1
|
Hill J, Yang EH, Lefebvre D, Doran S, van Diepen S, Raizman JE, Tsui AK, Rowe BH. The Impact of an Accelerated Diagnostic Protocol Using Conventional Troponin I for Patients With Cardiac Chest Pain in the Emergency Department. CJC Open 2024; 6:915-924. [PMID: 39026624 PMCID: PMC11252515 DOI: 10.1016/j.cjco.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/16/2024] [Indexed: 07/20/2024] Open
Abstract
Background This study strove to assess the impact of the implementation of an accelerated diagnostic protocol (ADP), using shortened serial-testing intervals and a conventional troponin I (c-TnI) test, on emergency department (ED) length of stay (LOS). Methods This retrospective cohort study included adults (aged ≥ 18 years) presenting to a Canadian ED with a primary complaint of cardiac chest pain between January 14, 2017 and January 15, 2019. For non-high-risk patients, the troponin delta timing decreased from 6 hours to 3 hours, and a different conventional troponin I level cut-point was implemented on January 15, 2018. The primary outcome was ED LOS. Secondary outcomes included disposition status, consultation proportions, and major adverse cardiac events within 30 days. Results A total of 3133 patient interactions were included. Although the overall decrease in median ED LOS was not significant (P = 0.074), a significant reduction occurred in ED LOS (-33 minutes; 95% confidence interval: -53.6 to -12.4 minutes) among patients who were discharged in the post-ADP group. Consultations were unchanged between groups (36.1% before vs 33.8% after; P = 0.17). The major adverse cardiac events outcomes were unchanged across cohorts (15.9% vs 15.3%; P = 0.62). Conclusions The implementation of an ADP, with a conventional troponin I test, for cardiac chest pain in a Canadian ED was not associated with a significant reduction of LOS for all patients; however, a significant reduction occurred for patients who were discharged, and the strategy appears safe.
Collapse
Affiliation(s)
- Jesse Hill
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Esther H. Yang
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- The Alberta Strategy for Patient-Oriented Research Support Unit, Alberta Health Services (AHS), Edmonton, Alberta, Canada
| | - Dennis Lefebvre
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Shandra Doran
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Sean van Diepen
- Mazankowski Heart Institute, Division of Cardiology, Department of Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Joshua E. Raizman
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- Alberta Precision Laboratories (APL), Edmonton, Alberta, Canada
| | - Albert K.Y. Tsui
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- Alberta Precision Laboratories (APL), Edmonton, Alberta, Canada
| | - Brian H. Rowe
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- Mazankowski Heart Institute, Division of Cardiology, Department of Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
2
|
Cembrowski G, Qiu Y, Sherazi A, Shea JL. Retrospective analysis of intra-patient laboratory variation demonstrates that the BD Vacutainer® Barricor™ blood collection tube reduces troponin variation. Clin Biochem 2023; 114:24-29. [PMID: 36706798 DOI: 10.1016/j.clinbiochem.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/14/2022] [Accepted: 01/23/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The BD Vacutainer® Barricor™ plasma blood collection tube uses a mechanical separator during centrifugation to separate plasma from the cellular elements of blood. Compared to use of plasma separator tubes (PST™) with gel, Barricor™ produces a cleaner sample with less residual cellular content. We sought to determine if Barricor™ reduces pre-analytical error compared to PST™. DESIGN & METHODS We used a model previously published that utilizes serial differences between intra-patient measurements transformed into a Taylor series of variation vs time with the y-intercept equal to the sum of short-term analytic variation, preanalytic variation and biologic variation. The intra-patient variation of chloride, sodium, potassium, and troponin-T (hs-TnT) obtained from the Emergency Department of a large tertiary care center sampled with PST™ (May 2015-April 2018, n = 59,762 specimens) or Barricor™ (May 2018-May 2021, n = 61,512 specimens) was evaluated. All specimens were analyzed on either Roche Modular or Cobas® instruments. For each analyte, pairs of intra-patient results were tabulated and separated by 1 h intervals. The average between-pair variations were then regressed against time. We also determined the number of intra-patient outliers using the reference change value for each analyte. RESULTS The Barricor™ hs-TnT y-intercept (-0.0132) was significantly lower than the PST™ intercept (0.9109; p = 0.022). This was also true for chloride (y-intercept = 1.0067 in Barricor™ and 1.3431 in PST™, p = 0.037). The percentage of hs-TnT outliers was significantly lower in Barricor™ (8.32 %) vs PST™ (12.2 %; p < 0.001). CONCLUSION The analytical and biological variations are assumed to be steady over the study periods; we ascribe the difference in the y-intercept to the preanalytical effect of the Barricor™ tube reducing platelets and other cellular debris.
