1
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Hart SA, Khan A, Booth GS, Wiencek JR. Tennessee hospital noncompliance with price transparency legislation for 8 common laboratory tests. Am J Clin Pathol 2024:aqae057. [PMID: 38733607 DOI: 10.1093/ajcp/aqae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/16/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVES The goal of this study was to assess hospital compliance with federal price transparency mandates and barriers to pricing information in Tennessee. METHODS All hospitals websites were queried for gross, cash, and BlueCross BlueShield of Tennessee prices for 8 high-frequency laboratory tests in 2 Centers for Medicare & Medicaid Services-mandated pricing sources: (1) a machine-readable file of all available services and (2) a consumer-friendly display of 300 shoppable services. Barriers, including click counts, data availability, and intrahospital price discrepancies, were noted. RESULTS Of the 145 Tennessee hospitals assessed, 97.2% were noncompliant with the Centers for Medicare & Medicaid Services final rule. Subanalysis of available machine-readable files, price estimators, and shoppable services files demonstrated 49.6%, 95.1%, and 78.6% noncompliance, respectively. Barriers to pricing information included requiring protected health information (55.9%), missing at least 1 pricing source (7.6%), having no pricing sources available (6.2%), and involving more than 3 clicks to access the cash price in machine-readable files (54.1%) and price estimators (68.6%.) Average intrahospital discrepancy for basic metabolic panel cash prices across pricing sources was $101.30 (range, $0-1012.40). CONCLUSIONS Our study showed high levels of noncompliance with price transparency laws, inconsistent and inaccessible pricing, and continued challenges facing patients in Tennessee.
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Affiliation(s)
- Stephanie A Hart
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, US
| | - Ayesha Khan
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, US
| | - Garrett S Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, US
| | - Joesph R Wiencek
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, US
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2
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Sarpong KAN, Hee Kim S, McCartney CR, Wiencek JR, Bazydlo LAL. Spironolactone metabolite causes falsely increased progesterone in the Abbott Architect immunoassay. Clin Biochem 2024; 126:110747. [PMID: 38484829 DOI: 10.1016/j.clinbiochem.2024.110747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Immunoassays are important for routine clinical testing and medical diagnosis. However, they are limited by cross-reactivity especially at low analyte concentrations. There is a critical need to investigate compounds that can interfere with immunoassays. Herein, we describe the identification of canrenone, a spironolactone metabolite that falsely increases progesterone concentrations on the Abbott Architect i2000 Immunoassay. METHODS Serum samples and assay diluents were spiked with spironolactone or canrenone and progesterone concentrations were measured on the Architect i2000 and Immulite XPi immunoassay platforms. Blood samples from patients taking spironolactone were analyzed with liquid chromatography-tandem mass spectrometry to evaluate the intrinsic response of progesterone concentrations to the presence of canrenone. RESULTS We measured approximately 10-fold higher progesterone concentrations on the Abbott Architect i2000 compared to reference immunoassay analyzers (Siemens Immulite XPi and Roche Cobas e601/602), suggesting an analytical error which is unique to the Architect i2000 antibody and/or assay conditions. By measuring serum progesterone after addition of spironolactone or canrenone to serum samples, we found that canrenone falsely increased progesterone on the Architect i2000 immunoassay. However, this interference was more pronounced at low serum progesterone concentrations. Moreover, a strong positive correlation was seen between canrenone and measured serum progesterone concentrations. CONCLUSIONS Our investigations are important for individuals who require progesterone measurements using the Architect i2000 immunoassay, especially because it is unlikely for clinicians to order canrenone measurements alongside progesterone measurements for individuals taking spironolactone. Further research is needed to determine whether canrenone can influence progesterone measurements on other immunoassay systems.
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Affiliation(s)
- Kwabena A N Sarpong
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Department of Biochemistry Cell and Molecular Biology, University of Ghana, Accra, Ghana.
| | - Su Hee Kim
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22903, USA; Center for Research in Reproduction, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - Christopher R McCartney
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22903, USA; Center for Research in Reproduction, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - Joesph R Wiencek
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lindsay A L Bazydlo
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
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3
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Laryea ET, Mitchell K, Hernández J, Stanford E, Twum K, Wiencek JR. Analytical performance evaluation and consumable waste reduction strategies using a tube-based quality control material. Clin Chem Lab Med 2024; 62:e9-e12. [PMID: 37433060 DOI: 10.1515/cclm-2023-0483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Erving T Laryea
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Kelsey Mitchell
- Diagnostic Laboratories, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Julia Hernández
- Diagnostic Laboratories, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric Stanford
- Diagnostic Laboratories, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kwaku Twum
- Department of Pathology and Laboratory Medicine, University of North Carolina, McLendon Clinical Laboratories, Chapel Hill, NC, USA
| | - Joesph R Wiencek
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA
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4
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Pater MS, Hernandez JA, Wiencek JR. College of American Pathologists Quality Cross Check -Chemistry and Therapeutic Drug Monitoring as a tool for biannual instrument correlations. Lab Med 2024:lmad111. [PMID: 38217365 DOI: 10.1093/labmed/lmad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Biannual instrument-correlation studies are required for nonwaived assays performed on multiple instruments. OBJECTIVE To determine the feasibility of using College of American Pathologists (CAP) Quality Cross Check-Chemistry and Therapeutic Drug Monitoring (CZQ) to assess instrument correlations among multiple analyzers, analyzer models, and Clinical Laboratory Improvement Amendments (CLIA) licenses for 55 unique analytes. METHODS Instrument correlation studies were performed on 9 Abbott ARCHITECT instruments (c4000 [n = 4], c8000 [n = 2], and c16000 [n = 3]) over 3 CLIA licenses using CZQ materials. The mean (SD) values, concentration difference, percent bias, and peer data for each individual level of CZQ were determined for each individual analyzer. Acceptable concentration and percentage for each analyte were set using criteria from CAP or other reputable sources such as the American Association of Bioanalysts or the Royal College of Pathologists of Australasia. Peer data were provided by CAP with the CZQ kit. RESULTS Correlations using CZQ materials showed that 94.5% of assays studied were within the acceptability criteria by percent bias only and 98.2% were within acceptability criteria by concentration difference. CONCLUSIONS The use of CZQ provides support to standardized correlation studies among instruments within and across separate CLIA licenses. However, widespread adoption of CZQ may be limited due to concerns regarding matrix effects, analyte ranges, and ease of data analysis.
