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Sacks DB, Kirkman MS, Little RR. Point-of-Care HbA1c in Clinical Practice: Caveats and Considerations for Optimal Use. Diabetes Care 2024; 47:1104-1110. [PMID: 38552140 PMCID: PMC11208753 DOI: 10.2337/dci23-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/04/2024] [Indexed: 06/22/2024]
Abstract
Hemoglobin A1c (A1C) is widely used for the diagnosis and management of diabetes. Accurate measurement of A1C is necessary for optimal clinical value. Assay standardization has markedly improved the accuracy and consistency of A1C testing. Devices to measure A1C at point of care (POC) are commercially available, allowing rapid results when the patient is seen. In this review, we describe how standardization of A1C testing was achieved, leading to high-quality results in clinical laboratories. We address the use of POC A1C testing in clinical situations and summarize the advantages and disadvantages of POC A1C testing. We emphasize the importance of considering the limitations of these devices and following correct testing procedures to ensure that accurate A1C results are obtained for optimal care of patients.
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Affiliation(s)
- David B. Sacks
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD
| | - M. Sue Kirkman
- Division of Endocrinology and Metabolism, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Randie R. Little
- Department of Pathology and Anatomical Sciences, University of Missouri School of Medicine, Columbia, MO
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Li M, Ge S, Shu X, Wu X, Liu H, Xu A, Ji L. Interference of hemoglobin variants with HbA1c measurements: comparison of 6 commonly used HbA1c methods with the IFCC reference method. Lab Med 2024:lmae034. [PMID: 38801245 DOI: 10.1093/labmed/lmae034] [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: 05/29/2024] Open
Abstract
BACKGROUND Glycated hemoglobin, or hemoglobin A1c (HbA1c), serves as a crucial marker for diagnosing diabetes and monitoring its progression. We aimed to assess the interference posed by common Hb variants on popular HbA1c measurement systems. METHODS A total of 63 variant and nonvariant samples with target values assigned by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) reference method were included. We assessed 6 methods for measuring HbA1c in the presence of HbS, HbC, HbD, HbE, and fetal hemoglobin (HbF): 2 cation-exchange high-performance liquid chromatography (HPLC) methods (Bio-Rad D-100 and HLC-723 G8), a capillary electrophoresis (CE) method (Sebia Capillarys 3 TERA), an immunoassay (Roche c501), an enzyme assay system (Mindray BS-600M), and a boronate affinity method (Primus Premier Hb9210). RESULTS The HbA1c results for nonvariant samples from the 6 methods were in good agreement with the IFCC reference method results. The Bio-Rad D-100, Capillarys 3, Mindray BS-600M, Premier Hb9210, and Roche c501 showed no interference from HbS, HbC, HbD, and HbE. Clinically significant interference was observed for the HLC-723 G8 standard mode. Elevated HbF levels caused significant negative biases for all 6 methods, which increased with increasing HbF concentration. CONCLUSION Elevated levels of HbF can severely affect HbA1c measurements by borate affinity, immunoassays, and enzyme assays.
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Affiliation(s)
- Mingyang Li
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, China
| | - Song Ge
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xin Shu
- Department of Laboratory Medicine, Wuhan Asia General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Xiongjun Wu
- Department of Laboratory Medicine, Shenzhen Integrated Traditional Chinese and Western Medicine Hospital, Shenzhen, China
| | - Haiyan Liu
- Department of Laboratory Medicine, Wuhan Asia General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Anping Xu
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, China
| | - Ling Ji
- Department of Laboratory Medicine, Peking University Shenzhen Hospital, Shenzhen, China
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Song Y, Xu A, Wang M, Shi J, Fu W, Ji L, Zhang R. Evaluation of effects from hemoglobin variants on HbA 1c measurements by different methods. Clin Chem Lab Med 2024; 0:cclm-2024-0186. [PMID: 38563053 DOI: 10.1515/cclm-2024-0186] [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: 02/14/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES The impact of seven hemoglobin variants (Hb Q-Thailand, Hb G-Honolulu, Hb Ube-2, Hb New York, Hb J-Bangkok, Hb G-Coushatta, and Hb E) on the outcome of HbA1c was investigated for six methods by comparing with liquid chromatography-tandem mass spectrometry (LC/MS/MS) reference method. METHODS Twenty-nine normal and 112 variant samples were measured by LC/MS/MS, Sebia Capillarys 3 TERA, Intelligene Biosystems QuanTOF, Premier Hb9210, Arkray HA-8190V, Bio-Rad D-100, and Tosoh G11, then evaluated for correlation, consistency, and mean relative bias among six methods. The lowest biological variation bias of ±2.8 % was an acceptable standard. RESULTS All methods showed poor correlation and consistency with LC/MS/MS for Hb E. The unacceptable biases were observed for Capillarys 3 TERA (-14.4 to -3.7 % for Hb Q-Thailand, Hb Ube-2, Hb New York, Hb J-Bangkok and Hb E), QuanTOF (-8.3 to -2.9 % for Hb Ube-2, Hb New York and Hb G-Coushatta), Premier Hb9210 (-18.3 to -3.6 % for Hb Q-Thailand, Hb Ube-2, Hb New York, Hb J-Bangkok and Hb E), HA-8190V variant mode (-17.3 to 6.6 % for Hb G-Honolulu, Hb Ube-2, Hb New York, Hb G-Coushatta and Hb E). All variant samples showed larger biases than ±2.8 % comparing HA-8190V fast mode, D-100, and G11 with LC/MS/MS. CONCLUSIONS The accuracy of different HbA1c methods was influenced by some Hb variants, especially Hb Ube-2 and Hb New York. Thus, laboratories need to choose appropriate methods to measure HbA1c with different Hb variants.