Collapse
Affiliation(s)
- George Cembrowski
- Laboratory Medicine and Pathology, University of Alberta, Cembrowski & Cembrowski Quality Control Consulting, Edmonton, AB, Canada
| | - Yuelin Qiu
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ali Sherazi
- Department of Research Services, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada; Department of Laboratory Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada
| | - Jennifer L Shea
- Department of Laboratory Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada; Department of Pathology, Dalhousie University, Halifax, NS, Canada.
| |
Collapse
|
3
|
Song D, Sun H, Ma L, Liu J, Gao Y, Zhang Q, Xiao P, Sun K, Shen M, Wang X, Zhou M. In-Vitro Diagnostic Reagent Evaluation of Commercially Available Cardiac Troponin I Assay Kits Using H/D Exchange Mass Spectrometry for Antibody-Epitope Mapping. Anal Chem 2023; 95:2278-2284. [PMID: 36647798 DOI: 10.1021/acs.analchem.2c03946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Cardiac troponin I (cTnI) is the biomarker of choice and considered a gold standard for the diagnosis of acute myocardial infarction. However, the quantitative results of cTnI assay kits from different manufacturers are not comparable. Based on the H/D exchange mass spectrometry (HDX-MS) workflow, we developed an in-vitro diagnostic reagent antibody evaluation strategy to analyze the interactions of epitopes and antibody cocktails─(R195, F12, S13) and (D1, D2, pAb2). The HDX results indicate that the quantitative result bias of the different reagents originates from the ability of antibodies to recognize various cTnI complex forms, such as free cTnI, hydrolyzed cTnI, and cTnI combined with cTnT or TnC as binary or ternary complexes (cTnIC, cTnTIC), in blood based on different epitopes. The data obtained from the peptide HDX of interest after treatment with various antibody cocktails clearly indicated epitope specificity. The consistency of quantitative results can be improved by a thorough investigation into the epitopes recognized by the antibodies of various diagnostic kits, which will lead to the standardization of cTnI diagnosis.
Collapse
Affiliation(s)
- Dewei Song
- Division of Chemical Metrology and Analytical Science, National Institute of Metrology, Beijing 100029, China
| | - Haofeng Sun
- Division of Chemical Metrology and Analytical Science, National Institute of Metrology, Beijing 100029, China.,School of Chemical and Engineering, Nanjing University of Science and Technology, Jiangsu 210094, China
| | - Lingyun Ma
- Division of Chemical Metrology and Analytical Science, National Institute of Metrology, Beijing 100029, China
| | - Jianyi Liu
- Division of Chemical Metrology and Analytical Science, National Institute of Metrology, Beijing 100029, China
| | - Yanhong Gao
- Laboratory Department of the First Medical Center of PLA General Hospital, Beijing 100039, China
| | - Qi Zhang
- Division of Chemical Metrology and Analytical Science, National Institute of Metrology, Beijing 100029, China.,School of Chemical Engineering, Beijing University of Chemical Technology, Beijing 100029, China
| | - Peng Xiao
- Division of Chemical Metrology and Analytical Science, National Institute of Metrology, Beijing 100029, China
| | - Keqi Sun
- Reference System Department, Maccura Biotechnology Co., Ltd., Chengdu 611713, China
| | - Min Shen
- Reference Laboratory, Medical System Biotechnology Co., Ltd., Ningbo 315104, China
| | - Xiaojian Wang
- Reference Laboratory, Beijing Strong Biotechnologies, Inc., Huairou, Beijing 101400, China
| | - Min Zhou
- School of Chemical and Engineering, Nanjing University of Science and Technology, Jiangsu 210094, China
| |
Collapse
|
4
|
Paul HA, Chi Q, Gifford JL, Seiden-Long I. Not T too! False elevations in high-sensitivity cardiac troponin T (hs-TnT) following specimen transport. Clin Biochem 2022; 115:86-91. [PMID: 36027942 DOI: 10.1016/j.clinbiochem.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
Abstract
Though false elevations attributed to preanalytical specimen handling have been widely reported for Troponin I (TnI), Troponin T (TnT) has appeared more robust to falsely elevated Tn. We describe reproducible false elevations in high sensitivity TnT (hs-TnT) in specimens after courier transport in plasma separator tubes (PST) off-site for testing. Hs-TnT was measured under 5 different conditions: 1) at collection location (N=24); 2) after transport upright in racks (N=66); 3) after transport with no control over tube agitation (N=69); 4) on transported aliquots (N=84); or 5) immediately after transport with no control over tube agitation (N=16), followed by keeping the specimen upright and re-measuring at 1hr, 2hr, 4hr, and 20-24hrs (N=6). To assess the degree of discrepancy, plasma from the original PST was aliquotted, re-centrifuged, potential debris removed, and hs-TnT re-measured. 43% of PST specimens collected offsite and transported with no control over tube agitation had clinically significant false elevations of hs-TnT which subsequently decreased following aliquotting and re-centrifugation (median decrease =9.9ng/L). Onsite testing or transported aliquots demonstrated no discrepancy. After being kept upright, discrepant specimens were not different from re-centrifuged aliquots by 4hrs (p=0.6141, repeated measures ANOVA with Dunn's multiple comparisons). Clinically significant false elevations of hs-TnT occurred in approximately 40% of separated PSTs that were transported in containers where specimens are transported with no control over tube agitation. This interference does not occur if plasma is aliquoted or if hs-TnT is tested at the collection site. In order to prevent these false elevations, and their potential patient impact on the diagnosis of acute myocardial infarction, specimens for hs-TnT measurement should be aliquoted at the collection location prior to transport.