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Affiliation(s)
- Megan S Pater
- Diagnostic Laboratories, Vanderbilt University Medical Center, Saint Louis University School of Medicine, St Louis, MO
- Department of Pharmacology and Physiology, Saint Louis University School of Medicine, St Louis, MO
| | - Júlia A Hernandez
- Diagnostic Laboratories, Vanderbilt University Medical Center, Saint Louis University School of Medicine, St Louis, MO
| | - Joesph R Wiencek
- Diagnostic Laboratories, Vanderbilt University Medical Center, Saint Louis University School of Medicine, St Louis, MO
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN
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5
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Hart SA, Wiencek JR, Booth GS. The healthcare price transparency illusion: does anyone know what laboratory tests cost? J Pediatr 2024; 264:113755. [PMID: 37739059 DOI: 10.1016/j.jpeds.2023.113755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/16/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Stephanie A Hart
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Joesph R Wiencek
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Garrett S Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee
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6
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Glover RT, Connelly J, Gammie A, Kilcoyne J, Ozben T, Santos A, Wiencek JR. Sustainability in Laboratory Medicine. Clin Chem 2023; 69:1212-1219. [PMID: 37795568 DOI: 10.1093/clinchem/hvad156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Raeshun T Glover
- Clinical Pathology Resident, Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - James Connelly
- Chief Executive Officer, My Green Lab, Spokane, WA, United States
| | - Alistair Gammie
- Independent Principal Consultant, QuidelOrtho, San Diego, CA, United States
| | - Jane Kilcoyne
- Research Chemist, Marine Institute, Rinville, Oranmore, Galway, Ireland
| | - Tomris Ozben
- President-Elect, International Federation of Clinical Chemistry and Laboratory Medicine, Milan, Italy
- Chair, EFLM Task Force-Green and Sustainable Laboratories, Milan, Italy
- Professor, Department of Medical Biochemistry, Medical Faculty, Akdeniz University, Antalya, Turkey
| | - Alicja Santos
- President and Chief Executive Officer, Polonium Foundation, Warsaw, Poland
| | - Joesph R Wiencek
- Associate Professor, Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN, United States
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7
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Hart S, Wiencek JR. Global Heatwaves Threaten Integrity of Patient Test Results: A Dire Warning for the Lab Medicine Community. J Appl Lab Med 2023; 8:1002-1005. [PMID: 37310070 DOI: 10.1093/jalm/jfad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/19/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Stephanie Hart
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Joesph R Wiencek
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, United States
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8
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Glover RT, Booth GS, Wiencek JR. Opportunities for recycling in an automated clinical chemistry laboratory produced by the comprehensive metabolic panel. Am J Clin Pathol 2023; 160:119-123. [PMID: 37029539 DOI: 10.1093/ajcp/aqad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/27/2023] [Indexed: 04/09/2023] Open
Abstract
OBJECTIVES Clinical laboratories perform a variety of tests for which biomedical waste is a byproduct. Of these, the complete metabolic panel (CMP) produces a significant portion of this waste. We investigated specific waste subsequent to performing CMPs over the course of a year and analyzed what percentage of the waste produced could have been recycled. METHODS Patient testing volumes were collected retrospectively from July 14, 2021, to July 14, 2022, for individual assays within the CMP performed on Abbott Alinity c instruments (n = 6). The average weights for components of the reagent kits, which includes wedges, boxes, and package inserts, were calculated. These weights, in conjunction with total patient testing volumes, were used to determine the amount of waste produced. RESULTS A total of 1089.2 kg of reagent kit waste was estimated to be produced by performing CMPs throughout a year. Of this waste, most (855.5 kg) was not recyclable, but a subset (233.6 kg) was. Overall, 21.4% of the total specific waste weight was found to be recyclable. CONCLUSIONS The CMP contributes a substantial amount of waste when performed on chemistry analyzer platforms in the clinical laboratory. Paper inserts and cardboard packaging, however, presented opportunities for recycling.
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Affiliation(s)
- Raeshun T Glover
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, US
| | - Garrett S Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, US
| | - Joesph R Wiencek
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, US
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9
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Hart SA, Wiencek JR. The Ethical Dilemma of a Patient's Immediate Access to Test Results. Clin Chem 2023; 69:773-774. [PMID: 37403308 DOI: 10.1093/clinchem/hvad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 07/06/2023]
Affiliation(s)
- Stephanie A Hart
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Joesph R Wiencek
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, United States
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10
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Wiencek JR. Genomic Newborn Screening: Baby Steps into the Future. Clin Chem 2023; 69:542-543. [PMID: 37115576 DOI: 10.1093/clinchem/hvad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/06/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Joesph R Wiencek
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, 1301 Medical Center Dr., Nashville, TN 37232-5310, United States
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11
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Wiencek JR, Das S, Beheshti A, Crucian BE, Karouia F, Trudel G, McMonigal KA. Lab Medicine in Space. Clin Chem 2023; 69:442-449. [PMID: 37038963 DOI: 10.1093/clinchem/hvad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/13/2023] [Indexed: 04/12/2023]
Affiliation(s)
- Joesph R Wiencek
- Assistant Professor, Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Saswati Das
- Assistant Professor, Department of Biochemistry, Atal Bihari Vajpayee Institute of Medical Sciences & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Afshin Beheshti
- Bioinformatician and Principal Investigator, KBR, Space Biosciences Division, NASA Ames Research Center, Moffett Field, CA, United States
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, United States
- COVID-19 International Research Team, Medford, MA, United States
| | - Brian E Crucian
- Lead Scientist, Biomedical Research and Environmental Sciences Division, National Aeronautics and Space Administration, Lyndon B. Johnson Space Center, Houston, TX, United States
| | - Fathi Karouia
- Scientist and Principal Investigator, Blue Marble Space Institute of Science, Exobiology Branch, NASA Ames Research Center, Moffett Field, CA, United States
- Space Research Within Reach, San Francisco, CA, United States
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Guy Trudel
- Professor, Bone and Joint Research Laboratory, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathleen A McMonigal
- Director of Clinical Laboratories, Space Medicine Division, National Aeronautics and Space Administration, Lyndon B. Johnson Space Center, Houston, TX, United States
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12
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Tolan NV, Krasowski MD, Mathias PC, Wiencek JR, Babic N, Chai PR, Chambliss AB, Choucair I, Demetriou CA, Erickson TB, Feldhammer M, French D, Hayes BD, Kang P, El-Khoury JM, Knezevic CE, Monte A, Nerenz RD, Okorodudu AO, Roper SM, Saitman A, Thiriveedhi V, Uljon SN, Vest A, Woodworth A, Yu M, Melanson SEF. Cannabis positivity rates in 17 emergency departments across the United States with varying degrees of marijuana legalization. Clin Toxicol (Phila) 2023; 61:248-259. [PMID: 37129223 PMCID: PMC10793079 DOI: 10.1080/15563650.2023.2177552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/10/2023] [Accepted: 02/02/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Many states in the United States have progressed towards legalization of marijuana including decriminalization, medicinal and/or recreational use. We studied the impact of legalization on cannabis-related emergency department visits in states with varying degrees of legalization. METHODS Seventeen healthcare institutions in fifteen states (California, Colorado, Connecticut, Florida, Iowa, Kentucky, Maryland, Massachusetts, Missouri, New Hampshire, Oregon, South Carolina, Tennessee, Texas, Washington) participated. Cannabinoid immunoassay results and cannabis-related International Classification of Diseases (ninth and tenth versions) codes were obtained for emergency department visits over a 3- to 8-year period during various stages of legalization: no state laws, decriminalized, medical approval before dispensaries, medical dispensaries available, recreational approval before dispensaries and recreational dispensaries available. Trends and monthly rates of cannabinoid immunoassay and cannabis-related International Classification of Diseases code positivity were determined during these legalization periods. RESULTS For most states, there was a significant increase in both cannabinoid immunoassay and International Classification of Diseases code positivity as legalization progressed; however, positivity rates differed. The availability of dispensaries may impact positivity in states with medical and/or recreational approval. In most states with no laws, there was a significant but smaller increase in cannabinoid immunoassay positivity rates. CONCLUSIONS States may experience an increase in cannabis-related emergency department visits with progression toward marijuana legalization. The differences between states, including those in which no impact was seen, are likely multifactorial and include cultural norms, attitudes of local law enforcement, differing patient populations, legalization in surrounding states, availability of dispensaries, various ordering protocols in the emergency department, and the prevalence of non-regulated cannabis products.
