve their performance whenever the clinical application of the test is made questionable by the failure to achieve MAU.
Collapse
Affiliation(s)
- Mauro Panteghini
- Department of Laboratory Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| |
Collapse
|
3
|
Panteghini M. An improved implementation of metrological traceability concepts is needed to benefit from standardization of laboratory results. Clin Chem Lab Med 2024; 0:cclm-2024-0428. [PMID: 38687497 DOI: 10.1515/cclm-2024-0428] [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: 04/05/2024] [Accepted: 04/12/2024] [Indexed: 05/02/2024]
Abstract
Non-harmonization of laboratory results represents a concrete risk for patient safety. To avoid harms, it is agreed that measurements by in vitro diagnostic medical devices (IVD-MD) on clinical samples should be traceable to higher-order references and adjusted to give the same result. However, metrological traceability is not a formal claim and has to be correctly implemented, which in practice does not happen for a non-negligible number of measurands. Stakeholders, such as higher-order reference providers, IVD manufacturers, and External Quality Assessment organizers, have major responsibilities and should improve their contribution by unambiguously and rigorously applying what is described in the International Organization for Standardization 17511:2020 standard and other documents provided by the international scientific bodies, such as Joint Committee on Traceability in Laboratory Medicine and IFCC. For their part, laboratory professionals should take responsibility to abandon non-selective methods and move to IVD-MDs displaying proper selectivity, which is one of the indispensable prerequisites for the correct implementation of metrological traceability. The practicality of metrological traceability concepts is not impossible but relevant education and appropriate training of all involved stakeholders are essential to obtain the expected benefits in terms of standardization.
Collapse
Affiliation(s)
- Mauro Panteghini
- Department of Laboratory Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
| |
Collapse
|
4
|
Rovegno L, Civera E, Infusino I, Panteghini M. State of the art of measurement uncertainty of serum ferritin. Clin Chem Lab Med 2024; 62:e6-e8. [PMID: 37466239 DOI: 10.1515/cclm-2023-0711] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023]
Affiliation(s)
- Leila Rovegno
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università degli Studi di Milano, Milan, Italy
| | - Elisa Civera
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università degli Studi di Milano, Milan, Italy
| | - Ilenia Infusino
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università degli Studi di Milano, Milan, Italy
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
5
|
Panteghini M. Documenting and validating metrological traceability of serum alanine aminotransferase measurements: a priority for medical laboratory community for providing high quality service in hepatology. Clin Chem Lab Med 2024; 62:249-252. [PMID: 37698363 DOI: 10.1515/cclm-2023-0900] [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: 08/13/2023] [Accepted: 08/29/2023] [Indexed: 09/13/2023]
Abstract
Alanine aminotransferase (ALT) represents the first-level test to detect individuals with hepatocellular damage of any etiology. However, it has been highlighted that the lack of assay harmonization may lead to overdiagnosis and unnecessary further testing if guideline-recommended fixed cut-offs are uncritically employed. To solve the issue of ALT (dis)harmonization and improve the interpretation of its values, a series of urgent actions for documenting and validating metrological traceability of serum ALT measurements, as described in this paper, are no longer postponeable. It is time that all medical laboratory stakeholders (in vitro diagnostic manufacturers, laboratorians, external quality assessment scheme organizers) actively co-operate to implement the ALT standardization in a concerted action following well-established theoretical assumptions and applying experimental approaches described in literature.
Collapse
Affiliation(s)
- Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| |
Collapse
|
6
|
Bianchi G, Frusciante E, Colombo G, Infusino I, Aloisio E, Panteghini M. Validation of metrological traceability of the new generation of Abbott Alinity alkaline phosphatase assay. Clin Chem Lab Med 2024; 62:280-287. [PMID: 37614121 DOI: 10.1515/cclm-2023-0553] [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: 05/25/2023] [Accepted: 08/06/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Recently, Abbott Diagnostics marketed a new generation of Alinity enzyme assays, introducing a multiparametric calibrator [Consolidated Chemistry Calibrator (ConCC)] in place of or in addition to factor-based calibrations. For alkaline phosphatase (ALP), both calibration options are offered, i.e., with ConCC (ALP2) and with an experimental calibration factor (ALP2F). Both options are declared traceable to the 2011 IFCC reference measurement procedure (RMP). Before to replace the old generation (ALP1) with the new one, we decided to validate the trueness of ALP2/ALP2F. METHODS Three approaches were employed: (a) preliminary comparison on 48 native frozen serum samples with ALP1, of which traceability to RMP was previously successfully verified; (b) examination of three banked serum pools (BSP) with values assigned by RMP; (c) direct comparison with RMP on a set of 24 fresh serum samples. Bias estimation and regression studies were performed, and the standard measurement uncertainty associated with ALP measurements on clinical samples (uresult) was estimated and compared with established analytical performance specifications (APS). ConCC commutability was also assessed. RESULTS A positive proportional bias was found with both ALP2 and ALP2F when compared to ALP1 and RMP. This positive bias was confirmed on BSP: in average, +13.1 % for ALP2 and +10.0 % for ALP2F, respectively. uresult were 13.28 % for ALP2 and 10.04 % for ALP2F, both not fulfilling the minimum APS of 4.0 %. Furthermore, ConCC was not commutable with clinical samples. CONCLUSIONS Our results unearth problems in the correct implementation of traceability of Alinity ALP2/ALP2F, with the risk for the new assay to be unfit for clinical purposes.
Collapse
Affiliation(s)
- Giorgia Bianchi
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Erika Frusciante
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Giulia Colombo
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Ilenia Infusino
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Elena Aloisio
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| |
Collapse
|
7
|
Van HT, Tran VT, Ha MT, Vu QH. Model of implementing proficiency testing in Vietnam, a developing country. Pract Lab Med 2023; 37:e00339. [PMID: 37886110 PMCID: PMC10598689 DOI: 10.1016/j.plabm.2023.e00339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/24/2023] [Accepted: 09/24/2023] [Indexed: 10/28/2023] Open
Abstract
Backgrounds and aims The aim of this study is to provide a good approach for a quantitative EQA scheme assigned value with limited resources. Materials and methods Twelve lyophilized EQA items were distributed to participants in 2021 from North to Southeast Vietnam to measure the concentration of nine parameters, including glucose, urea, creatinine, cholesterol, triglyceride, uric acid, AST, ALT, and GGT. The consensus value of the expert group and all participants were calculated and statistically compared to choose the most appropriate consensus value. Results Fifty-nine laboratories attended the EQA scheme, including an expert group using automatic biochemistry analyzers (AAs) and all participants with auto and semi-auto biochemistry (SAA) analyzers. Consensus values of six per nine parameters were different between the two groups for at least two EQA items, including glucose, creatinine, cholesterol, uric acid, AST, and ALT. The coefficients of variation of glucose, urea, creatinine, triglycerides, uric acid, and GGT in the expert group were significantly lower than those in all the participants. Conclusion Using the consensus values of expert groups as the assigned values of the EQA program is a relevant strategy to increase testing quality in developing countries with limited resources, such as Vietnam.
Collapse
Affiliation(s)
- Hy Triet Van
- University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
- University Medical Center Ho Chi Minh City, Viet Nam
- Quality Control Center for Medical Laboratory Under Ministry of Health, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
| | - Van Thanh Tran
- University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
- GIC Center, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
| | - Manh Tuan Ha
- University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
- University Medical Center Ho Chi Minh City, Viet Nam
| | | |
Collapse
|
8
|
Salzmann L, Spescha T, Singh N, Schierscher T, Bachmann M, Bauland F, Geistanger A, Risch L, Geletneky C, Seger C, Taibon J. An isotope dilution-liquid chromatography-tandem mass spectrometry (ID-LC-MS/MS)-based candidate reference measurement procedure (RMP) for the quantification of lamotrigine in human serum and plasma. Clin Chem Lab Med 2023; 61:1930-1941. [PMID: 36785916 DOI: 10.1515/cclm-2022-0997] [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: 10/05/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES We developed an isotope dilution (ID)-liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based candidate reference measurement procedure (RMP) for lamotrigine in human serum and plasma, using quantitative nuclear magnetic resonance-characterized reference standards to ensure traceability to the International System of Units. METHODS A sample preparation protocol based on protein precipitation combined with LC-MS/MS analysis using a C18 column for chromatographic separation was established for the quantification of lamotrigine in human serum and plasma. Assay validation was performed according to current guidelines. Spiked serum and plasma samples were used to assess selectivity and specificity; a post-column infusion experiment and comparison of standard line slopes were performed to ascertain possible matrix effects. Precision and accuracy were determined in a 5 days validation experiment. Measurement uncertainty was determined per the Guide to the Expression of Uncertainty in Measurement. RESULTS The method allowed the quantification of lamotrigine in serum and plasma in a range of 0.600-24.0 μg/mL without any observable matrix effects. The relative mean bias (n=6) ranged from 1.7 to 3.7%; intermediate precision, including variances in between-day, -calibration, and -injection, was ≤2.4%, independent of the level and matrix. Total measurement uncertainty for a single measurement was ≤2.6%; expanded uncertainty was ≤5.2% (coverage factor k=2). CONCLUSIONS This candidate RMP based on ID-LC-MS/MS provides a traceable and reliable platform for the standardization of routine assays and the evaluation of clinical samples.
Collapse
|
9
|
Borrillo F, Panteghini M. Current performance of C-reactive protein determination and derivation of quality specifications for its measurement uncertainty. Clin Chem Lab Med 2023; 61:1552-1557. [PMID: 36773318 DOI: 10.1515/cclm-2023-0069] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/31/2023] [Indexed: 02/13/2023]
Abstract
From External Quality Assessment data, current harmonization of CRP measuring systems appears to be satisfactory, the inter-assay CV being well below 10%. The inter-method variability is even better (close to 3%) when the widely used measuring systems are compared at CRP concentrations employed as cut-off for detecting sub-clinical infection (i.e., 10.0 mg/L) and measurement variability estimated, according to ISO 20914:2019 Technical Specification, from the intermediate within-lab reproducibility of 6-month consecutive measurement data. According to the state-of-the-art model (which is better suited for CRP), the maximum allowable measurement uncertainty (MAU) for CRP measurement on clinical samples with 10.0 mg/L concentrations is 3.76% (desirable quality). As measurement uncertainty (MU) of the only available reference material (ERM-DA474/IFCC) is ∼3%, to fulfil desirable MAU on clinical samples, IVD manufacturers should work to keep the contribution of remaining MU sources (commercial calibrator and intermediate within-lab reproducibility) lower than 2.3%.