Collapse
Affiliation(s)
- Heather A Paul
- Alberta Precision Laboratories and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Qingli Chi
- Alberta Precision Laboratories, Calgary, Alberta, Canada
| | - Jessica L Gifford
- Alberta Precision Laboratories and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Isolde Seiden-Long
- Alberta Precision Laboratories and Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada; Correspoooonding author at: Foothills Medical Centre, McCaig Tower, Rm 7507, 7(th) Floor, 3134 Hospital Drive NW, Canada.
| |
Collapse
|
5
|
Storage conditions, sample integrity, interferences, and a decision tool for investigating unusual high-sensitivity cardiac troponin results. Clin Biochem 2022; 115:67-76. [PMID: 35772501 DOI: 10.1016/j.clinbiochem.2022.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/31/2022] [Accepted: 06/22/2022] [Indexed: 11/24/2022]
Abstract
The current definition of high-sensitivity cardiac troponin (hs-cTn) assays is laboratory-based and their analytical attributes and characteristics have drawn significant attention in the literature at least partly due to the lower concentration cut-offs and changes in concentrations (i.e., deltas) employed in different algorithms and pathways to manage patient care. We propose that pre-analytical conditions such as sample type, storage conditions, and other interferences may also have a significant impact on hs-cTn concentrations and clinical management. The purpose of this literature review is to provide a summary of important pre-analytical and interference studies affecting hs-cTn concentrations. A breakdown of the literature for the major diagnostic companies providing core laboratory instrumentation (i.e., Abbott, Beckman, Ortho, Roche, and Siemens) is also provided. Finally, three cases are highlighted where knowledge of pre-analytical factors aids the hs-cTn clinically discordant investigations. This review highlights the importance of pre-analytical variables, especially storage condition, sample handling, and blood tubes used (i.e., sample type) when interpreting hs-cTn assays. Additional studies are needed to further elaborate on pre-analytical variables (i.e., centrifugation, sample type, stability) and interferences for all hs-cTn assays in clinical use, as knowledge of these variables may aid in hs-cTn clinically discordant investigations.
Collapse
|
6
|
Jordan A, Sherazi A, Stevens A, Quondam Franks C, Sturgeon K, Northrup V, Shea JL. Evaluation of BD Barricor™ and PST™ blood collection tubes compared to serum for testing 11 therapeutic drugs on a Roche Cobas® 8000 platform. Clin Biochem 2021; 100:60-66. [PMID: 34788637 DOI: 10.1016/j.clinbiochem.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The type of blood collection tube used when obtaining samples for therapeutic drug monitoring (TDM) has important implications on the accuracy of results. Serum tubes without a gel separator are currently considered best practice. We sought to evaluate the performance of Barricor™, a novel plasma tube that utilizes an inert mechanical separator, as well as a gel-based tube (PST™) for testing acetaminophen, digoxin, gentamicin, methotrexate, phenobarbital, phenytoin, salicylate, vancomycin, valproic acid, carbamazepine, and theophylline on a Roche Cobas® 8000 platform. METHODS Paired patient samples were collected from individuals taking at least one of the medications evaluated. These were supplemented with spiked specimens to ensure a minimum of 40 paired samples per drug. All drugs were measured within two hours of collection on Roche e602 or c502 instruments. Deming regression was used to assess bias between Barricor™ vs serum and PST™ vs serum. Seven-day refrigerated stability was also assessed in Barricor™, PST™, and serum tubes in a subset of samples (n = 10) for each drug. RESULTS Drug concentrations in Barricor™ were similar to serum for each drug assessed. In contrast, a negative bias was observed in PST™ compared to serum tubes for carbamazepine (-7.6%) and phenytoin (-6.8%) although this did not surpass our total allowable error goal of 10%. All drugs recovered within ±10% of baseline value when samples were stored refrigerated for 7 days except for carbamazepine, phenytoin, and phenobarbital where significant analyte loss was observed within the first day in PST™ tubes. CONCLUSION Barricor™ tubes are a suitable alternative to serum for TDM on the Roche Cobas® 8000 platform.