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Affiliation(s)
- Yichuan Song
- Department of Clinical Laboratory, 74639 Beijing Chao-Yang Hospital, Capital Medical University , Beijing, P.R. China
| | - Anping Xu
- Department of Laboratory Medicine, 74573 Peking University Shenzhen Hospital , Shenzhen, Guangdong, P.R. China
| | - Mo Wang
- Department of Clinical Laboratory, 74639 Beijing Chao-Yang Hospital, Capital Medical University , Beijing, P.R. China
| | - Jie Shi
- Department of Clinical Laboratory, 74639 Beijing Chao-Yang Hospital, Capital Medical University , Beijing, P.R. China
| | - Wenxuan Fu
- Department of Clinical Laboratory, 74639 Beijing Chao-Yang Hospital, Capital Medical University , Beijing, P.R. China
| | - Ling Ji
- Department of Laboratory Medicine, 74573 Peking University Shenzhen Hospital , Shenzhen, Guangdong, P.R. China
| | - Rui Zhang
- Department of Clinical Laboratory, 74639 Beijing Chao-Yang Hospital, Capital Medical University , Beijing, P.R. China
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Manita D, Ogino S, Marivoet S, Ogura M. Detectability of and interference by major and minor hemoglobin variants using a new-generation ion-exchange HPLC system with two switchable analysis modes. Pract Lab Med 2024; 38:e00346. [PMID: 38099267 PMCID: PMC10716769 DOI: 10.1016/j.plabm.2023.e00346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
Objectives High-performance liquid chromatography (HPLC) is commonly used to measure hemoglobin A1c (HbA1c) levels and detect hemoglobin variants (Hb-Vars). HLC-723GR01 (GR01) is a new-generation automated ion-exchange HPLC system with two switchable analysis modes, namely short (30 s/test) and long modes (50 s/test). We evaluated the general performance of both analysis modes of GR01 for quantifying HbA1c and detecting Hb-Vars. Design and methods We evaluated the instrument's precision based on CLSI protocol EP-05-A3. A comparison of the two analysis modes of GR01 against the standard mode of HLC-723G11 was performed on 100 whole blood samples. The GR01 long mode was compared with affinity HPLC (AF-HPLC) for detecting common Hb-Vars (HbE, HbD, HbS, and HbC, >20 samples). To examine the detection capability for minor Hb-Vars, we analyzed 26 Hb-Vars using multiple analyzers, including both analysis modes of GR01. Results Both modes of GR01 had within-laboratory coefficients of variation of ≤1.0 % from four samples with HbA1c concentrations of 32-86 mmol/mol. Good correlation was observed between GR01 and HLC-723G11. The results for HbA1c detection in the presence of the major variants revealed a strong correlation between the long mode of GR01 and AF-HPLC (r = 0.986-0.998), and the difference biases ranged 0.1-1.9 mmol/mol. In the long mode, only one variant had a difference bias exceeding 14 % [10 % (%NGSP)]. Conclusion The two analysis modes of GR01 were fast and had high accuracy and reproducibility, indicating their utility for routine clinical use in measuring HbA1c samples with Hb-Vars.
