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Uljon S, Tolan NV, Mahowald GK, Khaliq T, Urwiller ED, Fernandes MD, Basu SS, Kang P, Erickson TB, Hayes BD, Chai PR, Melanson SEF. Performance of a Norfentanyl Immunoassay in Specimens with Low Concentrations of Fentanyl and/or Norfentanyl. J Appl Lab Med 2024:jfae036. [PMID: 38656327 DOI: 10.1093/jalm/jfae036] [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] [Received: 12/16/2023] [Accepted: 03/22/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Many fentanyl immunoassays are limited in their ability to detect norfentanyl. Urine specimens collected from individuals who have been exposed to fentanyl frequently have detectable concentrations of norfentanyl (≥2 ng/mL) but low concentrations of fentanyl (<2 ng/mL) by LC-MS/MS. The Lin-Zhi Fentanyl II Immunoassay (Lin-Zhi) claims 100% cross-reactivity with norfentanyl and therefore may detect exposure missed by other assays. METHODS In addition to verifying the manufacturer's analytical sensitivity claims, we selected 92 urine specimens with low-positive Lin-Zhi results (1-99 absorbance units, lowest 10%) for analysis by the Immunalysis Health Equity Impact Assessment and ARK II fentanyl methods. The accuracy of the 3 immunoassays was compared to LC-MS/MS as the reference method. RESULTS Spiking studies using purified fentanyl and norfentanyl and a set of 100 consecutive specimens confirmed the manufacturer's claims of limit of detection for fentanyl (3.8 ng/mL) and norfentanyl (5.0 ng/mL). However, the 92 low-positive patient specimens demonstrated concentrations of norfentanyl and fentanyl below 2.0 ng/mL by LC-MS/MS, with 47 (51%) having only norfentanyl detected. When comparing Lin-Zhi to the Immunalysis and ARK II immunoassays, only 27 (29%) of the 92 specimens were concordant. Fifty-two (57%) of the specimens were positive by LC-MS/MS and Lin-Zhi but false negative by one or both other immunoassays. Seven specimens (8%) were positive by Lin-Zhi but negative by the other immunoassays and had undetectable concentrations (<2 ng/mL) of fentanyl and norfentanyl by LC-MS/MS. CONCLUSIONS The clinical sensitivity of the Lin-Zhi exceeds the manufacturer's claims, providing results comparable to LC-MS/MS methods.
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Affiliation(s)
- Sacha Uljon
- Department of Pathology, Massachusetts General Hospital, Boston, MA, United States
- Department of Pathology, Harvard Medical School, Boston, MA, United States
| | - Nicole V Tolan
- Department of Pathology, Harvard Medical School, Boston, MA, United States
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, United States
| | - Grace K Mahowald
- Department of Pathology, Massachusetts General Hospital, Boston, MA, United States
- Department of Pathology, Harvard Medical School, Boston, MA, United States
| | - Tahira Khaliq
- Department of Pathology, Massachusetts General Hospital, Boston, MA, United States
| | - Elizabeth D Urwiller
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, United States
| | | | - Sankha S Basu
- Department of Pathology, Harvard Medical School, Boston, MA, United States
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, United States
| | - Phillip Kang
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, United States
| | - Timothy B Erickson
- Department of Pathology, Harvard Medical School, Boston, MA, United States
- Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women's Hospital, Boston, MA, United States
| | - Bryan D Hayes
- Department of Pathology, Harvard Medical School, Boston, MA, United States
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, United States
| | - Peter R Chai
- Department of Pathology, Harvard Medical School, Boston, MA, United States
- Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women's Hospital, Boston, MA, United States
| | - Stacy E F Melanson
- Department of Pathology, Harvard Medical School, Boston, MA, United States
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, United States
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Zhao MM, Tolan NV. Commentary on Illegal Drug Use or Not-The Role of the Laboratory in Helping to Interpret Drug Test Results. J Appl Lab Med 2024:jfae007. [PMID: 38527113 DOI: 10.1093/jalm/jfae007] [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: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 03/27/2024]
Affiliation(s)
- Melissa M Zhao
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, United States
| | - Nicole V Tolan