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Affiliation(s)
- Nicole V. Tolan
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Matthew D. Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Patrick C. Mathias
- Department of Laboratory Medicine and Pathology, Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, WA, USA
| | - Joesph R. Wiencek
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Nikolina Babic
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Peter R. Chai
- Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women’s Hospital, Boston, MA, USA
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- The Fenway Institute, Boston, MA, USA
| | - Allison B. Chambliss
- Department of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Ibrahim Choucair
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Christiana A. Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus, USA
| | - Timothy B. Erickson
- Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Humanitarian Initiative, Cambridge, MA, USA
| | - Matthew Feldhammer
- Department of Pathology and Laboratory Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Deborah French
- Department of Laboratory Medicine, University of San Francisco, San Francisco, CA, USA
| | - Bryan D. Hayes
- Harvard Medical School, Boston, MA, USA
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Phillip Kang
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Joe M. El-Khoury
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Andrew Monte
- University of Colorado Anschutz, Aurora, CO, USA
| | - Robert D. Nerenz
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Stephen M. Roper
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Alec Saitman
- Providence Regional Laboratories, Portland, OR, USA
| | - Vamsi Thiriveedhi
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Sacha N. Uljon
- Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Alexis Vest
- University of Colorado Anschutz, Aurora, CO, USA
| | - Alison Woodworth
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY, USA
| | - Min Yu
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY, USA
| | - Stacy E. F. Melanson
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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13
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Wiencek JR, Pierre CC, Füzéry AK. Environmental factors in the preanalytical phase of laboratory testing. Clin Biochem 2023; 115:1-2. [PMID: 36898622 DOI: 10.1016/j.clinbiochem.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Affiliation(s)
- Joesph R Wiencek
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
| | - Christina C Pierre
- Department of Pathology and Laboratory Medicine, Penn Medicine Lancaster General Hospital, Lancaster, PA 17604-3555, USA
| | - Anna K Füzéry
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada; Alberta Precision Laboratories, Edmonton, Alberta, Canada
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14
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Pierre CC, Wiencek JR. The impact of environmental factors on external and internal specimen transport. Clin Biochem 2022; 115:13-21. [PMID: 36379239 DOI: 10.1016/j.clinbiochem.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/25/2022] [Accepted: 11/10/2022] [Indexed: 11/15/2022]
Abstract
The environment that a clinical specimen is exposed to is an important preanalytical factor in laboratory testing. There are numerous environmental conditions that a specimen may experience before it arrives at the clinical laboratory for analysis. Specimens collected at offsite locations are typically stored at the site and transported to the clinical laboratory via courier. Depending on the geographic location, season, method of storage and method of transport, the specimen can experience varying climate conditions that can lead to inaccurate test results. Specimens collected within the healthcare institution are not exempt from suboptimal storage and transport environments. For example, specimens transported via pneumatic tube systems can experience extreme agitation and rapid accelerations and decelerations. Suboptimal storage and transport temperatures occur less frequently within health systems due to multiple regulatory requirements for temperature monitoring; however, temperature monitoring may not occur at every stage of the preanalytical phase. This review will highlight both internal and external environmental conditions that can cause preanalytical errors in clinical laboratory testing. Strategies to mitigate environmentally-induced preanalytical errors and regulatory gaps for environmental monitoring in the preanalytical phase will also be discussed.
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Affiliation(s)
- Christina C Pierre
- Department of Pathology and Laboratory Medicine, Penn Medicine Lancaster General Hospital, Lancaster, PA 17604-3555, United States
| | - Joesph R Wiencek
- Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, 1301 Medical Center Drive, Nashville, TN 37232-5310, United States.
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15
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Nedelcu E, Wiencek JR, Pierre CC. A Pediatric Patient with a Complicated History of Sickle Cell Trait. Clin Chem 2022; 68:1245-1248. [PMID: 36201643 DOI: 10.1093/clinchem/hvac139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Elena Nedelcu
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA.,Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joesph R Wiencek
- Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christina C Pierre
- Department of Pathology and Laboratory Medicine, Penn Medicine Lancaster General Hospital, Lancaster, PA, USA
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16
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Hart S, Wiencek JR. Temperature Optimization Within 2 Uniquely Designed Courier Lockboxes During Extreme Summer Temperatures. Am J Clin Pathol 2022; 157:805-808. [PMID: 35038739 DOI: 10.1093/ajcp/aqab216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/30/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine optimal temperature profiles for 2 uniquely designed courier lockboxes (steel vs polymer) by standardizing daily ice (-20ºC) and cold (4-8ºC) pack placement. METHODS Paired courier lockboxes were placed outside in direct sunlight. Ambient outdoor and lockbox temperatures were monitored during 2 4-day cycles, and temperature mean and range were determined daily (time frame, 4:00-10:00 pm). Control lockboxes without packs were compared with experimental paired lockboxes with either 2 cold packs placed at 4:00 pm or 4 ice packs placed at 8:00 am and replaced with 4 cold packs at 4:00 pm daily. RESULTS Cycle 1 mean temperatures within control steel and polymer lockboxes were 31.8ºC (range, 18.4-44.1ºC) and 37.2ºC (range, 27.1-46.7ºC), respectively. The addition of 2 cold packs at 4:00 pm reduced mean temperatures to 29.1ºC (range, 19.1-37.2ºC) and 25.3ºC (range, 20.0-31.6ºC) in steel and polymer boxes, respectively. Cycle 2 mean temperatures within control steel and polymer lockboxes were 28.3ºC (range, 22.4-40.8ºC) and 31.6ºC (range, 23.8-41.0ºC), respectively. The addition of 4 ice packs at 8:00 am and replacement with 4 cold packs at 4:00 pm reduced mean temperatures to 24.3ºC (range, 17.4-27.9ºC) and 13.4ºC (range, 6.6-18.1ºC) in steel and polymer boxes, respectively. CONCLUSIONS Standardizing instructions for ice and cold packs can decrease internal courier lockbox temperatures.