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Affiliation(s)
| | | | | | - Masatsune Ogura
- Department of Clinical Laboratory Technology, Faculty of Medical Science, Juntendo University, Japan
- Department of Metabolism and Endocrinology, Eastern Chiba Medical Center, Japan
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Nichols JH, Berman M, Carrillo A, Manning S. Comparison of Hb A1c Quantification in the Presence of Hemoglobin Variants of an HPLC Assay with an Enzymatic Assay. J Appl Lab Med 2023; 8:1127-1132. [PMID: 37610380 DOI: 10.1093/jalm/jfad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/21/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND In this study, we evaluated the impact of hemoglobin (Hb) variants on the performance of the Abbott Alinity c and Bio-Rad Variant II Turbo 2.0 HPLC Hb A1c assays. METHODS The analytical performance of the Abbott Alinity c Hb A1c (enzymatic) assay was compared to the Bio-Rad Variant II Turbo 2.0 HPLC method using leftover whole blood EDTA samples with and without the presence of a hemoglobin variant. Assay precision was determined from an analysis of controls. Bias was estimated from analysis of a set of 40 samples analyzed by a Tosoh G8 HPLC instrument at the University of Missouri Diabetes Diagnostic Laboratory, an NGSP Secondary Reference Laboratory. RESULTS Between-day precision was excellent for both methods (<3%). Bias met NGSP criteria of ±5% to target value. Correlation between the Alinity and Bio-Rad methods was good for patient samples without a hemoglobinopathy (y = 1.028x - 0.38, standard error of the estimate (SEE) = 0.16, n = 36, mean bias = -0.22). A total of 700 hemoglobin variant samples were evaluated on the 2 methods. Of the hemoglobin variants, 640/700 gave results on both methods: hemoglobin (Hb) S trait (n = 452), C trait (n = 131), D trait (n = 23), E trait (n = 26), and a mixture of other hemoglobinopathies (n = 8) including beta thalassemia, high hemoglobin F, transfused Hb SC, transfused Hb SD, and transfused Hb SS, or unknown variant. There was good agreement for the 640 Hb variants between the methods with a range of mean differences of -0.10 to +0.06 depending on the variant, but more variability (SEE 0.25 to 0.39). Sixty samples did not have paired results. CONCLUSIONS To our knowledge, this study was the largest investigation of the effect of hemoglobinopathies on the Abbott Alinity c Hb A1c assay. Analytical performance varied depending on the specific hemoglobin variant trait when compared to the Bio-Rad Variant II Turbo 2.0 HPLC method.
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Affiliation(s)
- James H Nichols
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Marvin Berman
- Abbott Laboratories, Core Diagnostics, Abbott Park, IL, United States
| | - Alex Carrillo
- Abbott Laboratories, Rapid Diagnostics, Abbott Park, IL, United States
| | - Suzanne Manning
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Lernmark Å, Metzger BE, Nathan DM, Kirkman MS. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Diabetes Care 2023; 46:e151-e199. [PMID: 37471273 PMCID: PMC10516260 DOI: 10.2337/dci23-0036] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/11/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Numerous laboratory tests are used in the diagnosis and management of diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. APPROACH An expert committee compiled evidence-based recommendations for laboratory analysis in screening, diagnosis, or monitoring of diabetes. The overall quality of the evidence and the strength of the recommendations were evaluated. The draft consensus recommendations were evaluated by invited reviewers and presented for public comment. Suggestions were incorporated as deemed appropriate by the authors (see Acknowledgments). The guidelines were reviewed by the Evidence Based Laboratory Medicine Committee and the Board of Directors of the American Association for Clinical Chemistry and by the Professional Practice Committee of the American Diabetes Association. CONTENT Diabetes can be diagnosed by demonstrating increased concentrations of glucose in venous plasma or increased hemoglobin A1c (HbA1c) in the blood. Glycemic control is monitored by the people with diabetes measuring their own blood glucose with meters and/or with continuous interstitial glucose monitoring (CGM) devices and also by laboratory analysis of HbA1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of ketones, autoantibodies, urine albumin, insulin, proinsulin, and C-peptide are addressed. SUMMARY The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.
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Affiliation(s)
- David B. Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD
| | - Mark Arnold
- Department of Chemistry, University of Iowa, Iowa City, IA
| | - George L. Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, IL
| | - David E. Bruns
- Department of Pathology, University of Virginia Medical School, Charlottesville, VA
| | - Andrea R. Horvath
- New South Wales Health Pathology Department of Chemical Pathology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skane University Hospital Malmö, Malmö, Sweden
| | - Boyd E. Metzger
- Division of Endocrinology, Northwestern University, The Feinberg School of Medicine, Chicago, IL
| | - David M. Nathan
- Massachusetts General Hospital Diabetes Center and Harvard Medical School, Boston, MA
| | - M. Sue Kirkman
- Department of Medicine, University of North Carolina, Chapel Hill, NC
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Urrechaga E. Analytical evaluation and quality assessment of the ARKRAY ADAMS A1c Lite HA-8380V for HbA1c. Scand J Clin Lab Invest 2023; 83:358-365. [PMID: 37352386 DOI: 10.1080/00365513.2023.2225222] [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: 02/10/2023] [Revised: 06/09/2023] [Accepted: 06/11/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION ARKRAY ADAMS A1c Lite HA-8380V is a fully automated high- performance liquid chromatography system for the measurement of HbA1c. We aimed to evaluate its analytical performance using the Variant Mode. METHODS Carry-over, linearity, imprecision, trueness, interferences and comparison against ARKRAY ADAMS A1c HA-8180V and HA-8180T analyzers were studied. RESULTS Total CVs 0.93% (IFCC units), 0.63% (NGSP units) at low concentration and 1.01% (IFCC) 0.74% (NGSP), at high concentration. Mean difference with the target values was -0.44 mmol/mol (IFCC) -0.04% (NGSP). Carry-over, linearity and method comparison were excellent.The results were not affected in the range of total Hb 39-199 g/L, labile fraction 5.7%, carbamylated Hb 9.1% nor acetylated Hb 7.8%, effect of common variants was negligible. CONCLUSIONS the analyzer demonstrated very good analytical performances, according to the consensus criteria established for HbA1c; it is adequate for laboratories with medium-low workloads.