Collapse
Affiliation(s)
- Alexander Jordan
- Dalhousie Medicine New Brunswick, Dalhousie Medical School, Saint John, NB, Canada
| | - Ali Sherazi
- Department of Research Services, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada; Department of Laboratory Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada
| | - Ashley Stevens
- Department of Laboratory Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada
| | - Christina Quondam Franks
- Department of Laboratory Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada
| | - Kayla Sturgeon
- Department of Laboratory Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada
| | - Victoria Northrup
- Department of Research Services, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada; Department of Laboratory Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada
| | - Jennifer L Shea
- Department of Laboratory Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, NB, Canada; Department of Pathology, Dalhousie University, Halifax, NS, Canada.
| |
Collapse
|
7
|
Moon SY, Lee HS, Park MS, Kim IS, Lee SM. Evaluation of the Barricor Tube in 28 Routine Chemical Tests and Its Impact on Turnaround Time in an Outpatient Clinic. Ann Lab Med 2021; 41:277-284. [PMID: 33303712 PMCID: PMC7748094 DOI: 10.3343/alm.2021.41.3.277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/17/2020] [Accepted: 11/30/2020] [Indexed: 01/19/2023] Open
Abstract
Background We recently introduced the Barricor (BD, Franklin Lakes, NJ, USA) plasma separation tube, which uses a mechanical separator instead of a gel. We evaluated the effects of using the Barricor tube in a stat (statin) laboratory on the results and turnaround time (TAT) of routine chemical tests. We verified the impact of Barricor tube on reducing TAT and providing results similar to those obtained using serum separator tubes (SSTs). Methods We collected venous blood samples from 166 outpatients in Barricor tubes and SSTs and measured 28 routine analytes using an AU5800 instrument (Beckman Coulter, Brea, CA, USA). TAT indexes were compared before and after using Barricor tube. Results Mean percent differences were <5%, except for alanine aminotransferase , total CO2, high-density lipoprotein, phosphate, total protein, and direct bilirubin. The median TAT decreased from 45 to 38 minutes, and the rate of a TAT >60 minutes decreased from 7.84% to 2.66%, which was approximately one-third of that for SST. The reduction in TAT was attributable to a decrease in centrifugation time. Incomplete clotting and repeated centrifugation, which occurred frequently when using SST, also decreased after using the Barricor tubes. Conclusions The Barricor tube is an alternative to SST for routine chemical tests in institutions aiming to reduce TAT, with clinically allowable differences in test results.
Collapse
Affiliation(s)
- Soo Young Moon
- Department of Laboratory Medicine, Pusan National University Hospital, Busan, Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Han Sol Lee
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Min Soon Park
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - In-Suk Kim
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Laboratory Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Sun Min Lee
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| |
Collapse
|
8
|
Khoza SP, Ford S, Buthelezi EP, Tanyanyiwa DM. Comparative study of chemical pathology sample collection tubes at the largest hospital in South Africa. J Med Biochem 2021; 40:358-366. [PMID: 34616225 PMCID: PMC8451222 DOI: 10.5937/jomb0-27216] [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: 06/29/2020] [Accepted: 02/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background BarricorTM Lithium heparin plasma tubes are new blood tubes that have been introduced to overcome the effects of gel in serum separator tubes (SST) and the shortcomings of standard Lithium heparin plasma. We aimed to evaluate BarricorTM tubes as an alternative to serum separator tubes and compare the stability between the tubes. Methods Forty-four paired samples were collected using both BarricorTM and SST. We compared five analytes at baseline (<6 h) and after every 24 h using the PassingBablok and Bland-Altman plots. Aspartate aminotransferase (AST), potassium (K), phosphate (PO4) , lactate dehydrogenase (LDH), and creatinine were analysed in both tubes. We calculated the percentage difference for each analyte between the baseline and time intervals to assess analyte stability. The percentage difference was compared to the desirable specification for bias and reference change value (RCV). Results All analytes were comparable at baseline. Statistical differences (p<0.001) became evident after 24 h. PO4, K, and creatinine had a mean difference that exceeded the desirable specification for bias (-9.59%, - 9.35%, and -4.59%, respectively). Potassium was stable up to 24 h in both tubes. LDH showed better stability in SST (144 h vs 96 h). PO4 concentrations were more stable in both tubes with the SST (96 h vs 72 h). Creatinine and AST had the longest stability in both tubes compared to other analytes (144 h). Conclusions Data demonstrated variability and similarities in analyte concentrations and stability, respectively, in both tubes.