Collapse
Affiliation(s)
- Francesca Borrillo
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milano, Italy
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Mauro Panteghini
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milano, Italy
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| |
Collapse
|
10
|
Panteghini M. Evaluating and monitoring analytical quality by internal quality control. Clin Biochem 2023; 118:110594. [PMID: 37271492 DOI: 10.1016/j.clinbiochem.2023.110594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Mauro Panteghini
- Research Center for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milano, Italy.
| |
Collapse
|
11
|
Makris K, Mousa C, Cavalier E. Alkaline Phosphatases: Biochemistry, Functions, and Measurement. Calcif Tissue Int 2023; 112:233-242. [PMID: 36571614 DOI: 10.1007/s00223-022-01048-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/01/2022] [Indexed: 12/27/2022]
Abstract
Alkaline phosphatases (ALPs) are a group of isoenzymes, situated on the external layer of the cell membrane; they catalyze the hydrolysis of organic phosphate esters present in the extracellular space. Zinc and magnesium are significant co-factors for the biological activity of these enzymes. Although ALPs are available in various body tissues and have distinct physiochemical properties, they are true isoenzymes since they catalyze a similar reaction. In the liver, ALP is cytosolic and present in the canalicular membrane of the hepatocytes. ALPs are available in placenta, ileal mucosa, kidney, bone, and liver. However, most of the ALPs in serum (over 80%) are delivered from liver and bone and in more modest quantities from the intestines. Despite the fact that alkaline phosphatases are found in numerous tissues all through the body, their exact physiological function remains largely unknown.
Collapse
Affiliation(s)
- Konstantinos Makris
- Clinical Biochemistry Department, KAT General Hospital, Kifissia, Athens, Greece
- Laboratory for the Research of Musculoskeletal System "Th. Garofalidis", School of Medicine, National and Kapodistrian, University of Athens, Athens, Greece
| | - Chagigia Mousa
- 6th Orthopedic Department, KAT General Hospital, Kifissia, Athens, Greece
| | - Etienne Cavalier
- Department of Clinical Chemistry, CIRM, University of Liege, CHU de Liège, CHU Sart-Tilman, B-4000, Liège, Belgium.
| |
Collapse
|
12
|
Panteghini M. Redesigning the surveillance of in vitro diagnostic medical devices and of medical laboratory performance by quality control in the traceability era. Clin Chem Lab Med 2022; 61:759-768. [PMID: 36542481 DOI: 10.1515/cclm-2022-1257] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Abstract
IVD manufacturers have total responsibility in terms of the traceability of marketed in vitro diagnostic medical devices (IVD-MD). This includes the provision of a quality control (QC) material as a part of the measuring system, suitable for traceability verification and alignment surveillance by end-users in daily practice. This material [to be used for the internal QC (IQC) component I as described in this paper] should have unbiased target values and an acceptability range corresponding to analytical performance specifications (APS) for suitable (expanded) measurement uncertainty (MU) on clinical samples. On the other hand, medical laboratories (by the IQC component II as described in this paper) should improve the IQC process and its judging criteria to establish a direct link between their performance, estimated as MU of provided results, and APS defined according to recommended models to apply corrective actions if the performance is worsening with the risk to jeopardize the clinical validity of test results. The participation to external quality assessment (EQA) programs that meet specific metrological criteria is also central to the evaluation of performance of IVD-MDs and of medical laboratories in terms of harmonization and clinical suitability of their measurements. In addition to the use of commutable materials, in this type of EQA it is necessary to assign values to them with selected reference procedures and to define and apply maximum allowable APS to substantiate the suitability of laboratory measurements in the clinical setting.
Collapse
Affiliation(s)
- Mauro Panteghini
- Centre for Metrological Traceability in Laboratory Medicine (CIRME) , University of Milan , Milano , Italy
| |
Collapse
|
13
|
Ma L, Zhang B, Luo L, Shi R, Wu Y, Liu Y. Biological variation estimates obtained from Chinese subjects for 32 biochemical measurands in serum. Clin Chem Lab Med 2022; 60:1648-1660. [PMID: 35977427 DOI: 10.1515/cclm-2021-0928] [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: 08/20/2021] [Accepted: 06/24/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) have established a program of work to make available, and to enable delivery of well characterized data describing the biological variation (BV) of clinically important measurands. Guided by the EFLM work the study presented here delivers BV estimates obtained from Chinese subjects for 32 measurands in serum. METHODS Samples were drawn from 48 healthy volunteers (26 males, 22 females; age range, 21-45 years) for 5 consecutive weeks at Chinese laboratory. Sera were stored at -80 °C before triplicate analysis of all samples on a Cobas 8000 modular analyzer series. Outlier and homogeneity analyses were performed, followed by CV-ANOVA, to determine BV estimates with confidence intervals. RESULTS The within-subject biological variation (CVI) estimates for 30 of the 32 measurands studied, were lower than listed on the EFLM database; the exceptions were alanine aminotransferase (ALT), lipoprotein (a) (LP(a)). Most of the between-subject biological variation (CVG) estimates were lower than the EFLM database entries. CONCLUSIONS This study delivers BV data for a Chinese population to supplement the EFLM BV database. Population differences may have an impact on applications of BV Data.
Collapse
Affiliation(s)
- Liming Ma
- Department of Clinical Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, P.R. China
| | - Bin Zhang
- Department of Clinical Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, P.R. China
| | - Limei Luo
- Department of Clinical Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, P.R. China
| | - Rui Shi
- Department of Clinical Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, P.R. China
| | - Yonghua Wu
- Department of Clinical Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, P.R. China
| | - Yunshuang Liu
- Department of Clinical Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, P.R. China
| |
Collapse
|
14
|
Panteghini M. The simple reproducibility of a measurement result does not equal its overall measurement uncertainty. Clin Chem Lab Med 2022; 60:e221-e222. [PMID: 35802464 DOI: 10.1515/cclm-2022-0618] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
15
|
Panteghini M. Reply to Westgard et al.: 'Keep your eyes wide … as the present now will later be past'. Clin Chem Lab Med 2022; 60:e202-e203. [PMID: 35786491 DOI: 10.1515/cclm-2022-0557] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 01/02/2023]
Affiliation(s)
- Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università degli Studi di Milan, Italy
| |
Collapse
|
16
|
Thomas M, Greaves RF, Tingay DG, Loh TP, Ignjatovic V, Newall F, Oeum M, Tran MTC, Rajapaksa AE. Current and emerging technologies for the timely screening and diagnosis of neonatal jaundice. Crit Rev Clin Lab Sci 2022; 59:332-352. [PMID: 35188857 DOI: 10.1080/10408363.2022.2038074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Neonatal jaundice is one of the most common clinical conditions affecting newborns. For most newborns, jaundice is harmless, however, a proportion of newborns develops severe neonatal jaundice requiring therapeutic interventions, accentuating the need to have reliable and accurate screening tools for timely recognition across different health settings. The gold standard method in diagnosing jaundice involves a blood test and requires specialized hospital-based laboratory instruments. Despite technological advancements in point-of-care laboratory medicine, there is limited accessibility of the specialized devices and sample stability in geographically remote areas. Lack of suitable testing options leads to delays in timely diagnosis and treatment of clinically significant jaundice in developed and developing countries alike. There has been an ever-increasing need for a low-cost, simple to use screening technology to improve timely diagnosis and management of neonatal jaundice. Consequently, several point-of-care (POC) devices have been developed to address this concern. This paper aims to review the literature, focusing on emerging technologies in the screening and diagnosing of neonatal jaundice. We report on the challenges associated with the existing screening tools, followed by an overview of emerging sensors currently in pre-clinical development and the emerging POC devices in clinical trials to advance the screening of neonatal jaundice. The benefits offered by emerging POC devices include their ease of use, low cost, and the accessibility of rapid response test results. However, further clinical trials are required to overcome the current limitations of the emerging POC's before their implementation in clinical settings. Hence, the need for a simple to use, low-cost POC jaundice detection technology for newborns remains an unsolved challenge globally.
Collapse
Affiliation(s)
- Mercy Thomas
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Australia.,Department of Nursing, Royal Children's Hospital, Melbourne, Australia
| | - Ronda F Greaves
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.,Victorian Clinical Genetics Services, Melbourne, Australia.,International Federation of Clinical Chemistry and Laboratory Medicine-Emerging Technologies Division (C-ETPLM), Milan, Italy
| | - David G Tingay
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Australia.,Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Neonatology, Royal Children's Hospital, Melbourne, Australia
| | - Tze Ping Loh
- International Federation of Clinical Chemistry and Laboratory Medicine-Emerging Technologies Division (C-ETPLM), Milan, Italy.,Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Vera Ignjatovic
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Hematology, Murdoch Children's Research Institute, Melbourne, Australia
| | - Fiona Newall
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Nursing, Royal Children's Hospital, Melbourne, Australia
| | - Michelle Oeum
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia
| | - Mai Thi Chi Tran
- International Federation of Clinical Chemistry and Laboratory Medicine-Emerging Technologies Division (C-ETPLM), Milan, Italy.,National Children's Hospital, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam
| | - Anushi E Rajapaksa
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Australia.,Think Project Global, Melbourne, Australia
| |
Collapse
|
17
|
Pasqualetti S, Carnevale A, Dolci A, Panteghini M. A step towards optimal efficiency of HbA 1c measurement as a first-line laboratory test: the TOP-HOLE (Towards OPtimal glycoHemOgLobin tEsting) project. Clin Chem Lab Med 2022; 60:441-450. [PMID: 35041303 DOI: 10.1515/cclm-2021-1249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/06/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The TOP-HOLE (Towards OPtimal glycoHemOgLobin tEsting) project aimed to validate the HbA1c enzymatic method on the Abbott Alinity c platform and to implement the HbA1c testing process on the total laboratory automation (TLA) system of our institution. METHODS Three different measuring systems were employed: Architect c4000 stand-alone (s-a), Alinity c s-a, and Alinity c TLA. Eight frozen whole blood samples, IFCC value-assigned, were used for checking trueness. A comparison study testing transferability of HbA1c results from Architect to Alinity was also performed. The alignment of Alinity TLA vs. s-a was verified and the measurement uncertainty (MU) estimated according to ISO 20914:2019. Turnaround time (TAT) and full time equivalent (FTE) were used as efficiency indicators. RESULTS For HbA1c concentrations covering cut-offs adopted in clinical setting, the bias for both Architect and Alinity s-a was negligible. When compared with Architect, Alinity showed a mean positive bias of 0.54 mmol/mol, corresponding to a mean difference of 0.87%. A perfect alignment of Alinity TLA to the Alinity s-a was shown, and a MU of 1.58% was obtained, widely fulfilling the desirable 3.0% goal. After the full automation of HbA1c testing, 90% of results were released with a maximum TAT of 1 h, 0.30 FTE resource was also saved. CONCLUSIONS The traceability of Alinity HbA1c enzymatic assay to the IFCC reference system was correctly implemented. We successfully completed the integration of the HbA1c testing on our TLA system, without worsening the optimal analytical performance. The shift of HbA1c testing from s-a mode to TLA significantly decreased TAT.