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Affiliation(s)
- Eloísa Urrechaga
- Laboratory, Hospital Galdakao - Usansolo, Galdakao, Vizcaya, Spain
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8
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Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Lernmark Å, Metzger BE, Nathan DM, Kirkman MS. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Clin Chem 2023:hvad080. [PMID: 37473453 DOI: 10.1093/clinchem/hvad080] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/12/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Numerous laboratory tests are used in the diagnosis and management of diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. APPROACH An expert committee compiled evidence-based recommendations for laboratory analysis in screening, diagnosis, or monitoring of diabetes. The overall quality of the evidence and the strength of the recommendations were evaluated. The draft consensus recommendations were evaluated by invited reviewers and presented for public comment. Suggestions were incorporated as deemed appropriate by the authors (see Acknowledgments). The guidelines were reviewed by the Evidence Based Laboratory Medicine Committee and the Board of Directors of the American Association of Clinical Chemistry and by the Professional Practice Committee of the American Diabetes Association. CONTENT Diabetes can be diagnosed by demonstrating increased concentrations of glucose in venous plasma or increased hemoglobin A1c (Hb A1c) in the blood. Glycemic control is monitored by the people with diabetes measuring their own blood glucose with meters and/or with continuous interstitial glucose monitoring (CGM) devices and also by laboratory analysis of Hb A1c. The potential roles of noninvasive glucose monitoring, genetic testing, and measurement of ketones, autoantibodies, urine albumin, insulin, proinsulin, and C-peptide are addressed. SUMMARY The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.
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Affiliation(s)
- David B Sacks
- Department of Laboratory Medicine, National Institutes of Health, Bethesda, MD, United States
| | - Mark Arnold
- Department of Chemistry, University of Iowa, Iowa City, IA, United States
| | - George L Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, University of Chicago Medicine, Chicago, ILUnited States
| | - David E Bruns
- Department of Pathology, University of Virginia Medical School, Charlottesville, VA, United States
| | - Andrea R Horvath
- New South Wales Health Pathology Department of Chemical Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skane University Hospital Malmö, Malmö, Sweden
| | - Boyd E Metzger
- Division of Endocrinology, Northwestern University, The Feinberg School of Medicine, Chicago, IL, United States
| | - David M Nathan
- Massachusetts General Hospital Diabetes Center and Harvard Medical School, Boston, MA, United States
| | - M Sue Kirkman
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
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梁 利, 何 訸, 孙 婉, 李 友, 张 玫. [Hemoglobin C Variant Affecting Glycated Hemoglobin Test Results: A Rare Case Report]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:659-662. [PMID: 37248601 PMCID: PMC10475414 DOI: 10.12182/20230560209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Indexed: 05/31/2023]
Abstract
Hemoglobin (Hb) variants are common factors that affect the results of glycosylated hemoglobin (A1C) tests. Hemoglobin variants react differently to different testing methods. Herein, we presented the first ever report of the effect of hemoglobin C (Hb C) on the test results of A1C in the Chinese population. High performance liquid chromatography (HPLC) and capillary electrophoresis were performed to measure A1C. Hemoglobin electrophoresis was conducted to identify the hemoglobin variants. Hb sequencing was performed to determine the mutation sites on the β chain. HPLC showed decreased A1C results, which could be corrected by electrophoresis, but the electrophoresis graph still showed abnormal peaks. The hemoglobin electrophoresis results suggested that there were hemoglobin variants, which hemoglobin sequencing results revealed to be Hb C. Uncommon variations in a specific population tend to be overlooked. To avoid clinical decision-making being affected by the results of a single test, we recommend that an explanatory reporting model be routinely adopted for A1C tests so that all reports always contain explanatory notes for the testing methodology and analysis of the graphs.