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Affiliation(s)
- Stephanie Hart
- Vanderbilt University School of Medicine , Nashville, TN , USA
| | - Joesph R Wiencek
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine , Nashville, TN , USA
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Ford V, Frischtak H, Wiencek JR, Parsons AS. A High-Value Care Curriculum Using Individual and Group Structured Reflection. South Med J 2021; 114:797-800. [PMID: 34853857 DOI: 10.14423/smj.0000000000001325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE One-third of all healthcare dollars are wasted, primarily in the form of clinician-ordered unnecessary diagnostic tests and treatments. Medical education has likely played a central role in the creation and perpetuation of this problem. We aimed to create a curriculum for medical students to promote their contribution to high-value care conversations in the clinical environment. METHODS At a large university medical center between March 2017 and February 2018, we implemented a 3-phase curriculum combining multimodal educational initiatives with individual and group reflection for third-year medical students during their 12-week long Internal Medicine clerkship rotation. Students were asked to identify examples of clinical decision making that lacked attention to high-value care, propose solutions to the identified situation, and pinpoint barriers to the implementation of effective solutions using a structured reflection framework and then participate in a debrief debate with fellow students. To assess the curriculum, reflective narratives were coded by frequency and codes were compared with one another and with relevant high-value care literature to identify patterns and themes. RESULTS In total, 151 medical students participated in phase 1 and 119 in phase 3. For phase 2, 126 reflective narratives (94.7% participation rate) comprised 226 problems, 280 solutions, and 179 barriers. CONCLUSIONS When provided appropriate resources, medical students are able to identify relevant examples of low-value care, downstream solutions, and barriers to implementation through a structured reflection curriculum comprising written narratives and in-person debate.
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Affiliation(s)
- Vanessa Ford
- From the Department of Pediatrics, Emory University, Atlanta, Georgia, the Department of Family Medicine, Contra Costa Regional Medical Center, Martinez, California, the Department of Pathology, Vanderbilt University, Nashville, Tennessee, and the Department of Medicine, University of Virginia, Charlottesville
| | - Helena Frischtak
- From the Department of Pediatrics, Emory University, Atlanta, Georgia, the Department of Family Medicine, Contra Costa Regional Medical Center, Martinez, California, the Department of Pathology, Vanderbilt University, Nashville, Tennessee, and the Department of Medicine, University of Virginia, Charlottesville
| | - Joesph R Wiencek
- From the Department of Pediatrics, Emory University, Atlanta, Georgia, the Department of Family Medicine, Contra Costa Regional Medical Center, Martinez, California, the Department of Pathology, Vanderbilt University, Nashville, Tennessee, and the Department of Medicine, University of Virginia, Charlottesville
| | - Andrew S Parsons
- From the Department of Pediatrics, Emory University, Atlanta, Georgia, the Department of Family Medicine, Contra Costa Regional Medical Center, Martinez, California, the Department of Pathology, Vanderbilt University, Nashville, Tennessee, and the Department of Medicine, University of Virginia, Charlottesville
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Hart SA, Wiencek JR. Standardizing Instructions for Ice and Cold Pack Use Can Mitigate Summer Temperatures on Two Commercially Available Outdoor Courier Lockboxes. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
Clinical and Laboratory Standards Institute document GP44 recommends samples avoid temperatures >22°C during sample transport and storage. Outdoor courier lockboxes used in external sample transport can experience extreme temperatures (>40°C) in the summer. Ice (frozen at -20°C) and cold (refrigerated at 4-8°C) packs can be used to reduce internal lockbox temperatures during hot summer days. Unfortunately, there are no universally accepted instructions to maintain internal lockbox temperatures during these conditions. Therefore, our goal was to elucidate the impact of placing ice and cold packs at two specific time points to mitigate external summer temperatures in two commercially available outdoor courier lockboxes used at our institution.
Methods/Case Report
Two pairs of uniquely manufactured courier lockboxes (steel vs. urethane polymer) were placed outside in direct sunlight in Nashville, Tennessee during the second week of June 2021. Ambient outdoor and lockbox temperatures were monitored using data loggers during a four-day cycle. Each type of lockbox design had a control with no ice or cold packs. These controls were then compared to each experimental, paired lockbox with four ice packs placed at 8am and replaced with four cold packs at 4pm.
Results (if a Case Study enter NA)
The mean ambient outdoor temperature over these four days was 27.7°C (range: 22.2-39.8°C). Temperatures within the steel and urethane polymer lockboxes without ice or cold packs was 28.3°C (range: 22.4-40.8°C) and 31.6°C (range: 23.8-41.0°C), respectively. The addition of four ice packs at 8am and replaced with four cold packs at 4pm reduced temperatures in the steel box to 24.3°C (range: 17.4-27.9°C) whereas in the urethane polymer box temperatures were reduced to 13.4°C (range: 6.6-18.1°C).
Conclusion
Temperatures inside outdoor lockboxes can increase in summer commonly above the outdoor ambient temperature. Standardizing instructions for ice and cold packs can reduce internal outdoor courier lockbox temperatures during summer months, especially in urethane polymer lockboxes.