Collapse
Affiliation(s)
- Sara Pasqualetti
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | | | - Alberto Dolci
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
| |
Collapse
|
18
|
Panteghini M, Braga F, Camara JE, Delatour V, Van Uytfanghe K, Vesper HW, Zhang T. Optimizing Available Tools for Achieving Result Standardization: Value Added by Joint Committee on Traceability in Laboratory Medicine (JCTLM). Clin Chem 2021; 67:1590-1605. [PMID: 34633037 DOI: 10.1093/clinchem/hvab178] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/12/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The JCTLM created a Task Force on Reference Measurement System Implementation (TF-RMSI) to provide guidance on metrological traceability implementation for the in vitro diagnostics (IVD) community. CONTENT TF-RMSI investigated the reference measurement systems (RMS) for 13 common measurands by applying the following procedural steps: (a) extracting data from the JCTLM database of available certified reference materials (CRMs) and reference measurement procedures (RMPs); (b) describing the RMS to which each recruited CRM or RMP belongs; (c) identifying the intended use of the CRMs, and, if used as a common calibrator for IVD measuring systems and/or trueness assessment of field methods was included, checking the CRM's certificate for information about commutability with clinical samples; and (d) checking if the CRM or RMP measurement uncertainty (MU) has the potential to be small enough to avoid significantly affecting the analytical performance specifications (APS) for MU of clinical sample results when the MU from the IVD calibrator and from the end-user measuring system were combined. SUMMARY We produced a synopsis of JCTLM-listed higher-order CRMs and RMPs for the selected measurands, including their main characteristics for implementing traceability and fulfilling (or not) the APS for suitable MU. Results showed that traceability to higher-order references can be established by IVD manufacturers within the defined APS for most of the 13 selected measurands. However, some measurands do not yet have suitable CRMs for use as common calibrators. For these measurands, splitting clinical samples with a laboratory performing the RMP may provide a practical alternative for establishing a calibration hierarchy.
Collapse
Affiliation(s)
- Mauro Panteghini
- 'L. Sacco' Department of Biomedical and Clinical Sciences, Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milano, Italy
| | - Federica Braga
- 'L. Sacco' Department of Biomedical and Clinical Sciences, Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milano, Italy
| | - Johanna E Camara
- Chemical Sciences Division, National Institute of Standards and Technology, Gaithersburg, MD
| | - Vincent Delatour
- Chemistry and Biology Division, Laboratoire National de Metrologie et d'Essais (LNE), Paris, France
| | - Katleen Van Uytfanghe
- Ref4U-Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Hubert W Vesper
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, GA
| | - Tianjiao Zhang
- Division of clinical chemistry, National Center for Clinical Laboratories, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | | |
Collapse
|
19
|
Panteghini M, Braga F. Implementation of metrological traceability in laboratory medicine: where we are and what is missing. Clin Chem Lab Med 2021; 58:1200-1204. [PMID: 32069227 DOI: 10.1515/cclm-2019-1128] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/08/2020] [Indexed: 01/24/2023]
Abstract
Background The Joint Committee on Traceability in Laboratory Medicine (JCTLM) has recently created the Task Force on Reference Measurement System Implementation (TF-RMSI) for providing guidance on traceability implementation to in vitro diagnostics (IVD) manufacturers. Using serum creatinine (sCr) as an example, a preliminary exercise was carried out by checking what type of information is available in the JCTLM database and comparing this against derived analytical performance specifications (APS) for measurement uncertainty (MU) of sCr. Content APS for standard MU of sCr measurements were established as a fraction (≤0.75, minimum quality; ≤0.50, desirable quality; and ≤0.25, optimum quality) of the intra-individual biological variation of the measurand (4.4%). By allowing no more than one third of the total MU budget for patient samples to be derived from higher-order references, two out of the four JCTLM reference materials (RMs) at least allow minimum APS to be achieved for the MU of patient samples. Commutability was explicitly assessed for one of the JCTLM-listed matrixed RMs, which was produced in compliance with ISO 15194:2009 standard, whereas the remaining three RMs were assessed against the ISO 15194:2002 version of the standard, which only required the extent of commutability testing to be reported. Regarding the three listed reference methods, the MU associated with isotopic dilution-mass spectrometry coupled to gas chromatography (ID/GC/MS) and isotopic dilution-mass spectrometry coupled to liquid chromatography (ID/LC/MS) would allow APS to be fulfilled, while the isotope dilution surface-enhanced Raman scattering (ID/SERS) method displays higher MU. Summary The most recently listed RM for sCr in the JCTLM database meets the ISO 15194:2009 requirements with MU that would allow APS to be fulfilled and has had commutability demonstrated for use as a common calibrator in implementing traceability of sCr measurements. Splitting clinical samples with a laboratory performing ID/GC/MS or ID/LC/MS provides an alternative but would also require all components of uncertainty of these materials to be assessed. Outlook Using appropriately derived APS to judge whether reference measurement system components are fit for purpose represents a novel approach. The TF-RMSI is planning to review a greater number of measurands to provide more robust information about the state of the art of available reference measurement systems and their impact on the ability of clinical measurements to meet APS.
Collapse
Affiliation(s)
- Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università di Milano, Milan, Italy
| | - Federica Braga
- UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Via GB Grassi 74, 20157 Milan, Italy.,Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università di Milano, Milan, Italy, Phone: +390239042743, Fax: +390250319835
| |
Collapse
|
20
|
Aloisio E, Frusciante E, Pasqualetti S, Infusino I, Krintus M, Sypniewska G, Panteghini M. Traceability validation of six enzyme measurements on the Abbott Alinity c analytical system. Clin Chem Lab Med 2021; 58:1250-1256. [PMID: 32126012 DOI: 10.1515/cclm-2020-0015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/31/2020] [Indexed: 11/15/2022]
Abstract
Background Laboratory professionals should independently verify the correct implementation of metrological traceability of commercial measuring systems and determine if their performance is fit for purpose. We evaluated the trueness, uncertainty of measurements, and transferability of six clinically important enzyme measurements (alanine aminotransferase [ALT], alkaline phosphatase [ALP], aspartate aminotransferase [AST], creatine kinase [CK], γ-glutamyltransferase [γGT], and lactate dehydrogenase [LDH]) performed on the Abbott Alinity c analytical system. Methods Target values and associated uncertainties were assigned to three pools for each enzyme by using the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) reference measurement procedures (RMPs) and the pools were then measured on the Alinity system. Bias estimation and regression studies were performed, and the uncertainty associated with Alinity measurements was also estimated, using analytical performance specifications (APS) derived from biological variability of measurands as goals. Finally, to validate the transferability of the obtained results, a comparison study between two Alinity systems located in Milan, Italy, and Bydgoszcz, Poland, was carried out. Results Correct implementation of traceability to the IFCC RMPs and acceptable measurement uncertainty fulfilling desirable (ALP, AST, LDH) or optimal APS (ALT, CK, γGT) was verified for all evaluated enzymes. An optimal alignment between the two Alinity systems located in Milan and Bydgoszcz was also found for all enzyme measurements. Conclusions We confirmed that measurements of ALT, ALP, AST, CK, γGT, and LDH performed on the Alinity c analytical system are correctly standardized to the IFCC reference measurement systems and the system alignment is consistent between different platforms.
Collapse
Affiliation(s)
- Elena Aloisio
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Erika Frusciante
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Sara Pasqualetti
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Ilenia Infusino
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Magdalena Krintus
- Department of Laboratory Medicine, Collegium Medicum, Nicolaus Copernicus University, Torun, Poland
| | - Grazyna Sypniewska
- Department of Laboratory Medicine, Collegium Medicum, Nicolaus Copernicus University, Torun, Poland
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| |
Collapse
|
21
|
Badrick T. Integrating quality control and external quality assurance. Clin Biochem 2021; 95:15-27. [PMID: 33965412 DOI: 10.1016/j.clinbiochem.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022]
Abstract
Effective management of clinical laboratories relies upon an understanding of Quality Control and External Quality Assurance principles. These processes, when applied effectively, reduce patient risk and drive quality improvement. In this Review, we will describe the purpose of QC and EQA and their role in identifying analytical and process error. The two concepts are linked, and we will illustrate that linkage. Some EQA providers offer far more than analytical surveillance. They facilitate training and education and extend quality improvement and identify areas where there is potential for patient harm into the pre-and post-analytical phases of the total testing process.
Collapse
Affiliation(s)
- Tony Badrick
- Royal College of Pathologists of Australasia Quality Assurance Program, St Leonards, Sydney 2065, Australia.
| |
Collapse
|
22
|
Tong Q, Zhang S, Zuo C. EQA/PT scheme to improve the equivalence of enzymatic results between mutual recognition laboratories in Beijing. J Clin Lab Anal 2021; 35:e23814. [PMID: 33948986 PMCID: PMC8183905 DOI: 10.1002/jcla.23814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background To utilize the external quality assessment (EQA)/proficiency testing (PT) scheme to evaluate the equivalence of different clinical enzymatic measuring systems in Beijing. Methods The Beijing Center for Clinical Laboratory (BCCL) distributed three investigation samples to mutual recognition clinical laboratories in Beijing including alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ‐glutamyltransferase (GGT), creatine kinase (CK), and lactate dehydrogenase (LDH). These samples were derived from serum pools with values assigned by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) enzymatic reference measurement procedures (RMPs). Each laboratory performed duplicate tests of the samples. Then, the samples at level 1 were used to recalibrate individual measuring systems for repeating the tests. BCCL collected data for evaluation of their analytical quality. Results Before recalibration, the biases of ALT and AST tests were not traceable to the IFCC RMPs, and the bias pass rates of GGT, CK, and LDH tests were only 51.2%, 55.7%, and 48.6% respectively. After recalibration, the pass rates of ALT, AST, GGT, CK, and LDH increased to 95.1%, 82.9%, 95.1%, 97.1%, and 70.0% respectively. The EQA/PT also showed that after recalibration, more than 95% of laboratories met the optimum level specifications of the biological variation for ALT, AST, GGT, and CK tests and the desirable for LDH tests. Conclusion The enzymatic tests in Beijing need to be further standardized by category 1 or 2 EQA/PT scheme for mutual recognition between clinical laboratories. The criteria of biological variation are more relevant for determining the equivalence of clinical enzymatic tests.