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Affiliation(s)
- 利波 梁
- 四川大学华西医院 全科医学中心 (成都 610041)General Practice Medical Center/International Medical Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 訸 何
- 四川大学华西医院 全科医学中心 (成都 610041)General Practice Medical Center/International Medical Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 婉婷 孙
- 四川大学华西医院 全科医学中心 (成都 610041)General Practice Medical Center/International Medical Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 友琼 李
- 四川大学华西医院 全科医学中心 (成都 610041)General Practice Medical Center/International Medical Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 玫 张
- 四川大学华西医院 全科医学中心 (成都 610041)General Practice Medical Center/International Medical Center, West China Hospital, Sichuan University, Chengdu 610041, China
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Elgamouz A, Kawde AN, Shehadi IA, Sayari S, Abdullah Mohammed SA, Abdelrazeq A, Nassab CN, AbdelHamid AA, Hasan K. Modified Graphite Pencil Electrode Based on Graphene Oxide-Modified Fe 3O 4 for Ferrocene-Mediated Electrochemical Detection of Hemoglobin. ACS OMEGA 2023; 8:11880-11888. [PMID: 37033858 PMCID: PMC10077451 DOI: 10.1021/acsomega.2c07023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/16/2023] [Indexed: 06/19/2023]
Abstract
This study describes the synthesis of graphene oxide-modified magnetite (rGO/Fe3O4) and its use as an electrochemical sensor for the quantitative detection of hemoglobin (Hb). rGO is characterized by a 2θ peak at 10.03° in its X-ray diffraction, 1353 and 1586 cm-1 vibrations in Raman spectroscopy, while scanning electron microscopy coupled with energy-dispersive spectroscopy of rGO and rGO/Fe3O4 revealed the presence of microplate structures in both materials and high presence of iron in rGO/Fe3O4 with 50 wt %. The modified graphite pencil electrode, GPE/rGO/Fe3O4, is characterized using cyclic voltammetry. Higher electrochemical surface area is obtained when the GPE is modified with rGO/Fe3O4. Linear scan voltammetry is used to quantify Hb at the surface of the sensor using ferrocene (FC) as an electrochemical amplifier. Linear response for Hb is obtained in the 0.1-1.8 μM range with a regression coefficient of 0.995, a lower limit of detection of 0.090 μM, and a limit of quantitation of 0.28 μM. The sensor was free from interferents and successfully used to sense Hb in human urine. Due to the above-stated qualities, the GPE/rGO/Fe3O4 electrode could be a potential competitive sensor for trace quantities of Hb in physiological media.
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Evaluation of local hemoglobinopathy prevalence and promotion of accurate hemoglobin A1c testing using historical data retrieval. Clin Biochem 2023; 114:59-62. [PMID: 36746202 DOI: 10.1016/j.clinbiochem.2023.02.001] [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: 10/24/2022] [Revised: 01/17/2023] [Accepted: 02/01/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Heterozygous hemoglobin variants are known to cause method- and variant-specific interference with hemoglobin A1c (HbA1c) quantitation. Less attention has been paid to the role of other hemoglobin variants in confounding HbA1c testing. Here we evaluated the frequency with which enzymatic (ENZ) and immunoassay (IA) HbA1c quantitation methods, i.e., those unable to routinely detect the presence of hemoglobin variants, were used within our healthcare system for HbA1c analysis in patients with elevated fetal hemoglobin as well as compound heterozygous and homozygous variants. DESIGN & METHODS This analysis was enabled by automated review of HbA1c result history, implemented to promote detection of variants prior to HbA1c result reporting. RESULTS During a 54-week period, 319,290 HbA1c analyses were performed. We observed 110 unique patient cases (0.03% problem identification rate) in which HbA1c testing was ordered in the presence of either a homozygous or compound heterozygous hemoglobin variant or elevated hemoglobin F beyond the tolerance of the method. Among the 110 cases identified, 55 (50%) showed a compound heterozygous or homozygous hemoglobin variant while 55 (50%) showed elevated hemoglobin F. Of those cases involving a compound heterozygous or homozygous variant, 8/55 (15%) involved patients who had one or more ENZ or IA HbA1c results reported previously within our system. Of the 55 total compound heterozygous or homozygous variants identified, 37 (67%) were hemoglobin E, 10 (18%) hemoglobin S/C, 4 (7%) hemoglobin S, 2 (4%) hemoglobin C, 1 (2%) hemoglobin Camden, and 1 (2%) unidentified variant. CONCLUSIONS Exclusive use of methods unable to routinely detect the presence of hemoglobin variants may lead to reporting of HbA1c results that are not clinically meaningful.
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Shin A, Connolly S, Kabytaev K. Protein glycation in diabetes mellitus. Adv Clin Chem 2023; 113:101-156. [PMID: 36858645 DOI: 10.1016/bs.acc.2022.11.003] [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: 01/05/2023]
Abstract
Diabetes mellitus is the ninth leading cause of mortality worldwide. It is a complex disease that manifests as chronic hyperglycemia. Glucose exposure causes biochemical changes at the proteome level as reflected in accumulation of glycated proteins. A prominent example is hemoglobin A1c (HbA1c), a glycated protein widely accepted as a diabetic indicator. Another emerging biomarker is glycated albumin which has demonstrated utility in situations where HbA1c cannot be used. Other proteins undergo glycation as well thus impacting cellular function, transport and immune response. Accordingly, these glycated counterparts may serve as predictors for diabetic complications and thus warrant further inquiry. Fortunately, modern proteomics has provided unique analytic capability to enable improved and more comprehensive exploration of glycating agents and glycated proteins. This review broadly covers topics from epidemiology of diabetes to modern analytical tools such as mass spectrometry to facilitate a better understanding of diabetes pathophysiology. This serves as an attempt to connect clinically relevant questions with findings of recent proteomic studies to suggest future avenues of diabetes research.
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Affiliation(s)
- Aleks Shin
- Department of Pathology & Anatomical Sciences, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Shawn Connolly
- Department of Pathology & Anatomical Sciences, School of Medicine, University of Missouri, Columbia, MO, United States
| | - Kuanysh Kabytaev
- Department of Pathology & Anatomical Sciences, School of Medicine, University of Missouri, Columbia, MO, United States.