Collapse
Affiliation(s)
| | - Sarah Ford
- National Health Laboratory Service, Department of Chemical Pathology, Johannesburg, South Africa
| | | | - Donald M Tanyanyiwa
- Sefako Makgatho University of Health Sciences, Pretoria, South Africa.,National Health Laboratory Service, Department of Chemical Pathology, Johannesburg, South Africa
| |
Collapse
|
9
|
Wu AHB. Reduced pre-analytical issues for measuring troponin with use of a high sensitivity assay. Clin Biochem 2021; 95:89-90. [PMID: 33961813 DOI: 10.1016/j.clinbiochem.2021.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/06/2021] [Accepted: 05/02/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Alan H B Wu
- Department of Laboratory Medicine, University of California, San Francisco, CA 94110, USA.
| |
Collapse
|
10
|
Shin S, Oh J, Park HD. Comparison of Three Blood Collection Tubes for 35 Biochemical Analytes: The Becton Dickinson Barricor Tube, Serum Separating Tube, and Plasma Separating Tube. Ann Lab Med 2020; 41:114-119. [PMID: 32829587 PMCID: PMC7443522 DOI: 10.3343/alm.2021.41.1.114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/05/2020] [Accepted: 07/29/2020] [Indexed: 01/17/2023] Open
Abstract
The Barricor tube (Becton Dickinson [BD], Sunnyvale, CA, USA) was recently developed to mechanically separate plasma by increasing the centrifugation rate. We compared the Barricor tube with existing serum- and plasma-based tubes based on 35 biochemical analytes and preanalytical turnaround time (TAT). Blood samples were collected from 30 healthy volunteers in a Barricor tube, serum separating tube (SST, Vacutainer SST II Tube 8.5 mL, #368972; BD), or plasma separating tube (PST, Vacutainer PST Tube 8.0 mL, #367964; BD) in random order. Next, 27 chemistry analytes, six immunochemistry analytes, and two cardiac markers were compared using Passing-Bablok regression and the Bland-Altman method. Preanalytical TAT was measured for each tube. The Barricor tube exhibited bias exceeding the desirable limit for nine and four analytes compared with the SST and PST, respectively. The Barricor tube lactate dehydrogenase value showed a bias of −10.29% and −9.86% compared with that of the SST and PST, respectively. The preanalytical TAT of Barricor tube was 8.8 minutes, which was the shortest among the three tubes. The clinical performance of the Barricor tube was equivalent to that of the SST and PST for most analytes, with an apparent advantage in preanalytical TAT. When using the Barricor tube, the reference range needs to be changed for some analytes that exceed the desirable bias limit.
Collapse
Affiliation(s)
- Sunghwan Shin
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jongwon Oh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung-Doo Park
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
11
|
Raizman JE, Tsui AK, Goudreau BL, Füzéry AK, Estey M, Sadrzadeh H, Higgins T. Multi-platform analytical evaluation of the Beckman Coulter Access high-sensitivity troponin I assay across different laboratory sites using Barricor plasma. Clin Biochem 2020; 78:25-31. [DOI: 10.1016/j.clinbiochem.2019.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 11/25/2022]
|
12
|
Ramakers C, Meyer B, Yang W, Plokhoy E, Xiong Y, Church S, Kaushik N. Switching from serum to plasma: Implementation of BD Vacutainer® Barricor™ Plasma Blood Collection Tubes improves sample quality and laboratory turnaround time. Pract Lab Med 2020; 18:e00149. [PMID: 31909146 PMCID: PMC6938909 DOI: 10.1016/j.plabm.2019.e00149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND For blood, most 24/7 standard (immuno)chemistry parameters are either measured in serum or in lithium heparin plasma. Standard serum and plasma gel tubes have their shortcomings when timely analysis of high quality results is required. Serum requires clotting time and interference of gel globules in the plasma and adsorption of hydrophobic analytes into the gel layer potentially compromises high quality results from lithium heparin gel tubes. We sought to evaluate the impact of BD Vacutainer® Barricor™ Tube (Barricor™) on laboratory efficiency by measuring its effect on TAT and sample quality, as well as evaluate potential cost opportunities resulting from improved sample quality. METHODS TAT data and remediation activities were extracted and captured during two 6 months phases. Serum was used as the predominant matrix in the first phase and Barricor™ plasma was used in the second phase. RESULTS Barricor™ significantly reduced the median TAT, especially for routine-priority samples during peak-hours. The TAT key-performance-indicator (percentage of results available within 90 min) improved to >90% for STAT as well as routine priority samples. Converting from serum gel, Barricor™ reduced fibrin-related remediation activities from 2.3% to 0.4%. This resulted in remediation-related cost reduction of €6.010,47 over the study period. CONCLUSIONS By implementing Barricor™, we saw a significant reduction in TAT and a reduction in fibrin-related remediation time and costs, when compared to a predominant serum workflow. The improved TAT opens up the possibility of consolidating to one single priority level, eliminating the need for the use of the STAT priority level.