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Affiliation(s)
- S A Hart
- Vanderbilt University School of Medicine, Nashville, Tennessee, UNITED STATES
| | - J R Wiencek
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee, UNITED STATES
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Abstract
OBJECTIVES To determine the impact of short-term (<4-hour) exposure of summer-like temperatures on lithium heparin (uncentrifuged and centrifuged) samples stored in outdoor courier lockboxes in the Mid-Atlantic United States. METHODS Healthy adults (n = 8) were recruited to investigate the impact of the short-term exposure of lithium heparin samples (centrifuged and uncentrifuged) inside 2 LabLocker-KF300 courier lockboxes placed outside in direct sunlight during summer. Each courier lockbox was monitored every 5 minutes with a temperature data logger and contained either the standard number (n = 2) of cold packs (cold) or no standard cold packs (warm). Acceptable tolerance limits were defined for each analyte by significant change limit (SCL) analysis (P < .05), as previously described. RESULTS Significant changes were identified in each study condition for warm and cold lockbox conditions. Aspartate aminotransferase, glucose, lactate dehydrogenase, and potassium commonly crossed SCLs from mean baseline (t0) in the majority of conditions. CONCLUSIONS Outdoor courier lockboxes are an underrecognized source of preanalytical error.
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Affiliation(s)
- Megan E Dibbern
- Department of Pathology, University of Virginia School of Medicine, Charlottesville VA, USA
| | - Christina C Pierre
- Department of Pathology and Laboratory Medicine, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Joesph R Wiencek
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA
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Pierre CC, Wiencek JR. Lactate Dehydrogenase Variation in a Patient with History of Giant Cell Tumor. J Appl Lab Med 2021; 6:1355-1359. [PMID: 33421063 DOI: 10.1093/jalm/jfaa224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 10/28/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Christina C Pierre
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA
| | - Joesph R Wiencek
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA
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21
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Wiencek JR, Bachmann LM, Dinwiddie K, Miller GW, Bazydlo LAL. Cross-Institutional Evaluation of the Abbott ARCHITECT SARS-CoV-2 IgG Immunoassay. Lab Med 2021; 52:e137-e146. [PMID: 33929022 PMCID: PMC8135851 DOI: 10.1093/labmed/lmab011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To describe a cross-institutional approach to verify the Abbott ARCHITECT SARS-CoV-2 antibody assay and to document the kinetics of the serological response. METHODS We conducted analytical performance evaluation studies using the Abbott ARCHITECT SARS-CoV-2 antibody assay on 5 Abbott ARCHITECT i2000 automated analyzers at 2 academic medical centers. RESULTS Within-run and between-run coefficients of variance (CVs) for the antibody assay did not exceed 5.6% and 8.6%, respectively, for each institution. Quantitative and qualitative results agreed for lithium heparin plasma, EDTA-plasma and serum specimen types. Results for all SARS-CoV-2 IgG-positive and -negative specimens were concordant among analyzers except for 1 specimen at 1 institution. Qualitative and quantitative agreement was observed for specimens exchanged between institutions. All patients had detectable antibodies by day 10 from symptom onset and maintained seropositivity throughout specimen procurement. CONCLUSIONS The analytical performance characteristics of the Abbott ARCHITECT SARS-CoV-2 antibody assay within and between 2 academic medical center clinical laboratories were acceptable for widespread clinical-laboratory use.
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Affiliation(s)
- Joesph R Wiencek
- Department of Pathology, University of Virginia (UVA) School of Medicine, Charlottesville, Virginia
| | - Lorin M Bachmann
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Kelly Dinwiddie
- Medical Laboratories, University of Virginia Health System, Charlottesville, Virginia
| | - Greg W Miller
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia
| | - Lindsay A L Bazydlo
- Department of Pathology, University of Virginia (UVA) School of Medicine, Charlottesville, Virginia
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22
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Ju JY, Wiencek JR. A Deep C Dive. Clin Chem 2021; 66:860-861. [PMID: 32470123 DOI: 10.1093/clinchem/hvaa034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/06/2019] [Indexed: 11/14/2022]
Affiliation(s)
- Jennifer Y Ju
- Department of Pathology, University of Virginia, Charlottesville, VA
| | - Joesph R Wiencek
- Department of Pathology, University of Virginia, Charlottesville, VA
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23
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Keshavarz B, Wiencek JR, Workman LJ, Straesser MD, Muehling LM, Canderan G, Drago F, Bonham CA, Sturek JM, Ramani C, McNamara CA, Woodfolk JA, Kadl A, Platts-Mills TA, Wilson JM. Quantitative Measurement of IgG to Severe Acute Respiratory Syndrome Coronavirus-2 Proteins Using ImmunoCAP. Int Arch Allergy Immunol 2021; 182:417-424. [PMID: 33621972 PMCID: PMC8018212 DOI: 10.1159/000514203] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/03/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Detailed understanding of the immune response to severe acute respiratory syndrome coronavirus (SARS-CoV)-2, the cause of coronavirus disease 2019 (CO-VID-19) has been hampered by a lack of quantitative antibody assays. OBJECTIVE The objective was to develop a quantitative assay for IgG to SARS-CoV-2 proteins that could be implemented in clinical and research laboratories. METHODS The biotin-streptavidin technique was used to conjugate SARS-CoV-2 spike receptor-binding domain (RBD) or nucleocapsid protein to the solid phase of the ImmunoCAP. Plasma and serum samples from patients hospitalized with COVID-19 (n = 60) and samples from donors banked before the emergence of COVID-19 (n = 109) were used in the assay. SARS-CoV-2 IgG levels were followed longitudinally in a subset of samples and were related to total IgG and IgG to reference antigens using an ImmunoCAP 250 platform. RESULTS At a cutoff of 2.5 μg/mL, the assay demonstrated sensitivity and specificity exceeding 95% for IgG to both SARS-CoV-2 proteins. Among 36 patients evaluated in a post-hospital follow-up clinic, median levels of IgG to spike-RBD and nucleocapsid were 34.7 μg/mL (IQR 18-52) and 24.5 μg/mL (IQR 9-59), respectively. Among 17 patients with longitudinal samples, there was a wide variation in the magnitude of IgG responses, but generally the response to spike-RBD and to nucleocapsid occurred in parallel, with peak levels approaching 100 μg/mL, or 1% of total IgG. CONCLUSIONS We have described a quantitative assay to measure IgG to SARS-CoV-2 that could be used in clinical and research laboratories and implemented at scale. The assay can easily be adapted to measure IgG to mutated COVID-19 proteins, has good performance characteristics, and has a readout in standardized units.