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Yang X, Zeng X, Zhang Y, Kuang W, He D. Evaluation of interference from 16 hemoglobin variants on hemoglobin A 1c measurement by five methods. Scand J Clin Lab Invest 2023; 83:18-22. [PMID: 36534489 DOI: 10.1080/00365513.2022.2155990] [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: 12/24/2022]
Abstract
Hb variants prevalent in China are different from those in other countries. We aimed to assess the interference from Hb variants found in China on HbA1c measurement. All Hb variants were confirmed using Sanger sequencing. HbA1c was measured using a capillary electrophoresis method (Capillarys 3 OCTA), two cation-exchange high-performance liquid chromatography methods (ADAMS HA-8180V and HLC-723 G8 standard mode), an immunoassay (Cobas c501), and a boronate affinity chromatography method (Premier Hb9210). Premier Hb9210 was used as a comparative method. A total of 16 species of Hb variants were identified in 102 variant carriers. The most common variant was Hb E, followed by Hb Q-Thailand, Hb New York and Hb J-Bangkok. Clinically significant interference was observed for the Capillarys 3 OCTA (two Hb variants), ADAMS HA-8180V (seven Hb variants), HLC-723 G8 (14 Hb variants), and Cobas c501 (two Hb variants). The proportion of unacceptable HbA1c results was 13.7% for Capillarys 3 OCTA, 52.9% for HA-8180V, 83.3% for HLC-723 G8, and 3.9% for Cobas c501. Hb variants in China severely affect the accuracy of some commonly used HbA1c methods.
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Affiliation(s)
- Xiaoling Yang
- Department of Laboratory Medicine, Shenzhen Baoan District Songgang People's Hospital, Shenzhen, China
| | - Xianwei Zeng
- Department of Laboratory Medicine, Shenzhen Baoan District Songgang People's Hospital, Shenzhen, China
| | - Yonggang Zhang
- Department of Laboratory Medicine, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Wenbin Kuang
- Department of Laboratory Medicine, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Dabao He
- Department of Laboratory Medicine, Shenzhen Longhua District Central Hospital, Shenzhen, China
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Urrechaga E. Analytical evaluation and quality assessment of the ARKRAY ADAMS A1c HA-8190V for Hb A1c. Scand J Clin Lab Invest 2023; 83:136-142. [PMID: 36651844 DOI: 10.1080/00365513.2023.2167231] [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: 01/19/2023]
Abstract
ARKRAY ADAMS A1c HA-8190V is a fully automated high-pressure liquid chromatography (HPLC) system for the measurement of HbA1c. The runtime is 58 s per sample in the Variant mode and 24 s per sample in the Fast mode. We evaluated the analytical performance of this analyzer in the Variant mode, to verify the quality of analysis, according to the consensus criteria established for this measurand. Reproducibility, trueness, carry-over, linearity, interferences and comparison with ARKRAY ADAMS A1c HA-8180V and HA-8180T analyzers were evaluated. Total CVs were 0.76% (IFCC units) 0.55 (NGSP units) at low HbA1c concentration and 0.85% (IFCC units) 0.68 (NGSP units) at high HbA1c concentration. Mean difference with the target values was -1.25 mmol/mol (-0.119%) and total error at medium level was 2.83% (IFCC units), 2.46% (NGSP units) Carry-over was 0%. Linearity was shown in the range 27-122 mmol/mol (4.6-13.3%). The results were not affected in the range of total Hb 59-199 g/L, labile fraction up to 5.5%, carbamylated up to Hb 6.3% nor acetylated Hb up to 5.3%. Method comparison demonstrated good concordance between the methods. The analyzer demonstrated a high analytical performance adequate for routine clinical use in laboratories with high workloads.
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Affiliation(s)
- Eloísa Urrechaga
- Hematology Laboratory, Hospital Galdakao - Usansolo, Galdakao, Spain
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Romaniv TV, Skrypnyk NV, Synko UV, Voronych-Semchenko NM, Melnyk OV, Hryb AO, Boruchok IB. THE ASSESSMENT OF COMPENSATION OF CARBOHYDRATE METABOLISM IN PATIENTS WITH TYPE 2 DIABETES MELLITUS WITH METABOLIC SYNDROME BEYOND THE LIMITS OF GLYCATED HEMOGLOBIN. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1385-1390. [PMID: 37463372 DOI: 10.36740/wlek202306109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE The aim: To investigate glycemic variability in type 2 diabetes patients with metabolic syndrome (MS) and to assess its effect on diabetes compensation. PATIENTS AND METHODS Materials and methods: We used traditional indicators of glycemia variability according to the recommendations of the American Diabetes Association Professional Practice Committee. We proved that patients with type 2 diabetes mellitus with MS reliably have worse CGM indicators: Time in range TIR: (3.9-10.0 mmol/l) - 53.30±5.90%; Time above range (TAR): (time above range) (>10.1 mmol/l) - 43.33±5.96%; Time above TAR range (>13.9 mmol/l) - 22.1±3.91%; Glucose Variability СV - 44.10±4.89% compared to patients with type 2 diabetes without MS, which proves the negative effect of insulin resistance on compensation of diabetes. RESULTS Results: Determination of the level of EI in the blood, calculation of the Caro index, HOMA-IR are informative for verifying the presence of IR in patients with type 2 diabetes with MS. For optimal diabetes control, in addition to HbA1c, we must consider CGM data and % Time in range (TIR). CONCLUSION Conclusions: TIR should be used as a target point and an indicator of glycemic control in routine clinical practice. TIR provides accurate data on a patient's glycemic status and helps better control diabetes.