Collapse
Affiliation(s)
- Qing Tong
- Beijing Center for Clinical Laboratories, Beijing Chao-Yang Hospital affiliated to Capital Medical University, Beijing, China
| | - Shunli Zhang
- Department of Clinical Laboratory, Beijing Chao-Yang Hospital affiliated to Capital Medical University, Beijing, China
| | - Chang Zuo
- Department of Clinical Laboratory, Beijing Chao-Yang Hospital affiliated to Capital Medical University, Beijing, China
| |
Collapse
|
23
|
Badrick T. Biological variation: Understanding why it is so important? Pract Lab Med 2021; 23:e00199. [PMID: 33490349 PMCID: PMC7809190 DOI: 10.1016/j.plabm.2020.e00199] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/23/2020] [Indexed: 12/19/2022] Open
Abstract
This Review will describe the increasing importance of the concepts of biological variation to clinical chemists. The idea of comparison to 'reference' is fundamental in measurement. For the biological measurands, that reference is the relevant patient population, a clinical decision point based on a trial or an individual patient's previous results. The idea of using biological variation to set quality goals was then realised for setting Quality Control (QC) and External Quality Assurance (EQA) limits. The current phase of BV integration into practice is using Patient-Based Real-Time Quality Control (PBRTQC) and Patient Based Quality Assurance (PBQA) to detect a change in assay performance. The challenge of personalised medicine is to determine an individual reference interval. The Athletes Biological Passport may provide the solution.
Collapse
Affiliation(s)
- Tony Badrick
- Royal College of Pathologists of Australasia Quality Assurance Programs, St Leonards Sydney, NSW, 2065, Australia
| |
Collapse
|
24
|
Pasqualetti S, Chibireva M, Borrillo F, Braga F, Panteghini M. Improving measurement uncertainty of plasma electrolytes: a complex but not impossible task. Clin Chem Lab Med 2020; 59:e129-e132. [PMID: 33048834 DOI: 10.1515/cclm-2020-1399] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/04/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Sara Pasqualetti
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.,Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Mariia Chibireva
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.,Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Francesca Borrillo
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.,Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Federica Braga
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.,Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.,Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| |
Collapse
|
25
|
Coskun A, Braga F, Carobene A, Tejedor Ganduxe X, Aarsand AK, Fernández-Calle P, Díaz-Garzón Marco J, Bartlett W, Jonker N, Aslan B, Minchinela J, Boned B, Gonzalez-Lao E, Marques-Garcia F, Perich C, Ricos C, Simón M, Sandberg S. Systematic review and meta-analysis of within-subject and between-subject biological variation estimates of 20 haematological parameters. Clin Chem Lab Med 2020; 58:25-32. [PMID: 31503541 DOI: 10.1515/cclm-2019-0658] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 08/07/2019] [Indexed: 01/06/2023]
Abstract
Background Interpretation of the complete blood count (CBC) parameters requires reliable biological variation (BV) data. The aims of this study were to appraise the quality of publications reporting BV data for CBC parameters by applying the BV Data Critical Appraisal Checklist (BIVAC) and to deliver global BV estimates based on BIVAC compliant studies. Methods Relevant publications were identified by a systematic literature search and evaluated for their compliance with the 14 BIVAC criteria, scored as A, B, C or D, indicating decreasing compliance. Global CVI and CVG estimates with 95% CI were delivered by a meta-analysis approach using data from BIVAC compliant papers (grades A-C). Results In total, 32 studies were identified; four received a BIVAC grade A, 2 B, 20 C and 6 D. Meta-analysis derived CVI and CVG estimates were generally lower or in line with those published in a historical BV database available online. Except for reticulocytes, CVI estimates of erythrocyte related parameters were below 3%, whereas platelet (except MPV and PDW) and leukocyte related parameters ranged from 5% to 15%. Conclusions A systematic review of CBC parameters has provided updated, global estimates of CVI and CVG that will be included in the newly published European Federation of Clinical Chemistry and Laboratory Medicine BV Database.
Collapse
Affiliation(s)
- Abdurrahman Coskun
- Acibadem Mehmet Ali Aydınlar University, School of Medicine, Department of Medical Biochemistry Atasehir, Istanbul, Turkey, Phone: +90 532 744 66 83, Fax: +90 216 576 51 20
| | - Federica Braga
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Anna Carobene
- Servizio Medicina di Laboratorio, Ospedale San Raffaele, Milan, Italy
| | - Xavier Tejedor Ganduxe
- Metropolitana Nord Clinical Laboratory (LCMN), Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Aasne K Aarsand
- Department of Medical Biochemistry and Pharmacology, Norwegian Porphyria Centre (NAPOS), Haukeland University Hospital, Bergen, Norway.,Norwegian Organization for Quality Improvement of Laboratory Examinations (NOKLUS), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Pilar Fernández-Calle
- Department of Laboratory Medicine, La Paz University Hospital, Madrid, Spain.,Analytical Quality Commission, Spanish Society of Laboratory Medicine (SEQCML), Barcelona, Spain
| | - Jorge Díaz-Garzón Marco
- Department of Laboratory Medicine, La Paz University Hospital, Madrid, Spain.,Analytical Quality Commission, Spanish Society of Laboratory Medicine (SEQCML), Barcelona, Spain
| | - William Bartlett
- College of Medicine, Dentistry and Nursing, Dundee University, Dundee, Scotland, UK
| | - Niels Jonker
- Certe, Wilhelmina Ziekenhuis Assen, Assen, The Netherlands
| | - Berna Aslan
- Institute for Quality Management in Healthcare (IQMH), Centre for Proficiency Testing, Toronto, Ontario, Canada
| | - Joana Minchinela
- Analytical Quality Commission, Spanish Society of Laboratory Medicine (SEQCML), Barcelona, Spain.,Metropolitana Nord Clinical Laboratory (LCMN), Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Beatriz Boned
- Analytical Quality Commission, Spanish Society of Laboratory Medicine (SEQCML), Barcelona, Spain.,Royo Villanova Hospital, Zaragoza, Spain
| | - Elisabet Gonzalez-Lao
- Analytical Quality Commission, Spanish Society of Laboratory Medicine (SEQCML), Barcelona, Spain.,Quality Healthcare Consulting, Grupo ACMS, Madrid, Spain
| | - Fernando Marques-Garcia
- Analytical Quality Commission, Spanish Society of Laboratory Medicine (SEQCML), Barcelona, Spain.,Department of Clinical Biochemistry, University Hospital of Salamanca, Salamanca, Spain
| | - Carmen Perich
- Analytical Quality Commission, Spanish Society of Laboratory Medicine (SEQCML), Barcelona, Spain.,Clinic Laboratory Hospital Vall d'Hebron, Barcelona, Spain
| | - Carmen Ricos
- Analytical Quality Commission, Spanish Society of Laboratory Medicine (SEQCML), Barcelona, Spain
| | - Margarita Simón
- Analytical Quality Commission, Spanish Society of Laboratory Medicine (SEQCML), Barcelona, Spain.,Intercomarcal Laboratory Consortiums of Alt Penedès, Anoia and Garraf, Barcelona, Spain
| | - Sverre Sandberg
- Department of Medical Biochemistry and Pharmacology, Norwegian Porphyria Centre (NAPOS), Haukeland University Hospital, Bergen, Norway.,Norwegian Organization for Quality Improvement of Laboratory Examinations (NOKLUS), Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Global Health and Primary Care, Faculty of Medicine, University of Bergen, Norway
| | | |
Collapse
|
26
|
The internal quality control in the traceability era. ACTA ACUST UNITED AC 2020; 59:291-300. [DOI: 10.1515/cclm-2020-0371] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/15/2022]
Abstract
Abstract
To be accurate and equivalent, laboratory results should be traceable to higher-order references. Furthermore, their quality should fulfill acceptable measurement uncertainty (MU) as defined to fit the intended clinical use. With this aim, in vitro diagnostics (IVD) manufacturers should define a calibration hierarchy to assign traceable values to their system calibrators. Medical laboratories should know and verify how manufacturers have implemented the traceability of their calibrators and estimate the corresponding MU on clinical samples. Accordingly, the internal quality control (IQC) program should be redesigned to permit IVD traceability surveillance through the verification by medical laboratories that control materials, provided by the manufacturer as a part of measuring systems, are in the clinically suitable validation range (IQC component I). Separately, laboratories should also monitor the reliability of employed IVD measuring systems through the IQC component II, devoted to estimation of MU due to random effects and to obtaining MU of provided results, in order to apply prompt corrective actions if the performance is worsening when compared to appropriate analytical specifications, thus jeopardizing the clinical validity of test results.
Collapse
|
27
|
Ricós C, Fernández-Calle P, Marqués F, Minchinela J, Salas Á, Martínez-Bru C, Boned B, Rioja RG, Cortés M, González-Lao E, García Lario J, Ganduxé XT, Bullich S, Ventura M, Simón M, Vilaplana C, González-Tarancón R, Fernández-Fernández MP, Bauzá FR, Corte Z, Llopis MA, Díaz-Garzón J, Perich C. Impacto de la introducción de un programa externo de categoría 1 en la vigilancia de la estandarización entre laboratorios clínicos en España. ADVANCES IN LABORATORY MEDICINE 2020; 1:20190016. [PMCID: PMC10197293 DOI: 10.1515/almed-2019-0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/30/2019] [Indexed: 12/29/2023]
Abstract
Introducción El objetivo de este estudio es comprobar la evolución de las especificaciones de la prestación analítica (EPA) utilizadas en programas de garantía externa de la calidad (EQA) y el papel de un programa de categoría 1 en la vigilancia de la estandarización de la prestación de los laboratorios clínicos en España. Métodos Se ha revisado la bibliografía sobre tipos de especificaciones de la calidad usados en programas de otros países y se ha comprobado su evolución; se ha comparado el posible impacto de distintas EPA empleadas en ocho países en la toma de decisiones clínicas con tres ejemplos de magnitudes: sodio, tirotropina (TSH) y tiempo de tromboplastina parcial activado (TTPA). Resultados Se ha evidenciado la estandarización entre métodos analíticos comprobando si los resultados medios se desvían respecto al valor de referencia certificado del control dentro de las EPA derivadas de la variación biológica (VB). Las EPA usadas en EQA han evolucionado desde el estado del arte hacia la VB. Si se aplican los resultados que se aceptarían con algunas EPA se podrían producir decisiones clínicas erróneas. Conclusiónes En España, solo 2 de las 18 magnitudes biológicas estudiadas se pueden considerar bien estandarizadas. Sería necesaria una colaboración más estrecha entre los laboratorios y proveedores de sistemas analíticos para resolver las discrepancias.