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Affiliation(s)
- Behnam Keshavarz
- Division of Allergy & Clinical Immunology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Joesph R. Wiencek
- Department of Pathology, University of Virginia, Charlottesville, Virginia, USA
| | - Lisa J. Workman
- Division of Allergy & Clinical Immunology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Matthew D. Straesser
- Division of Allergy & Clinical Immunology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Lyndsey M. Muehling
- Division of Allergy & Clinical Immunology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Glenda Canderan
- Division of Allergy & Clinical Immunology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Fabrizio Drago
- Division of Cardiovascular Medicine and the Robert M. Berne Cardiovascular Center, University of Virginia, Charlottesville, Virginia, USA
| | - Catherine A. Bonham
- Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jeffrey M. Sturek
- Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Chintan Ramani
- Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Coleen A. McNamara
- Division of Cardiovascular Medicine and the Robert M. Berne Cardiovascular Center, University of Virginia, Charlottesville, Virginia, USA
| | - Judith A. Woodfolk
- Division of Allergy & Clinical Immunology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Alexandra Kadl
- Division of Pulmonary and Critical Care, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
- Department of Pharmacology, University of Virginia, Charlottesville, Virginia, USA
| | - Thomas A.E. Platts-Mills
- Division of Allergy & Clinical Immunology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jeffrey M. Wilson
- Division of Allergy & Clinical Immunology, Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
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Keshavarz B, Wiencek JR, Workman LJ, Straesser MD, Muehling LM, Canderan G, Drago F, Bonham CA, Sturek JM, Ramani C, McNamara CA, Woodfolk JA, Kadl A, Platts-Mills TAE, Wilson JM. Quantitative measurement of IgG to SARS-CoV-2 proteins using ImmunoCAP. medRxiv 2020. [PMID: 33200147 DOI: 10.1101/2020.11.09.20228411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Detailed understanding of the immune response to SARS-CoV-2, the cause of coronavirus disease 2019 (COVID-19), has been hampered by a lack of quantitative antibody assays. Objective To develop a quantitative assay for IgG to SARS-CoV-2 proteins that could readily be implemented in clinical and research laboratories. Methods The biotin-streptavidin technique was used to conjugate SARS-CoV-2 spike receptor-binding-domain (RBD) or nucleocapsid protein to the solid-phase of the ImmunoCAP resin. Plasma and serum samples from patients with COVID-19 (n=51) and samples from donors banked prior to the emergence of COVID-19 (n=109) were used in the assay. SARS-CoV-2 IgG levels were followed longitudinally in a subset of samples and were related to total IgG and IgG to reference antigens using an ImmunoCAP 250 platform. Results Performance characteristics demonstrated 100% sensitivity and 99% specificity at a cut-off level of 2.5 µg/mL for both SARS-CoV-2 proteins. Among 36 patients evaluated in a post-hospital follow-up clinic, median levels of IgG to spike-RBD and nucleocapsid were 34.7 µg/mL (IQR 18-52) and 24.5 µg/mL (IQR 9-59), respectively. Among 17 patients with longitudinal samples there was a wide variation in the magnitude of IgG responses, but generally the response to spike-RBD and to nucleocapsid occurred in parallel, with peak levels approaching 100 µg/mL, or 1% of total IgG. Conclusions We have described a quantitative assay to measure IgG to SARS-CoV-2 that could be used in clinical and research laboratories and implemented at scale. The assay can easily be adapted to measure IgG to novel antigens, has good performance characteristics and a read-out in standardized units.
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25
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Wiencek JR, Head CL, Sifri CD, Parsons AS. Clinical Ordering Practices of the SARS-CoV-2 Antibody Test at a Large Academic Medical Center. Open Forum Infect Dis 2020; 7:ofaa406. [PMID: 33072813 PMCID: PMC7553244 DOI: 10.1093/ofid/ofaa406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/28/2020] [Indexed: 11/12/2022] Open
Abstract
Background The novel severe acute respiratory coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) originated in December 2019 and has now infected almost 5 million people in the United States. In the spring of 2020, private laboratories and some hospitals began antibody testing despite limited evidence-based guidance. Methods We conducted a retrospective chart review of patients who received SARS-CoV-2 antibody testing from May 14, 2020, to June 15, 2020, at a large academic medical center, 1 of the first in the United States to provide antibody testing capability to individual clinicians in order to identify clinician-described indications for antibody testing compared with current expert-based guidance from the Infectious Diseases Society of America (IDSA) and the Centers for Disease Control and Prevention (CDC). Results Of 444 individual antibody test results, the 2 most commonly described testing indications, apart from public health epidemiology studies (n = 223), were for patients with a now resolved COVID-19-compatible illness (n = 105) with no previous molecular testing and for asymptomatic patients believed to have had a past exposure to a person with COVID-19-compatible illness (n = 60). The rate of positive SARS-CoV-2 antibody testing among those indications consistent with current IDSA and CDC guidance was 17% compared with 5% (P < .0001) among those indications inconsistent with such guidance. Testing inconsistent with current expert-based guidance accounted for almost half of testing costs. Conclusions Our findings demonstrate a dissociation between clinician-described indications for testing and expert-based guidance and a significantly different rate of positive testing between these 2 groups. Clinical curiosity and patient preference appear to have played a significant role in testing decisions and substantially contributed to testing costs.
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Affiliation(s)
- Joesph R Wiencek
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, Virginia, USA.,Laboratory Stewardship Committee, University of Virginia Health, Charlottesville, Virginia, USA
| | - Carter L Head
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Costi D Sifri
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA.,Office of Hospital Epidemiology, University of Virginia Health, Charlottesville, Virginia, USA
| | - Andrew S Parsons
- Department of Medicine, Section Hospital Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Yang J, Wiencek JR. Biotin sulfoxide is an interferent in several Roche cobas e411 immunoassays. Clin Chim Acta 2020; 510:12-14. [PMID: 32628921 DOI: 10.1016/j.cca.2020.06.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Jianbo Yang
- Medical Laboratories, University of Virginia Health, Charlottesville, VA, United States
| | - Joesph R Wiencek
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, United States.
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Yang J, Wiencek JR. Mitigating biotin interference in two Roche immunoassays by premixing biotinylated capturing molecules with streptavidin coated beads. Clin Chim Acta 2020; 505:130-135. [PMID: 32084383 DOI: 10.1016/j.cca.2020.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/31/2020] [Accepted: 02/17/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Biotin is an interference in many streptavidin-biotin based immunoassays, causing falsely decreased results with sandwich immunoassays and falsely increased results with competitive immunoassays. It has been discussed that premixing streptavidin coated beads and biotinylated capturing molecules may prevent biotin interference. This study was designed to test whether such modification could mitigate biotin interference in two originally susceptible sandwich immunoassays. METHODS Roche C-peptide and human growth hormone (hGH) immunoassays utilize three reagent containers for streptavidin coated beads (M), biotinylated capturing antibody (R1) and ruthenylated antibody (R2). The reagents were modified by premixing reagent M and R1. Following incubation, the beads were placed back in the M-container and R1-supernatant back to R1-container. Patient specimens were selected, spiked with biotin to 1055 ng/mL, and measured by both the original, unmodified reagent and modified reagent on Roche cobas e411 analyzer. The biotin interference dose response curves were also compared using pooled patient specimen spiked with different concentrations of biotin. RESULTS For the original reagent, 1055 ng/mL of biotin decreased C- peptide results by 88% and hGH results by 97%. After reagent modification, this interference effect was nearly eliminated for C- peptide but remained about 20% decreased for hGH. CONCLUSION Premixing streptavidin beads and biotinylated capturing molecules is an effective approach to mitigate biotin interference for certain immunoassays.