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Affiliation(s)
- Taras V Romaniv
- IVANO-FRANKIVSK NATIONAL MEDICAL UNIVERSITY, IVANO-FRANKIVSK, UKRAINE
| | - Nadiya V Skrypnyk
- IVANO-FRANKIVSK NATIONAL MEDICAL UNIVERSITY, IVANO-FRANKIVSK, UKRAINE
| | - Ulyana V Synko
- IVANO-FRANKIVSK NATIONAL MEDICAL UNIVERSITY, IVANO-FRANKIVSK, UKRAINE
| | | | - Oleh V Melnyk
- DAUGHTER ENTERPRISE «SANATORIUM "MORSHYNRESORT" PRIVATE JOINT STOCK COMPANY «UKRPROFOZDOROVNYTSIA», MORSHYN, UKRAINE
| | - Anna O Hryb
- IVANO-FRANKIVSK NATIONAL MEDICAL UNIVERSITY, IVANO-FRANKIVSK, UKRAINE
| | - Igor B Boruchok
- IVANO-FRANKIVSK NATIONAL MEDICAL UNIVERSITY, IVANO-FRANKIVSK, UKRAINE
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16
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Badiou S, Dupuy AM, Cunat S, Delay A, Alcaraz S, Aguilar-Martinez P, Cristol JP, Galtier F. A case of inter-assay HbA1c discrepancy due to Hemoglobin G-Copenhagen. Clin Chim Acta 2022; 535:27-29. [PMID: 35963305 DOI: 10.1016/j.cca.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/02/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVE A clinician was intrigued about HbA1c upper 9% (75 mmol/mol) in a 76 year-old women with normal glycemia. Further explorations were performed in order to understand this discordance. METHODS First HbA1c test was performed on a HLC -723 G11 apparatus (Tosoh Bioscience) and thereafter compared to the HLC-723-G8 (Tosoh Bioscience), the Capillaris 3 Tera (Sebia) and the DCA Vantage point of care testing (POCT) (Siemens) apparatus. In addition, study of Hemoglobin (Hb) fraction and mutation analysis of HBB gene was realized due to the suspicion of an Hb variant. RESULTS Twice high results of HbA1c (9.3%, 78 mmol/mol and 10%, 86 mmol/mol) on the HLC-723 G11 was not confirmed with other instruments. HbA1c result for the same sample was 5.2% (33 mmol/mol) for the HLC-723 G8, 5.3% (34 mmol/mol) for the Capillaris and 6.2% (44 mmol/mol) for the DCA Vantage POCT. The subject had normal glycemia and none signs of diabetes mellitus. An abnormal Hb fraction was visualized on the graphs for the HLC-723 G11 and Capillaris but not for the HLC-723 G8 analyzer. Study of Hb fraction confirmed the presence of an abnormal Hb fraction that was identifed as an Hb G-Copenhagen through mutation analysis of HBB gene. CONCLUSION This case evidenced an interference on HbA1c test in presence of Hb G-Copenhagen depending to the analyzer used. This report help to alert of such possibility and to remain that a discordance between HbA1c and glycemia can be due to an Hb variant.
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Affiliation(s)
- Stéphanie Badiou
- Department of Biochemistry, Centre de Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier cedex 5, France
| | - Anne-Marie Dupuy
- Department of Biochemistry, Centre de Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France
| | - Séverine Cunat
- Department of Hematology Biology, University Hospital of Montpellier, Montpellier, France
| | - Agnès Delay
- Maison de santé Forum Medica, 34980 St Gély du Fesc, France
| | - Stéphanie Alcaraz
- Department of Biochemistry, University Hospital of Nîmes, Nîmes, Montpellier, France
| | | | - Jean-Paul Cristol
- Department of Biochemistry, Centre de Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, 34295 Montpellier cedex 5, France.