Collapse
Affiliation(s)
- Carmen Ricós
- Comité de Programas Externos de la Calidad, SEQC, Barcelona, Spain
- Comisión de Calidad Analítica, SEQC, Barcelona, Spain
- Plaza Gala Placidia 2, ático, Barcelona, Spain
| | - Pilar Fernández-Calle
- Comité de Programas Externos de la Calidad, SEQC, Barcelona, Spain
- Comisión de Calidad Analítica, SEQC, Barcelona, Spain
| | | | | | - Ángel Salas
- Comité de Programas Externos de la Calidad, SEQC, Barcelona, Spain
| | | | - Beatriz Boned
- Comisión de Calidad Analítica, SEQC, Barcelona, Spain
| | | | - Marià Cortés
- Comité de Programas Externos de la Calidad, SEQC, Barcelona, Spain
| | | | | | | | - Sandra Bullich
- Comité de Programas Externos de la Calidad, SEQC, Barcelona, Spain
| | - Montse Ventura
- Comité de Programas Externos de la Calidad, SEQC, Barcelona, Spain
| | - Margarida Simón
- Comité de Programas Externos de la Calidad, SEQC, Barcelona, Spain
- Comisión de Calidad Analítica, SEQC, Barcelona, Spain
| | - Carlos Vilaplana
- Comité de Programas Externos de la Calidad, SEQC, Barcelona, Spain
| | | | | | | | - Zoraida Corte
- Comisión de Calidad Analítica, SEQC, Barcelona, Spain
| | | | | | - Carmen Perich
- Comité de Programas Externos de la Calidad, SEQC, Barcelona, Spain
- Comisión de Calidad Analítica, SEQC, Barcelona, Spain
| |
Collapse
|
28
|
Braga F, Panteghini M. The utility of measurement uncertainty in medical laboratories. Clin Chem Lab Med 2020; 58:1407-1413. [PMID: 32126011 DOI: 10.1515/cclm-2019-1336] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/31/2020] [Indexed: 11/15/2022]
Abstract
The definition and enforcement of reference measurement systems, based on the implementation of metrological traceability of patient results to higher-order (reference) methods and/or materials, together with a clinically acceptable level of measurement uncertainty (MU), are fundamental requirements to produce accurate and equivalent laboratory results. The MU associated with each step of the traceability chain should be governed to obtain a final combined MU on clinical samples fulfilling the requested performance specifications. MU is useful for a number of reasons: (a) for giving objective information about the quality of individual laboratory performance; (b) for serving as a management tool for the medical laboratory and in vitro diagnostics (IVD) manufacturers, forcing them to investigate and eventually fix the identified problems; (c) for helping those manufacturers that produce superior products and measuring systems to demonstrate the superiority of those products; (d) for identifying analytes that need analytical improvement for their clinical use and ask IVD manufacturers to work for improving the quality of assay performance and (e) for abandoning assays with demonstrated insufficient quality. Accordingly, the MU should not be considered a parameter to be calculated by medical laboratories just to fulfill accreditation standards, but it must become a key quality indicator to describe both the performance of an IVD measuring system and the laboratory itself.
Collapse
Affiliation(s)
- Federica Braga
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università di Milano, Milan, Italy.,UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Via GB Grassi 74, 20157 Milan, Italy, Phone: +390239042743, Fax: +390250319835
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Università di Milano, Milan, Italy
| |
Collapse
|
29
|
Ricós C, Fernández-Calle P, Marqués F, Minchinela J, Salas Á, Martínez-Bru C, Boned B, Gómez-Rioja R, Cortés M, González-Lao E, García-Lario JV, Tejedor-Ganduxé X, Bullich S, Ventura M, Simón M, Vilaplana C, González-Tarancón R, Fernández-Fernández MP, Ramón-Bauzá F, Corte Z, Llopis MA, Díaz-Garzón J, Perich C. Impact of implementing a category 1 external quality assurance scheme for monitoring harmonization of clinical laboratories in Spain. ADVANCES IN LABORATORY MEDICINE 2020; 1:20200008. [PMID: 37362553 PMCID: PMC10197279 DOI: 10.1515/almed-2020-0008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/30/2019] [Indexed: 06/28/2023]
Abstract
BACKGROUND The objective of the present study was to examine the evolution of the analytical performance specifications (APS) used in External Quality Assurance (EQA) schemes, as well as the efficacy of a category 1 EQA scheme in monitoring the harmonization of clinical laboratory results in Spain. METHODS A review of the literature on the types of quality specifications used in schemes in other countries and their evolution was performed. In addition, a comparative analysis of the potential impact that different APS from eight countries had on clinical decision-making was made based on three measurands: sodium, thyroid-stimulating hormone (TSH), and activated partial thromboplastin time (aPTT). RESULTS Harmonization of analytical methods was demonstrated by assessing whether average results deviated from the certified reference value of control materials within the APS derived from biological variation (BV). The APS used in EQA have evolved from state-of-the-art models to BV. Poor clinical decision-making would occur if the results accepted by some APS were applied. CONCLUSIONS In Spain, only 2 of the 18 measurands studied are considered to be well harmonized. Closer collaboration between laboratories and analytical system providers would be required to resolve discrepancies.
Collapse
Affiliation(s)
- Carmen Ricós
- Comité de Programas Externos de la Calidad, SEQC, Barcelona, Spain
- Comisión de Calidad Analítica, SEQC, Barcelona, Spain
- Plaza Gala Placidia 2, ático, Barcelona, Spain
| | - Pilar Fernández-Calle
- Comité de Programas Externos de la Calidad, SEQC, Barcelona, Spain
- Comisión de Calidad Analítica, SEQC, Barcelona, Spain
| | | | | | - Ángel Salas
- Comité de Programas Externos de la Calidad, SEQC, Barcelona, Spain
| | | | - Beatriz Boned
- Comisión de Calidad Analítica, SEQC, Barcelona, Spain
| | | | - Marià Cortés
- Comité de Programas Externos de la Calidad, SEQC, Barcelona, Spain
| | | | | | | | - Sandra Bullich
- Comité de Programas Externos de la Calidad, SEQC, Barcelona, Spain
| | - Montse Ventura
- Comité de Programas Externos de la Calidad, SEQC, Barcelona, Spain
| | - Margarida Simón
- Comité de Programas Externos de la Calidad, SEQC, Barcelona, Spain
- Comisión de Calidad Analítica, SEQC, Barcelona, Spain
| | - Carlos Vilaplana
- Comité de Programas Externos de la Calidad, SEQC, Barcelona, Spain
| | | | | | | | - Zoraida Corte
- Comisión de Calidad Analítica, SEQC, Barcelona, Spain
| | | | | | - Carmen Perich
- Comité de Programas Externos de la Calidad, SEQC, Barcelona, Spain
- Comisión de Calidad Analítica, SEQC, Barcelona, Spain
| |
Collapse
|
30
|
Yan Y, Pu Y, Long Q, Zhang J, Zhang T, Zhou W, Zeng J, Zhang C, Chen W, Zhang C. Commutability of external quality assessment materials for serum magnesium and calcium measurements. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 79:404-411. [PMID: 31271069 DOI: 10.1080/00365513.2019.1636404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The commutability of pooled patient sera (PPS) and control materials (CM) should be evaluated to investigate their suitability for use in an external quality assessment (EQA) program. Individual human samples, PPS and CM were analyzed by four routine methods and inductively coupled plasma mass spectrometry reference methods for magnesium and calcium measurements. The commutability was analyzed according to EP14-A3 protocol and the difference in bias approach, respectively. For magnesium measurements, all PPS were commutable and 3/5 CM were commutable for all measurement systems according to the EP14-A3 protocol. For calcium measurements, most PPS were commutable for all measurement systems, but the CM were only commutable with the Cobas c702 system. The IFCC approach produced similar commutability profiles, except that a large number of inconclusive results appeared. The routine methods exhibited excellent linearity and precision. The majority of relative biases between the routine and reference methods were beyond the bias limits. The commutability of the CM and PPS vary depending on which evaluation approach and criterion is applied. Superiority in the commutability of PPS over CM was observed whichever evaluation approach is applied.
Collapse
Affiliation(s)
- Ying Yan
- National Center for Clinical Laboratories and Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology , Beijing , China
| | - Yungang Pu
- National Center for Clinical Laboratories and Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology , Beijing , China.,Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Qichen Long
- National Center for Clinical Laboratories and Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology , Beijing , China.,Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Jiangtao Zhang
- National Center for Clinical Laboratories and Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology , Beijing , China
| | - Tianjiao Zhang
- National Center for Clinical Laboratories and Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology , Beijing , China
| | - Weiyan Zhou
- National Center for Clinical Laboratories and Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology , Beijing , China
| | - Jie Zeng
- National Center for Clinical Laboratories and Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology , Beijing , China
| | - Chao Zhang
- National Center for Clinical Laboratories and Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology , Beijing , China
| | - Wenxiang Chen
- National Center for Clinical Laboratories and Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology , Beijing , China.,Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Chuanbao Zhang
- National Center for Clinical Laboratories and Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology , Beijing , China.,Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| |
Collapse
|
31
|
Ceriotti F, Cobbaert C. Harmonization of External Quality Assessment Schemes and their role - clinical chemistry and beyond. Clin Chem Lab Med 2019; 56:1587-1590. [PMID: 29715181 DOI: 10.1515/cclm-2018-0265] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 04/05/2018] [Indexed: 11/15/2022]
Abstract
Abstract
The article tries to reply to the following three questions: Are External Quality Assessment Schemes (EQAS) really fit for purpose? Are all schemes equivalent and sufficiently harmonized? Is the role of EQAS similar and necessary in all branches of laboratory medicine? Although the reply to the first two questions is, unfortunately, negative for several reasons (lack of commutable material with reference method values, EQAS with different scopes, etc.), the reply to the third one is positive: EQAS are a necessary source of information on trueness and accuracy and must be fully developed for all the branches of the clinical laboratory.