Collapse
Affiliation(s)
- Christian Ramakers
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | | | | | - Yan Xiong
- Becton Dickinson, Franklin Lakes, NJ, USA
| | | | | |
Collapse
|
13
|
Barricor blood collection tubes are equivalent to PST for a variety of chemistry and immunoassay analytes except for lactate dehydrogenase. Clin Chim Acta 2019; 496:18-24. [PMID: 31201816 DOI: 10.1016/j.cca.2019.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The BD Barricor tube uses a novel mechanical separator designed to eliminate gel artifacts, decrease cellular contamination, and improve stability. Here, we evaluated the Barricor tube as a possible replacement for PST using Beckman Coulter analyzers under both optimal, alternative, and suboptimal centrifugation conditions based on BD recommendations. METHODS Paired PST and Barricor samples were collected from 4 local hospitals and processed based on site-specific preanalytical systems involving automated or manual centrifugation. Centrifugation conditions ranged from 1912 ×g for 10 min (suboptimal), 2060 g for 10 min (alternative), and 4000 ×g for 3 or 10 min (optimal). Tube volume (4.5 vs. 5.5 ml) was also assessed. Forty-three chemistry and immunochemistry analytes were measured on Beckman Coulter DxC and DxI analyzers. RESULTS Using an automated preanlaytical system with suboptimal spin conditions, no bias between PST and Barricor was observed for all analytes tested except lactate dehydrogenase (LD). Further investigation revealed significant increase in LD when Barricor was spun for 10 min at 1912, 2060 and 4000 ×g, ranging from +7.4-19.4% vs. PST across the entire measurement interval (87-493 U/l). Smaller tube volume was also associated with higher LD. Differences in LD occurred despite no change in other hemolysis markers such as potassium, phosphate, and AST. CONCLUSIONS LD is most sensitive to varying centrifugation conditions (time and speed) in Barricor tubes. We recommend that BD centrifugation protocols should be closely evaluated to determine if Barricor is equivalent to PST under local preanalytical configurations.
Collapse
|
14
|
Badiou S, Vuillot O, Bargnoux AS, Kuster N, Lefebvre S, Sebbane M, Cristol JP, Dupuy AM. Improved quality of samples and laboratory turnaround time using 3.5 mL low vacuum BD Vacutainer ® Barricor tubes in the emergency department. Pract Lab Med 2019; 16:e00128. [PMID: 31289734 PMCID: PMC6593183 DOI: 10.1016/j.plabm.2019.e00128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 06/04/2019] [Indexed: 11/25/2022] Open
Abstract
Background Centrifugation is a consuming time step which participates to increase the turnaround time (TAT) in laboratories, likewise hemolysis sample that needs a re-sampling could delay management of patients. Recently, it has been postulated that BD Barricor™ tube could allow to decrease the centrifugation time and prevent hemolysis, two key feature to ensure high-quality results. Aim of the study was to evaluate the impact of replacing 4 mL BD vacutainer heparin lithium tube by low vacuum 3.5 mL BD vacutainer Barricor™ tube in an emergency department (ED) on hemolysis rate and TAT. Methods Data of hemolysis index (HI) and TAT were compared between the first period of 15 days using 4 mL BD vacutainer heparin lithium tubes with 15 min at 2000xg as centrifugation setting and a second period of 15 days using BD vacutainer Barricor™ tube centrifuged 3 min at 4000xg. Results A significantly reduced time duration between reception of sample and available results in informatics lab system was observed with the reduction time of centrifugation allowed by use of Barricor™ tube compared to regular heparin lithium tubes (p < 0.001). A significative decrease in hemolysis rate also occurred in the second period as samples with HI < 10 reached from 52.5% in the first period to 68.5% (p < 0.001) in the second. Conclusion Low vacuum BarricorTM tubes allowing a higher speed of centrifugation improve lab TAT without impairment of sample quality as a significant reduction of hemolysis was observed, a double advantage which is of particular interest for ED. Improving turnaround time and quality samples is a challenge for all laboratories. Hemolyzed samples occurrence is higher in the emergency department. Low vacuum tube can reduce the hemolysis rate of blood sampling. Higher speed centrifugation could reduce centrifugation time and turnaround time. Low vacuum Barricor tube in emergency unit improve hemolysis rate and turnaround time.