| | - Florence Galtier
- Inserm CIC 1411, University Hospital of Montpellier, Montpellier, France; Department of Endocrinology, University Hospital of Montpellier, Montpellier, France
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Zhang R, Song Y, Xu A, Wang M, Ji L, Wang Q, Shi J, Zhao R, Fu W. Comparability of different methods of glycated hemoglobin measurement for samples of patients with variant and non-variant hemoglobin. Clin Chim Acta 2022; 533:168-174. [PMID: 35780822 DOI: 10.1016/j.cca.2022.06.024] [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: 03/23/2022] [Revised: 06/07/2022] [Accepted: 06/22/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Glycated hemoglobin (e.g., HbA1c) is measured to monitor patients with diabetes. However, the measurement results can vary according to the analysis method and presence of variant hemoglobin. Thus, we compared HbA1c results between liquid chromatography-tandem mass spectrometry (LC-MS/MS) as the reference method and matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS). METHODS %HbA1c were measured using the 2 methods in 45 non-variant and 73 heterozygous variant samples. Precision was calculated; the results were compared using Passing-Bablok regression and the concordance correlation coefficient (CCC). The average bias between methods was compared with the lowest bias of 2.3% for biological variation. RESULTS The precision of the 2methods was <2%. The R2 for the non-variant samples were 0.986 and the CCC was 0.99. Based on α- and β-chain, the variant samples were divided into 4 groups: α-chain, α-chain negligible, β-chain, and β-chain negligible variants. The R2 between the 2 methods of the 4 groups were >0.95; However, the average biases of α-chain and β-chain variants were above the minimum bias. CONCLUSION LC-MS/MS and MALDI-TOF MS had good comparability in the measurement of HbA1c in non-variant samples, but the existence of variant hemoglobin caused discrepancies.
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Affiliation(s)
| | | | | | | | - Ling Ji
- Peking University Shenzhen Hospital
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18
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Lima DA, Schuch RA, Salgueiro JS, Pintão MCT, Carvalho VM. Evaluation of Volumetric Absorptive Microsampling and Mass Spectrometry Data-Independent Acquisition of Hemoglobin-Related Clinical Markers. J Proteome Res 2022; 21:1816-1828. [PMID: 35770882 DOI: 10.1021/acs.jproteome.1c00892] [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: 11/29/2022]
Abstract
Data-independent acquisition (DIA) allows comprehensive proteome coverage, while it also potentially works as a unified protocol to determine a multitude of proteins found in blood. Because of its high specificity, mass spectrometry may greatly reduce the interference observed in other assays to evaluate blood markers. Here, we combined DIA with volumetric absorptive microsampling (VAMS) and automated proteomics sample processing in a platform to assess clinical markers. As a proof of concept, we evaluated two hemoglobin-related biomarkers: the glycated hemoglobin (HbA1c) and hemoglobin (Hb) variants. HbA1c by DIA showed good correlation with the reference method, but method imprecision did not meet the quality requirement for this biomarker. We developed a strategy to identify Hb variants based on a customized database combined with a workflow for DIA data extraction and rigorous peptide evaluation. Data are available via ProteomeXchange with identifier PXD029918.
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Affiliation(s)
- Debora A Lima
- Chromatography Division, Fleury Group, 04344-070 São Paulo, São Paulo, Brazil.,Research and Development Division, Fleury Group, 04344-070 São Paulo, São Paulo, Brazil
| | - Rodrigo A Schuch
- Research and Development Division, Fleury Group, 04344-070 São Paulo, São Paulo, Brazil
| | - Jéssica S Salgueiro
- Chromatography Division, Fleury Group, 04344-070 São Paulo, São Paulo, Brazil
| | | | - Valdemir M Carvalho
- Research and Development Division, Fleury Group, 04344-070 São Paulo, São Paulo, Brazil.,Graduate Program in Pathophysiology and Toxicology, School of Pharmaceutical Sciences, University of São Paulo, 05508-000 São Paulo, São Paulo, Brazil
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Lenters-Westra E, English E. The never ending story of Hb-variants interferences on the measurement of HbA1c. Clin Chim Acta 2022; 532:61-63. [DOI: 10.1016/j.cca.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/25/2022]
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20
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An Automated Hydrodynamically Mediated Technique for Preparation of Calibration Solutions via Capillary Electrophoresis System as a Promising Alternative to Manual Pipetting. Molecules 2021; 26:molecules26206268. [PMID: 34684849 PMCID: PMC8540481 DOI: 10.3390/molecules26206268] [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: 09/15/2021] [Revised: 10/10/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
In this paper, a novel procedure for preparing calibration solutions for capillary electrophoresis (CE)-based quantitative analysis is proposed. Our approach, named the automated hydrodynamically mediated technique (AHMT), uses a capillary and a pressure system to deliver the expected amount of working solution and diluent directly to a sample vial. As a result, calibration solutions are prepared automatically inside the CE instrument, without any or with minimal manual operation. Two different modes were tested: forward and reverse, differing in the direction of hydrodynamic flow. The calibration curves obtained for a model mixture of analytes using AHMT were thorough compared to the standard procedure based on manual pipetting. The results were consistent, though the volume of obtained calibration solutions and the potential risk of random errors were significantly minimized by AHMT. Its effectiveness was further enhanced by the application of SCIEX® nanoVials, reducing the actual volume of calibration solutions down to 10 μL.
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