Collapse
Affiliation(s)
- Ferruccio Ceriotti
- Clinical Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, Milan 20122, Italy, Phone: +390255032876, Fax: +3902255032219
| | - Christa Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
32
|
|
33
|
Braga F, Panteghini M. Commutability of reference and control materials: an essential factor for assuring the quality of measurements in Laboratory Medicine. ACTA ACUST UNITED AC 2019; 57:967-973. [DOI: 10.1515/cclm-2019-0154] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 02/25/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Traceability to a common reference ensures equivalence of results obtained by different assays. Traceability is achieved by an unbroken sequence of calibrations, using reference materials (RMs) that must be commutable. Using non-commutable RMs for calibration will introduce a bias in the calibrated method producing incorrect results for clinical samples (CS). Commutability was defined in 1973 as “the ability of an enzyme material to show inter-assay activity changes comparable to those of the same enzyme in human serum” and later extended as a characteristic of all RMs. However, the concept is still poorly understood and appreciated. Commutability assessment has been covered in CLSI guidelines and requires: (a) selection of 20 CS spanning the relevant concentration range; (b) analysis of both RM and CS with the pair of procedures; (c) data elaboration using regression analysis and calculation if RM fall within the 95% prediction interval defined by CS. This approach has been criticized and to improve it The International Federation of Clinical Chemistry and Laboratory Medicine established a working group that recently finalized recommendations. Commutability is also a requirement for the applicability of external quality assessment (EQA) results in the evaluation of the performance of participating laboratories in terms of standardization of their measurements. Unfortunately, EQA materials are usually not validated for commutability.
Collapse
Affiliation(s)
- Federica Braga
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan , Via G.B. Grassi 74 , Milano , Italy , Phone: +39 02 39042766
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan , Milano , Italy
| |
Collapse
|
34
|
Ricós C, Perich C, Boned B, González-Lao E, Diaz-Garzón J, Ventura M, Bullich S, Corte Z, Minchinela J, Marques F, Simón M, Alvarez V, García-Lario JV, Fernández-Fernández P, Fernández-Calle P. Standardization in laboratory medicine: Two years' experience from category 1 EQA programs in Spain. Biochem Med (Zagreb) 2018; 29:010701. [PMID: 30591811 PMCID: PMC6294154 DOI: 10.11613/bm.2019.010701] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/25/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction Standardization is the ability to obtain interchangeable results leading to same medical interpretation. External quality assessment (EQA) is the main support of the on-going harmonization initiatives. Aim of study was to evaluate results obtained from two years category 1 EQA program experience in Spain and determine the impact of applying this type of EQA program on the analytical standardization. Materials and methods According to the analytical method, traceability and instrument different groups were established which results were evaluated by calculating mean, coefficient of variation and percent of deviation to the reference value. Analytical performance specifications used to the results' evaluation were derived from biological variation for bias and from the inter-laboratory coefficients of variation found in a previous pilot study. Results Only creatinine measured by enzymatic methods gave excellent results, although few laboratories used this method. Creatine kinase and GGT gave good precision and bias in all, but one instrument studied. For the remaining analytes (ALT, ALP, AST, bilirubin, calcium, chloride, glucose, magnesium, potassium, sodium, total protein and urate) some improvement is still necessary to achieve satisfactory standardization in our setting. Conclusions The two years of category 1 EQA program experience in Spain have manifested a lack of standardization of 17 most frequent biochemistry tests used in our laboratories. The impact of the information obtained on the lack of standardization is to recommend abandoning methods such as ALT, AST without exogenous pyridoxal phosphate, Jaffe method for creatinine, and do not use non-commutable calibrators, such as aqueous solutions for calcium and sodium.
Collapse
Affiliation(s)
- Carmen Ricós
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain
| | - Carmen Perich
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain.,Clinical Laboratory Department, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Beatriz Boned
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain.,Aragonese Health Service, Royo Villanova Hospital, Zaragoza, Spain
| | - Elisabet González-Lao
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain.,Quality Healthcare Consulting, ACMS Group, Madrid, Spain
| | - Jorge Diaz-Garzón
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain.,La Paz University Hospital, Madrid, Spain
| | | | - Sandra Bullich
- External Quality Assurance Programs, SEQCML, Barcelona, Spain
| | - Zoraida Corte
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain.,Clinical Analysis Service, Hospital San Agustin, Aviles, Principality of Asturias, Spain
| | - Joana Minchinela
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain.,Metropolitana Nord Unified Laboratory (LUMN), Germans Trias I Pujol University Hospital, Badalona, Spain
| | - Fernando Marques
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain.,Department of Clinical Biochemistry, University Hospital of Salamanca, Salamanca, Spain
| | - Margarita Simón
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain.,Intercomarcal laboratory consortiums of Alt Penedès, Anoia and Garraf, Barcelona, Spain
| | - Virtudes Alvarez
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain
| | - José-Vicente García-Lario
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain.,Clinical Laboratory, Hospital Campus de la Salud, Granada, Spain
| | | | - Pilar Fernández-Calle
- Spanish Society of Laboratory Medicine (SEQCML), Analytical Quality Commission, Barcelona, Spain.,La Paz University Hospital, Madrid, Spain
| |
Collapse
|
35
|
Thelen M, Vanstapel F, Brguljan PM, Gouget B, Boursier G, Barrett E, Kroupis C, Lohmander M, Šprongl L, Vodnik T, Bernabeu-Andreu F, Vukasović I, Sönmez Ç, Linko S, Brugnoni D, Vaubourdolle M, Huisman W, Panteghini M. Documenting metrological traceability as intended by ISO 15189:2012: A consensus statement about the practice of the implementation and auditing of this norm element. ACTA ACUST UNITED AC 2018; 57:459-464. [DOI: 10.1515/cclm-2018-1212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 11/12/2018] [Indexed: 11/15/2022]
Abstract
Abstract
ISO15189:2012 requires medical laboratories to document metrological traceability of their results. While the ISO17511:2003 standard on metrological traceability in laboratory medicine requires the use of the highest available level in the traceability chain, it recognizes that for many measurands there is no reference above the manufacturer’s selected measurement procedure and the manufacturer’s working calibrator. Some immunoassays, although they intend to measure the same quantity and may even refer to the same reference material, unfortunately produce different results because of differences in analytical selectivity as manufacturers select different epitopes and antibodies for the same analyte. In other cases, the cause is the use of reference materials, which are not commutable. The uncertainty associated with the result is another important aspect in metrological traceability implementation. As the measurement uncertainty on the clinical samples is influenced by the uncertainty of all steps higher in the traceability chain, laboratories should be provided with adequate and appropriate information on the uncertainty of the value assignment to the commercial calibrators that they use. Although the between-lot variation in value assignment will manifest itself as part of the long-term imprecision as estimated by the end-user, information on worst-case to be expected lot-lot variation has to be communicated to the end-user by the IVD provider. When laboratories use ancillary equipment that potentially could have a critical contribution to the reported results, such equipment needs verification of its proper calibration and criticality to the result uncertainty could be assessed by an approach based on risk analysis, which is a key element of ISO15189:2012 anyway. This paper discusses how the requirement for metrological traceability as stated in ISO15189 should be met by the medical laboratory and how this should be assessed by accreditation bodies.
Collapse
Affiliation(s)
- Marc Thelen
- Laboratory for Clinical Chemistry and Haematology , Amphia, PO Box 90158 , 4800 RK Breda , The Netherlands ; and SKML , Radboud University , Nijmegen , The Netherlands
| | - Florent Vanstapel
- Laboratory Medicine, Department of Public Health, Biomedical Sciences Group , University Hospital Leuven , Leuven , Belgium
| | | | | | - Guilaine Boursier
- CHU Montpellier , University Montpellier, Department of Genetics, Rare Diseases and Personalized Medicine , Montpellier , France
| | | | - Christos Kroupis
- Department of Clinical Biochemistry , Attikon University General Hospital, Medical School, National and Kapodistrian University of Athens , Haidari , Greece
| | | | - Luděk Šprongl
- Clinical Laboratory, Hospital Kladno , Kladno , Czech Republic
| | - Tatjana Vodnik
- Center of Medical Biochemistry, Clinical Center of Serbia, Center of Medical Biochemistry, Clinical Center of Serbia , Belgrade , Serbia
| | | | - Ines Vukasović
- Sestre Milosrdnice University Hospital Center , Department of Clinical Chemistry , Zagreb , Croatia
| | - Çiğdem Sönmez
- Central Laboratory – Oncology Education and Research Hospital , Ankara , Turkey
| | - Solveig Linko
- Faculty of Medicine – Helsinki University , Helsinki , Finland
| | - Duilio Brugnoni
- Clinical Chemistry Laboratory – Spedali Civili , Brescia , Italy
| | | | - Willem Huisman
- Consultant European Specialist in Clinical Chemistry and Laboratory Medicine , The Hague , The Netherlands
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences “Luigi Sacco” , University of Milano Medical School, Research Centre for Metrological Traceability in Laboratory Medicine (CIRME) , Milan , Italy
| |
Collapse
|
36
|
Yan Y, Han B, Zhao H, Ma R, Wang J, Wang D, Hu C, Chen W, Zhang C. Commutability of external quality assessment materials for serum sodium and potassium measurements. ACTA ACUST UNITED AC 2018; 57:465-475. [PMID: 30157026 DOI: 10.1515/cclm-2018-0385] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 07/19/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background
The commutability of electrolyte trueness verification materials (ETVs) and commercial general chemistry materials (GCs) was evaluated to investigate their suitability for use in an external quality assessment (EQA) program for serum sodium and potassium measurements.
Methods
Eighty fresh individual human samples (40 for sodium measurements and 40 for potassium measurements), six ETVs and three GCs were analyzed by five routine methods (validated methods) and by inductively coupled plasma mass spectrometry reference methods (comparative methods) for the determination of sodium and potassium. The commutability was analyzed according to Clinical and Laboratory Standards Institute (CLSI) EP14-A3 protocol and difference in bias approach, respectively. The linearity, bias and imprecision of the routine methods were also assessed according to CLSI guidelines.
Results
According to EP14-A3 protocol, ETVs were commutable for all assays, and GCs were commutable for 3/5 assays for sodium. ETVs were commutable in most assays except Cobas C501, while GCs showed no commutability except in case of AU5821 for potassium. According to a difference in bias approach, the commutability of ETVs was inconclusive for most routine assays for both sodium and potassium, and GCs were inconclusive for sodium and non-commutable for potassium in most routine assays. The routine methods exhibited excellent linearities and precisions. The majority and minority of relative biases between the routine and reference methods were beyond the bias limits for sodium and potassium, respectively.
Conclusions
Superiority in the commutability of ETVs over GCs was observed among the sodium and potassium assays whichever evaluation approach was applied.