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Affiliation(s)
- Jianbo Yang
- Medical Laboratories, University of Virginia Health, Charlottesville, VA, United States
| | - Joesph R Wiencek
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, United States.
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Wiencek JR, Gehrie EA, Keiser AM, Szklarski PC, Johnson-Davis KL, Booth GS. Detection of Nicotine and Nicotine Metabolites in Units of Banked Blood. Am J Clin Pathol 2019; 151:516-521. [PMID: 30715103 DOI: 10.1093/ajcp/aqy176] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To determine the concentrations of nicotine and nicotine metabolites in RBC units as a means to estimate the point prevalence of exposure within the healthy donor pool. METHODS Segments from 105 RBC units were tested for the presence of nicotine, cotinine, or trans-3'-hydroxycotinine by liquid chromatography-tandem mass spectrometry. RESULTS Of the 20 (19%) units that contained detectable concentrations of nicotine, cotinine, or trans-3'-hydroxycotinine, 19 (18.1%) contained concentrations consistent with the use of a nicotine-containing product within 48 hours of specimen collection. One RBC unit contained nicotine concentrations consistent with passive exposure. CONCLUSIONS Chemicals from nicotine-containing products are detectable within the US RBC supply. Further investigation is needed to determine the risks of transfusion-associated exposure to nicotine and other tobacco-associated chemicals among vulnerable patient populations such as neonates.
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Affiliation(s)
- Joesph R Wiencek
- Department of Pathology, University of Virginia School of Medicine, Charlottesville
| | - Eric A Gehrie
- Department of Pathology, Division of Transfusion Medicine, Johns Hopkins University, Baltimore, MD
| | - Amaris M Keiser
- Department of Pediatrics, Division of Neonatology, Johns Hopkins University, Baltimore, MD
| | - Penny C Szklarski
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Kamisha L Johnson-Davis
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT
- Department of Pathology, University of Utah Health Sciences Center, Salt Lake City
| | - Garrett S Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
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Wiencek JR, McCartney CR, Chang AY, Straseski JA, Auchus RJ, Woodworth A. Challenges in the Assessment and Diagnosis of Polycystic Ovary Syndrome. Clin Chem 2019; 65:370-377. [DOI: 10.1373/clinchem.2017.284331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/05/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Joesph R Wiencek
- Assistant Professor, Department of Pathology, Division of Laboratory Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - Christopher R McCartney
- Associate Professor, Department of Medicine, Division of Endocrinology and Metabolism, University of Virginia School of Medicine, Charlottesville, VA
| | - Alice Y Chang
- Assistant Professor, Department of Medicine, Division of Endocrinology, Metabolism, Diabetes and Nutrition, Mayo Clinic, Rochester, MN
| | - Joely A Straseski
- Associate Professor, Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT
| | - Richard J Auchus
- The James A. Shayman and Andrea S. Kevrick Professor of Translational Medicine, Departments of Internal Medicine and Pharmacology, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI
| | - Alison Woodworth
- Associate Professor, Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, KY
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Wiencek JR, Dietzen DJ, Murray T, Dawling S, Colby JM, Nichols JH. Persistently Increased Alloisoleucine in a Patient with Seizures. Clin Chem 2018; 64:1433-1437. [PMID: 30266717 DOI: 10.1373/clinchem.2017.278804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 01/04/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Joesph R Wiencek
- Division of Laboratory Medicine, Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA; .,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Dennis J Dietzen
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis.,Core Laboratory, St. Louis Children's Hospital, St. Louis, MO
| | - Teresa Murray
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | | | - Jennifer M Colby
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - James H Nichols
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
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Wiencek JR, Lo SF. Advances in the Diagnosis and Management of Cystic Fibrosis in the Genomic Era. Clin Chem 2018; 64:898-908. [DOI: 10.1373/clinchem.2017.274670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/17/2018] [Indexed: 01/08/2023]
Abstract
Abstract
BACKGROUND
Cystic fibrosis (CF) is a complex autosomal recessive disease that continues to present unique diagnostic challenges. Because CF was first described in 1938, there has been a substantial growth of genetic and phenotypic information about the disorder. During the past few years, as more evidence has become available, a consortium of international experts determined that the 2008 guidelines from the CF Foundation needed to be reviewed and updated.
CONTENT
The goal of this review is to highlight the latest advances in CF multidisciplinary care, together with the recent updates to the 2017 CF Foundation diagnostic guidelines.
SUMMARY
Data from newborn screening programs, patient registries, clinical databases, and functional research have led to a better understanding of the CF transmembrane conductance regulator (CFTR) gene. Recent consensus guidelines have provided recommendations for clinicians and laboratorians to better assist with interpretation of disease status and related CF mutations. The highly recommended Clinical and Functional Translation of CFTR project should be the first resource in the evaluation of disease severity for CF mutations. Screen-positive newborns and patients with high clinical suspicion for CF are always recommended to undergo confirmatory sweat chloride testing with interpretations based on updated reference intervals. Every patient diagnosed with CF should receive genotyping, as novel molecular therapies are becoming standard of practice. The future of CF management must consider healthcare system disparities as CF transitions from a historically childhood disease to a predominantly adult epidemic.