Collapse
Affiliation(s)
- S Badiou
- Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France.,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - O Vuillot
- Department of Emergency, Lapeyronie University Hospital, Montpellier, France
| | - A S Bargnoux
- Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France.,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - N Kuster
- Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France.,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - S Lefebvre
- Department of Emergency, Lapeyronie University Hospital, Montpellier, France
| | - M Sebbane
- Department of Emergency, Lapeyronie University Hospital, Montpellier, France
| | - J P Cristol
- Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France.,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - A M Dupuy
- Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France
| |
Collapse
|
15
|
Kittanakom S, Ly V, Arnoldo A, Beattie A, Kavsak PA. Pre-analytical variables affecting discordant results on repeat sample testing for cardiac troponin I. Clin Biochem 2018; 63:158-160. [PMID: 30393000 DOI: 10.1016/j.clinbiochem.2018.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/14/2018] [Accepted: 10/23/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Saranya Kittanakom
- William Osler Health System, Brampton, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
| | - Vinh Ly
- William Osler Health System, Brampton, Ontario, Canada
| | | | - Aimee Beattie
- William Osler Health System, Brampton, Ontario, Canada
| | | |
Collapse
|
16
|
Dupuy AM, Badiou S, Daubin D, Bargnoux AS, Magnan C, Klouche K, Cristol JP. Comparison of Barricor™ vs. lithium heparin tubes for selected routine biochemical analytes and evaluation of post centrifugation stability. Biochem Med (Zagreb) 2018; 28:020902. [PMID: 29666561 PMCID: PMC5898955 DOI: 10.11613/bm.2018.020902] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 02/07/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Obtaining suitable results unaffected by pre- or postanalytical phases is pivotal for clinical chemistry service. We aimed comparison and stability of nine biochemical analytes after centrifugation using Barricor™ plasma tubes with mechanical separator vs standard Vacutainer® lithium heparin tubes. MATERIALS AND METHODS We collected samples on six healthy volunteers and nine patients from intensive care units into 6 mL plastic Vacutainer® lithium heparin tubes and 5.5 mL plastic Barricor™ plasma tubes. All tubes were centrifuged within 30 minutes after venipuncture. First, we compared results of nine biochemical analytes from lithium heparin tubes with Barricor™ tubes for each analyte using Passing-Bablok and Bland-Altman analyses. Second, we calculated the difference of analyte concentrations between baseline and time intervals in tubes stored at + 4 °C. Based on the total change limit we calculated the maximum allowable concentrations percentage change from baseline. RESULTS The majority of correlation coefficients were close to 0.99 indicating good correlation in the working range. Bland-Altman analyses showed an acceptable concordance for all analytes. In consequence, the Barricor™ tube might be an alternative to regular lithium heparin tube. Stability with this new generation tube is improved for eight analytes (except for aspartate aminotransferase) in comparison with regular lithium heparin tubes. CONCLUSIONS By using Barricor™ tubes and prompt centrifugation, supplemental analysis or re-analysis for eight analytes including alanine aminotransferase, alkaline phosphatase, C-reactive protein, high sensitivity troponin T, lactate dehydrogenase, NT-pro BNP, potassium and sodium could be performed within 72 h of specimen collection.
Collapse
Affiliation(s)
- Anne Marie Dupuy
- Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France
| | - Stéphanie Badiou
- Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, Montpellier, France
| | - Delphine Daubin
- Intensive Care Medicine Department, Lapeyronie University Hospital, Montpellier, France
| | - Anne Sophie Bargnoux
- Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, Montpellier, France
| | - Chloé Magnan
- Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France
| | - Kadda Klouche
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, Montpellier, France
- Intensive Care Medicine Department, Lapeyronie University Hospital, Montpellier, France
| | - Jean Paul Cristol
- Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, Montpellier, France
| |
Collapse
|
17
|
Fournier JE, Northrup V, Clark C, Fraser J, Howlett M, Atkinson P, Shea JL. Evaluation of BD Vacutainer® Barricor™ blood collection tubes for routine chemistry testing on a Roche Cobas® 8000 Platform. Clin Biochem 2018; 58:94-99. [PMID: 29885310 DOI: 10.1016/j.clinbiochem.2018.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Barricor™ Vacutainers® are a novel non-gel separator blood collection tube. These tubes enable faster pre-analytical processing which could reduce turnaround time and be beneficial in an acute care setting. We sought to evaluate the bias, stability, and integrity of plasma generated from these tubes compared to Plasma Separator Tubes™ (PST) for 50 routine chemistry analytes on a Roche Cobas® 8000 analyzer. METHODS Paired samples were collected from 150 patients originating in the emergency department and outpatient collections at the Saint John Regional Hospital. Barricor™ vacutainers were centrifuged for 3 min at 4000g and PST™ vacutainers for 10 min at 1300 g within two hours of collection. Plasma samples (n = 126) were then analyzed for 50 chemistry analytes and bias determined between tubes. Ten-day stability of AST, glucose, potassium, phosphate, and LDH was also assessed in a subset of paired samples (n = 4). Lastly, the quality of plasma (n = 20) was assessed through measurement of cell counts on a DxH Hematology Analyzer. RESULTS All 50 analytes demonstrated comparable results across a broad concentration range between Barricor™ and PST™ vacutainers (average percent bias -1.5% to 6.1%; Deming linear regression slopes 0.933-1.041; correlation coefficients ≥ 0.9144). AST, potassium, glucose and LDH were stable for 10 days in Barricor™ vacutainers (change from baseline < 10%) but <5 days in PST™ vacutainers while phosphate was stable for 4 days in Barricor™ vs 2 days in PST™ vacutainers. Platelet counts were statistically lower in Barricor™ compared to PST™ vacutainers. CONCLUSION Our data suggest that Barricor™ vacutainers are an acceptable alternative to PST™ vacutainers while offering the added benefit of decreased pre-analytical processing time, increased stability of certain analytes, and possibly less cellular contamination.