Collapse
Affiliation(s)
- Ying Yan
- Beijing Hospital, National Center of Gerontology, National Center for Clinical Laboratories and Beijing Engineering Research Center of Laboratory Medicine , Dongdan, Beijing , P.R. China
- Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , P.R. China
| | - Bingqing Han
- Beijing Hospital, National Center of Gerontology, National Center for Clinical Laboratories and Beijing Engineering Research Center of Laboratory Medicine , Dongdan, Beijing , P.R. China
- Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , P.R. China
| | - Haijian Zhao
- Beijing Hospital, National Center of Gerontology, National Center for Clinical Laboratories and Beijing Engineering Research Center of Laboratory Medicine , Dongdan, Beijing , P.R. China
- Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , P.R. China
| | - Rong Ma
- Beijing Hospital, National Center of Gerontology, National Center for Clinical Laboratories and Beijing Engineering Research Center of Laboratory Medicine , Dongdan, Beijing , P.R. China
- Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , P.R. China
| | - Jing Wang
- Beijing Hospital, National Center of Gerontology, National Center for Clinical Laboratories and Beijing Engineering Research Center of Laboratory Medicine , Dongdan, Beijing , P.R. China
- Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , P.R. China
| | - Donghuan Wang
- Beijing Hospital, National Center of Gerontology, National Center for Clinical Laboratories and Beijing Engineering Research Center of Laboratory Medicine , Dongdan, Beijing , P.R. China
- Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , P.R. China
| | - Cuihua Hu
- Beijing Hospital, National Center of Gerontology, National Center for Clinical Laboratories and Beijing Engineering Research Center of Laboratory Medicine , Dongdan, Beijing , P.R. China
- Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , P.R. China
| | - Wenxiang Chen
- Beijing Hospital, National Center of Gerontology, National Center for Clinical Laboratories and Beijing Engineering Research Center of Laboratory Medicine , Dongdan, Beijing , P.R. China
- Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , P.R. China
| | - Chuanbao Zhang
- Researcher, Beijing Hospital, National Center of Gerontology, National Center for Clinical Laboratories and Beijing Engineering Research Center of Laboratory Medicine , 1 Dahua Road, Dongdan , Beijing 100730 , P.R. China
- Chinese Academy of Medical Sciences and Peking Union Medical College , No. 9 Dongdan Santiao Road , Beijing 100005 , P.R. China , Phone: +86 010 5811 5059, Fax: +86 010 6513 2968
| |
Collapse
|
37
|
Aloisio E, Carnevale A, Pasqualetti S, Birindelli S, Dolci A, Panteghini M. Implementation of an internal quality control programme for the photometric determination of icteric index. J Clin Pathol 2018; 71:851-852. [PMID: 29858233 DOI: 10.1136/jclinpath-2017-204937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/10/2018] [Accepted: 05/11/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Elena Aloisio
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | | | - Sara Pasqualetti
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Sarah Birindelli
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Alberto Dolci
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| |
Collapse
|
38
|
Aloisio E, Frusciante E, Pasqualetti S, Quercioli M, Panteghini M. Traceability of alkaline phosphatase measurement may also vary considerably using the same analytical system: the case of Abbott Architect. Clin Chem Lab Med 2018; 56:e135-e137. [PMID: 29257752 DOI: 10.1515/cclm-2017-1007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/23/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Elena Aloisio
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), Via GB Grassi 74, 20157 Milan, Italy, Phone: +39 02 50319848, Fax: +39 02 39042896
| | - Erika Frusciante
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Sara Pasqualetti
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Massimo Quercioli
- Reference Centre for External Quality Control, Careggi University-Hospital, Florence, Italy
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| |
Collapse
|
39
|
Braga F, Panteghini M. Defining permissible limits for the combined uncertainty budget in the implementation of metrological traceability. Clin Biochem 2018. [PMID: 29526674 DOI: 10.1016/j.clinbiochem.2018.03.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In addition to the correct implementation of calibration traceability, the definition and the achievement of an appropriate analytical performance specification for the total uncertainty budget (GU) is essential to ensure that laboratory measurements are clinically usable. To understand if it is possible to fulfil these specifications, limits for combined uncertainty across the entire metrological traceability chain should be defined. We recommended that no more than one third of GU should be consumed by the uncertainty of higher order references and ≤50% of GU by the combined measurement uncertainty at the manufacturer's calibration level. The remaining allowable uncertainty should be available for random sources, i.e. for the imprecision of the commercial measuring system (including the reagent batch-to-batch variation) and the individual laboratory performance, as a safety margin to fulfil GU. Based on this approach, it is of interest to assess for each analyte measured in the clinical laboratory the status of the uncertainty budget of its measurement associated with the selected metrological traceability chain. Accordingly, we report three didactic cases that could occur in the clinical practice. This approach is very helpful to identify those analytes for which further technological improvements are probably needed to reduce uncertainty associated with their measurement.
Collapse
Affiliation(s)
- Federica Braga
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy.
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| |
Collapse
|
40
|
Braga F, Pasqualetti S, Panteghini M. The role of external quality assessment in the verification of in vitro medical diagnostics in the traceability era. Clin Biochem 2018; 57:23-28. [PMID: 29428441 DOI: 10.1016/j.clinbiochem.2018.02.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/31/2018] [Accepted: 02/07/2018] [Indexed: 01/28/2023]
Abstract
Once an in-vitro diagnostic (IVD) measuring system has been marketed and introduced into daily practice, the possible sources of degradation of its performance are numerous. It is therefore essential to put in place a continuous post-market surveillance of the quality of performance of the IVD system and of the laboratories that perform measurements in clinical setting. The participation to external quality assessment (EQA) schemes that meet specific metrological criteria is central to the evaluation of performance of clinical laboratories in terms of standardization and clinical suitability of their measurements. In addition to the use of commutable materials, in this type of EQA it is necessary to assign values (and uncertainty) to them with reference procedures and to define and apply clinically permissible analytical performance specifications to substantiate the suitability of laboratory measurements in the clinical setting. Unfortunately, there are still few permanent EQA programs fully covering these requirements because some practical constraints, including technical and economic aspects, which limit their introduction. It is, however, clear that these issues should be quickly overcome, since EQA schemes are in a unique position to add substantial value to the practice of laboratory medicine, by identifying analytes that need improved harmonization and by stimulating and sustaining standardization initiatives that are needed to support clinical practice. Importantly, this will definitively help those manufacturers that produce superior products to demonstrate the superiority of those products and oblige end users (and consequently industry) to abandon assays with demonstrated insufficient quality.
Collapse
Affiliation(s)
- Federica Braga
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy.
| | - Sara Pasqualetti
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milan, Italy
| |
Collapse
|
41
|
Infusino I, Panteghini M. Measurement uncertainty: Friend or foe? Clin Biochem 2018; 57:3-6. [PMID: 29410277 DOI: 10.1016/j.clinbiochem.2018.01.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/31/2018] [Accepted: 01/31/2018] [Indexed: 11/15/2022]
Abstract
The definition and enforcement of a reference measurement system, based on the implementation of metrological traceability of patients' results to higher order reference methods and materials, together with a clinically acceptable level of measurement uncertainty, are fundamental requirements to produce accurate and equivalent laboratory results. The uncertainty associated with each step of the traceability chain should be governed to obtain a final combined uncertainty on clinical samples fulfilling the requested performance specifications. It is important that end-users (i.e., clinical laboratory) may know and verify how in vitro diagnostics (IVD) manufacturers have implemented the traceability of their calibrators and estimated the corresponding uncertainty. However, full information about traceability and combined uncertainty of calibrators is currently very difficult to obtain. Laboratory professionals should investigate the need to reduce the uncertainty of the higher order metrological references and/or to increase the precision of commercial measuring systems. Accordingly, the measurement uncertainty should not be considered a parameter to be calculated by clinical laboratories just to fulfil the accreditation standards, but it must become a key quality indicator to describe both the performance of an IVD measuring system and the laboratory itself.
Collapse
Affiliation(s)
- Ilenia Infusino
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milano, Italy.
| | - Mauro Panteghini
- Research Centre for Metrological Traceability in Laboratory Medicine (CIRME), University of Milan, Milano, Italy
| |
Collapse
|
42
|
Pasqualetti S, Carnevale A, Aloisio E, Dolci A, Panteghini M. Different calibrator options may strongly influence the trueness of serum transferrin measured by Abbott Architect systems. Clin Chim Acta 2018; 477:119-120. [DOI: 10.1016/j.cca.2017.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 10/18/2022]
|
43
|
Jansen RT, Cobbaert CM, Weykamp C, Thelen M. The quest for equivalence of test results: the pilgrimage of the Dutch Calibration 2.000 program for metrological traceability. ACTA ACUST UNITED AC 2018; 56:1673-1684. [DOI: 10.1515/cclm-2017-0796] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/17/2017] [Indexed: 01/02/2023]
Abstract
Abstract
Calibration 2.000 was initiated 20 years ago for standardization and harmonization of medical tests. The program also intended to evaluate adequate implementation of the In Vitro Diagnostics (IVD) 98/79/EC directive, in order to ensure that medical tests are fit-for-clinical purpose. The Calibration 2.000 initiative led to ongoing verification of test standardization and harmonization in the Netherlands using commutable external quality assessment (EQA)-tools and a type 1 EQA-design, where feasible. National support was guaranteed by involving all laboratory professionals as well as laboratory technicians responsible for EQA and quality officers. A category 1 EQA-system for general chemistry analytes, harmonizers for specific analytes like hGH and IGF-1, and commutable materials for other EQA-sections have been developed and structurally introduced in the EQA-schemes. The type 1 EQA-design facilitates the dialogue between individual specialists in laboratory medicine and the IVD-industry to reduce lot-to-lot variation and to improve standardization. In such a way, Calibration 2.000 sheds light on the metrological traceability challenges that we are facing and helps the laboratory community to get the issues on the table and resolved. The need for commutable trueness verifiers and/or harmonizers for other medical tests is now seen as paramount. Much knowledge is present in the Netherlands and for general chemistry, humoral immunology and protein chemistry, a few endocrinology tests, and various therapeutic drug monitoring (TDM) tests, commutable materials are available. Also the multi sample evaluation scoring system (MUSE) and the category 1 EQA-design offer many possibilities for permanent education of laboratory professionals to further improve the between and within laboratory variation and the test equivalence.