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Affiliation(s)
- Joesph R Wiencek
- Division of Laboratory Medicine, Department of Pathology, University of Virginia School of Medicine and Health System, Charlottesville, VA
| | - Stanley F Lo
- Department of Pathology, Medical College of Wisconsin and Department of Pathology and Laboratory Medicine, Children's Hospital of Wisconsin, Milwaukee, WI
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Campbell ST, Wiencek JR. DNA Sequencing in the Clinical Laboratory: A Ladder to the Future. Clin Chem 2018; 64:757. [PMID: 32100832 DOI: 10.1373/clinchem.2017.285221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 01/09/2018] [Indexed: 11/06/2022]
Affiliation(s)
| | - Joesph R Wiencek
- Division of Laboratory Medicine, Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA
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Wiencek JR, Nichols JH. Impact of Ambient Seasonal Temperature on Specimens Stored in Courier Lockboxes. ACTA ACUST UNITED AC 2018; 2:973-976. [DOI: 10.1373/jalm.2017.025247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/12/2017] [Indexed: 11/06/2022]
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Wiencek JR, Booth GS, Nichols JH. A Primed Hemoglobinopathy Screen. Clin Chem 2017; 63:1423-1424. [PMID: 28751324 DOI: 10.1373/clinchem.2016.270496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/24/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Joesph R Wiencek
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN; .,Current affiliation: Division of Laboratory Medicine, Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA
| | - Garrett S Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - James H Nichols
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
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Wiencek JR, Bowman C, Adams B, Sussman C, Sephel G, Linton MF, Nichols JH, Woodworth A. Falsely Decreased Carbon Dioxide in Patients with Hypertriglyceridemia. ACTA ACUST UNITED AC 2017; 2:123-125. [DOI: 10.1373/jalm.2017.023234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/13/2017] [Indexed: 11/06/2022]
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Affiliation(s)
- Joesph R Wiencek
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Garrett S Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
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Abstract
Laboratory testing for drugs of abuse has become standard practice in many settings both forensic and clinical. Urine is the predominant specimen, but other specimens are possible including hair, nails, sweat, and oral fluid. Point-of-care test kits provide for rapid analysis at the site where specimens are collected allowing for immediate action on the results. POCT is based on immunochromatography where the drug in the patient's sample competes with drug and antibody conjugates in the test to develop or block the development of a colored line. Most POCTs are visually interpreted in a few minutes. The potential for false positives is possible due to drug cross-reactivity with the antibodies in the test. False negatives are also possible due to dilution of the sample and the potential for adulteration or sample substitution by the patient. POCT shows more variability than central laboratory testing because of the variety of operators involved in the testing process, but POCT has good agreement for most tests with mass spectrometry provided comparable cutoffs and cross-reactivity of drugs/metabolites are considered. Validation of the test performance with the intended operators will identify potential interferences and operational issues before implementing the test in routine practice. POCT offers faster turnaround of test results provided the limitations and challenges of the test are considered.
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Affiliation(s)
- Joesph R Wiencek
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jennifer M Colby
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - James H Nichols
- Vanderbilt University Medical Center, Nashville, TN, United States.
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Wiencek JR, Hirbawi J, Yee VC, Kalafatis M. The Dual Regulatory Role of Amino Acids Leu480 and Gln481 of Prothrombin. J Biol Chem 2016; 291:1565-1581. [PMID: 26601957 DOI: 10.1074/jbc.m115.691956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Indexed: 11/06/2022] Open
Abstract
Prothrombin (FII) is activated to α-thrombin (IIa) by prothrombinase. Prothrombinase is composed of a catalytic subunit, factor Xa (fXa), and a regulatory subunit, factor Va (fVa), assembled on a membrane surface in the presence of divalent metal ions. We constructed, expressed, and purified several mutated recombinant FII (rFII) molecules within the previously determined fVa-dependent binding site for fXa (amino acid region 473-487 of FII). rFII molecules bearing overlapping deletions within this significant region first established the minimal stretch of amino acids required for the fVa-dependent recognition exosite for fXa in prothrombinase within the amino acid sequence Ser(478)-Val(479)-Leu(480)-Gln(481)-Val(482). Single, double, and triple point mutations within this stretch of rFII allowed for the identification of Leu(480) and Gln(481) as the two essential amino acids responsible for the enhanced activation of FII by prothrombinase. Unanticipated results demonstrated that although recombinant wild type α-thrombin and rIIa(S478A) were able to induce clotting and activate factor V and factor VIII with rates similar to the plasma-derived molecule, rIIa(SLQ→AAA) with mutations S478A/L480A/Q481A was deficient in clotting activity and unable to efficiently activate the pro-cofactors. This molecule was also impaired in protein C activation. Similar results were obtained with rIIa(ΔSLQ) (where rIIa(ΔSLQ) is recombinant human α-thrombin with amino acids Ser(478)/Leu(480)/Gln(481) deleted). These data provide new evidence demonstrating that amino acid sequence Leu(480)-Gln(481): 1) is crucial for proper recognition of the fVa-dependent site(s) for fXa within prothrombinase on FII, required for efficient initial cleavage of FII at Arg(320); and 2) is compulsory for appropriate tethering of fV, fVIII, and protein C required for their timely activation by IIa.
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Affiliation(s)
- Joesph R Wiencek
- From the Department of Chemistry and; Center for Gene Regulation in Health and Disease, Cleveland State University, Cleveland, Ohio 44115
| | - Jamila Hirbawi
- From the Department of Chemistry and; Center for Gene Regulation in Health and Disease, Cleveland State University, Cleveland, Ohio 44115
| | - Vivien C Yee
- the Department of Biochemistry, Case Western Reserve University, Cleveland, Ohio 44106, and
| | - Michael Kalafatis
- From the Department of Chemistry and; Center for Gene Regulation in Health and Disease, Cleveland State University, Cleveland, Ohio 44115,; the Department of Molecular Cardiology, Lerner Research Institute, and; Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio 44195.
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Abstract
Single chain factor V (fV) circulates as an Mr 330,000 quiescent pro-cofactor. Removal of the B domain and generation of factor Va (fVa) are vital for procoagulant activity. We investigated the role of the basic amino acid region 1000–1008 within the B domain of fV by constructing a recombinant mutant fV molecule with all activation cleavage sites (Arg709/Arg1018/Arg1545) mutated to glutamine (fVQ3), a mutant fV molecule with region 1000–1008 deleted (fVΔB9), and a mutant fV molecule containing the same deletion with activation cleavage sites changed to glutamine (fVΔB9/Q3). The recombinant molecules along with wild type fV (fVWT) were transiently expressed in COS-7L cells, purified, and assessed for their ability to bind factor Xa (fXa) prior to and following incubation with thrombin. The data showed that fVQ3 was severely impaired in its interaction with fXa before and after incubation with thrombin. In contrast, KD(app) values for fVΔB9 (0.9 nm), fVaΔB9 (0.4 nm), and fVΔB9/Q3 (0.7 nm) were similar to the affinity of fVaWT for fXa (0.3 nm). Two-stage clotting assays revealed that although fVQ3 was deficient in its clotting activity, fVΔB9/Q3 had clotting activity comparable with fVaWT. The kcat value of prothrombinase assembled with fVΔB9/Q3 was minimally affected, whereas the Km value of the reaction was increased 57-fold compared with the Km value obtained with prothrombinase assembled with fVaWT. These findings strongly suggest that amino acid region 1000–1008 of fV is a regulatory sequence protecting the organisms from spontaneous binding to fXa and unnecessary prothrombinase complex formation, which in turn results in catastrophic physiological consequences.
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Affiliation(s)
- Joesph R Wiencek
- From the Department of Chemistry, Cleveland State University, Cleveland, Ohio 44115
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