Collapse
Affiliation(s)
- Jeffrey E Fournier
- Dalhousie Medicine New Brunswick, Dalhousie Medical School, Saint John, NB, Canada
| | - Victoria Northrup
- Department of Research Services, Saint John Regional Hospital, Saint John, NB, Canada; Department of Laboratory Medicine, Saint John Regional Hospital, Saint John, NB, Canada
| | - Claudette Clark
- Department of Laboratory Medicine, Saint John Regional Hospital, Saint John, NB, Canada
| | - Jacqueline Fraser
- Department of Emergency Medicine, Saint John Regional Hospital, Saint John, NB, Canada
| | - Michael Howlett
- Department of Emergency Medicine, Saint John Regional Hospital, Saint John, NB, Canada; Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Paul Atkinson
- Department of Emergency Medicine, Saint John Regional Hospital, Saint John, NB, Canada; Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jennifer L Shea
- Department of Laboratory Medicine, Saint John Regional Hospital, Saint John, NB, Canada; Department of Pathology, Dalhousie University, Halifax, NS, Canada.
| |
Collapse
|
18
|
Padoan A, Zaninotto M, Piva E, Sciacovelli L, Aita A, Tasinato A, Plebani M. Quality of plasma samples and BD Vacutainer Barricor tubes: Effects of centrifugation. Clin Chim Acta 2018; 483:271-274. [PMID: 29753681 DOI: 10.1016/j.cca.2018.05.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/09/2018] [Accepted: 05/09/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUNDS The BD Vacutainer® Barricor™ Plasma collection tube (BD Barricor) uses an innovative non-gel separation method. This study compared the plasma residual cell count (PRCC) obtained from BD Barricor and from BD PST II plasma tubes. METHODS Four BD Barricors and one BD PST II were collected from 40 donors. BD PST II was centrifuged at 1300g/10 min, while the BD Barricors were centrifuged at 1800g/10 min, 4000g/3 min, 4000g/7 min and 4000g/15 min. PRCC was evaluated measuring white blood cells (WBC), red blood cells (RBC) and Platelets (PLT) counts by Siemens ADVIA 2120. Cell-free hemoglobin was quantified by haemolysis index (HI) by Roche Cobas c501. RESULTS BD PST II Median WBC, RBC and PLT counts were 0.38 (109/L), 0.0291 (1012/L) and 113.5 (109/L), respectively. Considering the BD PST II as reference, PRCC differences were expressed as median bias percentage. WBC showed a significant reduction at all the conditions (p < 0.01), being the reductions: 63.9% (1800g/10 min), 69.9% (4000g/3 min), 75.0% (4000g/7 min) and 82.7% (4000g/15 min). RBC reductions 29.7% (1800g/10 min), 33.8% (4000g/3 min), 39.6% (4000g/7 min) and 66.4 (4000g/15 min) were all significant (p < 0.01). PLT reductions were 1.6% at 1800g/10 min (p = ns), 1.2% at 4000g/3 min (p = ns), 27.1% at 4000g/7 min (p = 0.046) and 46.6% at 4000g/15 min (p = 0.005). BD Barricor centrifuged for 7 and 15 min at 4000g showed an increased haemolysis. CONCLUSIONS BD Barricors plasma quality improved with increasing the centrifugation times but already at 4000g/3 min, the suggested centrifugation condition, a significant improvement was achieved.
Collapse
Affiliation(s)
- Andrea Padoan
- Department of Medicine - DIMED, University of Padova, via Giustiniani 2, 35128 Padova, Italy; Department of Laboratory Medicine, University-Hospital of Padova, via Giustiniani 2, 35128 Padova, Italy.
| | - Martina Zaninotto
- Department of Laboratory Medicine, University-Hospital of Padova, via Giustiniani 2, 35128 Padova, Italy
| | - Elisa Piva
- Department of Laboratory Medicine, University-Hospital of Padova, via Giustiniani 2, 35128 Padova, Italy
| | - Laura Sciacovelli
- Department of Laboratory Medicine, University-Hospital of Padova, via Giustiniani 2, 35128 Padova, Italy
| | - Ada Aita
- Department of Medicine - DIMED, University of Padova, via Giustiniani 2, 35128 Padova, Italy; Department of Laboratory Medicine, University-Hospital of Padova, via Giustiniani 2, 35128 Padova, Italy
| | - Adriano Tasinato
- Department of Laboratory Medicine, University-Hospital of Padova, via Giustiniani 2, 35128 Padova, Italy
| | - Mario Plebani
- Department of Medicine - DIMED, University of Padova, via Giustiniani 2, 35128 Padova, Italy; Department of Laboratory Medicine, University-Hospital of Padova, via Giustiniani 2, 35128 Padova, Italy
| |
Collapse
|