Collapse
Affiliation(s)
- Rob T.P. Jansen
- SKML , Mercator 1, Toernooiveld 214 , 6525EC Nijmegen , The Netherlands
| | | | - Cas Weykamp
- Queen Beatrix Hospital , MCA Laboratory , Winterswijk , The Netherlands
| | - Marc Thelen
- Amphia Hospital, Clinical Chemistry and Haematology , Breda , The Netherlands
| |
Collapse
|
44
|
Panteghini M, Ceriotti F, Jones G, Oosterhuis W, Plebani M, Sandberg S. Strategies to define performance specifications in laboratory medicine: 3 years on from the Milan Strategic Conference. Clin Chem Lab Med 2017; 55:1849-1856. [PMID: 29031018 DOI: 10.1515/cclm-2017-0772] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 09/05/2017] [Indexed: 11/15/2022]
Abstract
Measurements in clinical laboratories produce results needed in the diagnosis and monitoring of patients. These results are always characterized by some uncertainty. What quality is needed and what measurement errors can be tolerated without jeopardizing patient safety should therefore be defined and specified for each analyte having clinical use. When these specifications are defined, the total examination process will be "fit for purpose" and the laboratory professionals should then set up rules to control the measuring systems to ensure they perform within specifications. The laboratory community has used different models to set performance specifications (PS). Recently, it was felt that there was a need to revisit different models and, at the same time, to emphasize the presuppositions for using the different models. Therefore, in 2014 the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) organized a Strategic Conference in Milan. It was felt that there was a need for more detailed discussions on, for instance, PS for EQAS, which measurands should use which models to set PS and how to set PS for the extra-analytical phases. There was also a need to critically evaluate the quality of data on biological variation studies and further discussing the use of the total error (TE) concept. Consequently, EFLM established five Task Finish Groups (TFGs) to address each of these topics. The TFGs are finishing their activity on 2017 and the content of this paper includes deliverables from these groups.
Collapse
|
45
|
Thelen MHM, Jansen RTP, Weykamp CW, Steigstra H, Meijer R, Cobbaert CM. Expressing analytical performance from multi-sample evaluation in laboratory EQA. Clin Chem Lab Med 2017; 55:1509-1516. [PMID: 28182577 DOI: 10.1515/cclm-2016-0970] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/20/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND To provide its participants with an external quality assessment system (EQAS) that can be used to check trueness, the Dutch EQAS organizer, Organization for Quality Assessment of Laboratory Diagnostics (SKML), has innovated its general chemistry scheme over the last decade by introducing fresh frozen commutable samples whose values were assigned by Joint Committee for Traceability in Laboratory Medicine (JCTLM)-listed reference laboratories using reference methods where possible. Here we present some important innovations in our feedback reports that allow participants to judge whether their trueness and imprecision meet predefined analytical performance specifications. METHODS Sigma metrics are used to calculate performance indicators named 'sigma values'. Tolerance intervals are based on both Total Error allowable (TEa) according to biological variation data and state of the art (SA) in line with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Milan consensus. RESULTS The existing SKML feedback reports that express trueness as the agreement between the regression line through the results of the last 12 months and the values obtained from reference laboratories and calculate imprecision from the residuals of the regression line are now enriched with sigma values calculated from the degree to which the combination of trueness and imprecision are within tolerance limits. The information and its conclusion to a simple two-point scoring system are also graphically represented in addition to the existing difference plot. CONCLUSIONS By adding sigma metrics-based performance evaluation in relation to both TEa and SA tolerance intervals to its EQAS schemes, SKML provides its participants with a powerful and actionable check on accuracy.
Collapse
|
46
|
Little RR, Wielgosz RI, Josephs R, Kinumi T, Takatsu A, Li H, Stein D, Burns C. Implementing a Reference Measurement System for C-Peptide: Successes and Lessons Learned. Clin Chem 2017; 63:1447-1456. [PMID: 28646033 PMCID: PMC5575958 DOI: 10.1373/clinchem.2016.269274] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 04/25/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Assessment of endogenous insulin secretion by measuring C-peptide concentrations is widely accepted. Recent studies have shown that preservation of even small amounts of endogenous C-peptide production in patients with type 1 diabetes reduces risks for diabetic complications. Harmonization of C-peptide results will facilitate comparison of data from different research studies and later among clinical laboratory results at different sites using different assay methods. CONTENT This review provides an overview of the general process of harmonization and standardization and the challenges encountered with implementing a reference measurement system for C-peptide. SUMMARY Efforts to harmonize C-peptide results are described, including those by the National Institute of Diabetes and Digestive and Kidney Diseases-led C-peptide Standardization Committee in the US, activities in Japan, efforts by the National Institute for Biological Standards and Control in the UK, as well as activities led by the Bureau International des Poids et Mesures and the National Metrology Institute in China. A traceability scheme is proposed along with the next steps for implementation. Suggestions are made for better collaboration to optimize the harmonization process for other measurands.
Collapse
Affiliation(s)
- Randie R Little
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO;
| | | | - Ralf Josephs
- Bureau International des Poids et Mesures, Sèvres Cedex, France
| | - Tomoya Kinumi
- Bio-Medical Standards Group, National Metrology Institute of Japan, National Institute of Advanced Industrial Science and Technology, Ibaraki, Japan
| | - Akiko Takatsu
- Bio-Medical Standards Group, National Metrology Institute of Japan, National Institute of Advanced Industrial Science and Technology, Ibaraki, Japan
| | - Hongmei Li
- National Institute of Metrology, Beijing, China
| | - Daniel Stein
- Division of Endocrinology and Metabolism, Diabetes Research and Training Center, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY
| | - Chris Burns
- National Institute for Biological Standards and Control, South Mimms, UK
| |
Collapse
|
47
|
Pre-analytical and analytical aspects affecting clinical reliability of plasma glucose results. Clin Biochem 2017; 50:587-594. [PMID: 28300544 DOI: 10.1016/j.clinbiochem.2017.03.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/01/2017] [Accepted: 03/10/2017] [Indexed: 12/24/2022]
Abstract
The measurement of plasma glucose (PG) plays a central role in recognizing disturbances in carbohydrate metabolism, with established decision limits that are globally accepted. This requires that PG results are reliable and unequivocally valid no matter where they are obtained. To control the pre-analytical variability of PG and prevent in vitro glycolysis, the use of citrate as rapidly effective glycolysis inhibitor has been proposed. However, the commercial availability of several tubes with studies showing different performance has created confusion among users. Moreover, and more importantly, studies have shown that tubes promptly inhibiting glycolysis give PG results that are significantly higher than tubes containing sodium fluoride only, used in the majority of studies generating the current PG cut-points, with a different clinical classification of subjects. From the analytical point of view, to be equivalent among different measuring systems, PG results should be traceable to a recognized higher-order reference via the implementation of an unbroken metrological hierarchy. In doing this, it is important that manufacturers of measuring systems consider the uncertainty accumulated through the different steps of the selected traceability chain. In particular, PG results should fulfil analytical performance specifications defined to fit the intended clinical application. Since PG has tight homeostatic control, its biological variability may be used to define these limits. Alternatively, given the central diagnostic role of the analyte, an outcome model showing the impact of analytical performance of test on clinical classifications of subjects can be used. Using these specifications, performance assessment studies employing commutable control materials with values assigned by reference procedure have shown that the quality of PG measurements is often far from desirable and that problems are exacerbated using point-of-care devices.
Collapse
|
48
|
Ferraro S, Borille S, Carnevale A, Frusciante E, Bassani N, Panteghini M. Verification of the harmonization of human epididymis protein 4 assays. Clin Chem Lab Med 2017; 54:1635-43. [PMID: 27028735 DOI: 10.1515/cclm-2015-1142] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/26/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Serum human epididymis protein 4 (HE4) has gained relevance as an ovarian cancer (OC) biomarker and new automated methods have replaced the first released manual EIA by tracing results to it. We verified agreement and bias of automated methods vs. EIA as well as possible effects on patients' management. METHODS One hundred and fifteen serum samples were measured by Abbott Architect i2000, Fujirebio Lumipulse G1200, Roche Modular E170, and Fujirebio EIA. Passing-Bablok regression was used to compare automated assays to EIA and agreement between methods was estimated by Lin's concordance correlation coefficient (CCC). The bias vs. EIA was estimated and compared to specifications derived from HE4 biological variation. RESULTS Median (25th-75th percentiles) HE4 concentrations (pmol/L) were 84.5 (60.1-148.8) for EIA, 82.7 (50.3-153.9) for Abbott, 89.1 (55.2-154.9) for Roche, and 112.2 (67.8-194.2) for Fujirebio. Estimated regressions and agreements (95% confidence interval) were: Abbott=1.01(0.98-1.03) EIA-4.8(-7.5/-2.6), CCC=0.99(0.99-1.00); Roche=0.91(0.89-0.93) EIA+5.7(4.2/8.0), CCC=0.98(0.98-0.99); Fujirebio=1.20(1.17-1.24) EIA+ 2.4(-0.6/4.9), CCC=0.97(0.96-0.98). The average bias vs. EIA resulted within the desirable goal for Abbott [-3.3% (-6.1/-0.5)] and Roche [-0.2% (-3.0/2.5)]. However, while for Abbott the bias was constant and acceptable along the measurement concentration range, Roche bias increased up to -28% for HE4 values >250 pmol/L. Lumipulse showed a markedly positive bias [25.3% (21.8/28.8)]. CONCLUSIONS Abbott and Roche assays exhibited a good comparability in the range of HE4 values around the previously recommended 140 pmol/L cut-off. For patient monitoring, however, the assay used for determining serial HE4 must not be changed as results from different systems in lower and higher concentration ranges can markedly differ.
Collapse
|
49
|
Armbruster D. Metrological Traceability of Assays and Comparability of Patient Test Results. Clin Lab Med 2017; 37:119-135. [DOI: 10.1016/j.cll.2016.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
50
|
Jones GRD. The role of EQA in harmonization in laboratory medicine - a global effort. Biochem Med (Zagreb) 2017; 27:23-29. [PMID: 28392723 PMCID: PMC5382853 DOI: 10.11613/bm.2017.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 12/27/2016] [Indexed: 12/03/2022] Open
Abstract
There are many activities currently being undertaken in the field of laboratory medicine under the broad heading of "harmonization". These include traceability of results to international reference standards, processes to align results from assays where traceability has not been achieved (analytical harmonization) and international or national clinical guidelines based on studies from many parts of the world. Many of these issues are global in nature, with clinical evidence derived from studies performed in all parts of the world and multinational diagnostic companies providing assays worldwide. As with all aspects of medicine, progress can only be assured where these is evidence of effectiveness of the activities. External Quality Assurance (EQA) programs are designed to meet this need. Currently EQA processes have significant limitations in meeting the global needs of the laboratory medicine community. This paper aims to identify the steps that can be taken to allow current and future EQA programs to provide information on global variation in results. It is only by being aware of result differences that steps can be taken to improve performance.
Collapse
Affiliation(s)
- Graham R D Jones
- Department of Chemical Pathology, SydPath, St Vincent's Hospital, Sydney, NSW Australia; University of NSW, Sydney, Australia
| |
Collapse
|