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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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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Tolan NV, DeSimone MS, Fernandes MD, Lewis JE, Simmons DP, Schur PH, Brigl M, Tanasijevic MJ, Desjardins M, Sherman AC, Baden LR, Snyder M, Melanson SE. Lessons learned: A look back at the performance of nine COVID-19 serologic assays and their proposed utility. Clin Biochem 2023; 117:60-68. [PMID: 36878344 PMCID: PMC9985916 DOI: 10.1016/j.clinbiochem.2023.03.003] [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: 10/11/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Serologic assays for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been proposed to assist with the acute diagnosis of infection, support epidemiological studies, identify convalescent plasma donors, and evaluate vaccine response. METHODS We report an evaluation of nine serologic assays: Abbott (AB) and Epitope (EP) IgG and IgM, EUROIMMUN (EU) IgG and IgA, Roche anti-N (RN TOT) and anti-S (RS TOT) total antibody, and DiaSorin (DS) IgG. We evaluated 291 negative controls (NEG CTRL), 91 PCR positive (PCR POS) patients (179 samples), 126 convalescent plasma donors (CPD), 27 healthy vaccinated donors (VD), and 20 allogeneic hematopoietic stem cell transplant (HSCT) recipients (45 samples). RESULTS We observed good agreement with the method performance claims for specificity (93-100%) in NEG CTRL but only 85% for EU IgA. The sensitivity claims in the first 2 weeks of symptom onset was lower (26-61%) than performance claims based on > 2 weeks since PCR positivity. We observed high sensitivities (94-100%) in CPD except for AB IgM (77%), EP IgM (0%). Significantly higher RS TOT was observed for Moderna vaccine recipients then Pfizer (p-values < 0.0001). A sustained RS TOT response was observed for the five months following vaccination. HSCT recipients demonstrated significantly lower RS TOT than healthy VD (p < 0.0001) at dose 2 and 4 weeks after. CONCLUSIONS Our data suggests against the use of anti-SARS-CoV-2 assays to aid in acute diagnosis. RN TOT and RS TOT can readily identify past-resolved infection and vaccine response in the absence of native infection. We provide an estimate of expected antibody response in healthy VD over the time course of vaccination for which to compare antibody responses in immunosuppressed patients.
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Affiliation(s)
- Nicole V Tolan
- Brigham and Women's Hospital, Department of Pathology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Mia S DeSimone
- Brigham and Women's Hospital, Department of Pathology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Maria D Fernandes
- Brigham and Women's Hospital, Department of Pathology, Boston, MA, United States
| | - Joshua E Lewis
- Brigham and Women's Hospital, Department of Pathology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Daimon P Simmons
- Brigham and Women's Hospital, Department of Pathology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Peter H Schur
- Brigham and Women's Hospital, Department of Pathology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Manfred Brigl
- Brigham and Women's Hospital, Department of Pathology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Milenko J Tanasijevic
- Brigham and Women's Hospital, Department of Pathology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Michaël Desjardins
- Harvard Medical School, Boston, MA, United States; Brigham and Women's Hospital, Department of Medicine, Division of Infectious Diseases, Boston, MA, United States
| | - Amy C Sherman
- Harvard Medical School, Boston, MA, United States; Brigham and Women's Hospital, Department of Medicine, Division of Infectious Diseases, Boston, MA, United States
| | - Lindsey R Baden
- Harvard Medical School, Boston, MA, United States; Brigham and Women's Hospital, Department of Medicine, Division of Infectious Diseases, Boston, MA, United States
| | | | - Stacy Ef Melanson
- Brigham and Women's Hospital, Department of Pathology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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Gottlieb ER, Estiverne C, Tolan NV, Melanson SEF, Mendu ML. Estimated GFR With Cystatin C and Creatinine in Clinical Practice: A Retrospective Cohort Study. Kidney Med 2023; 5:100600. [PMID: 36879723 PMCID: PMC9984886 DOI: 10.1016/j.xkme.2023.100600] [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: 01/19/2023] Open
Abstract
Rationale & Objective Estimation of glomerular filtration rate (eGFR) and staging of chronic kidney disease (CKD) are essential to guide management. Although creatinine is routinely used, a recent national task force recommended the use of cystatin C for confirmation. The objective of this study was to examine the following parameters: (1) how cystatin C correlates with creatinine eGFR; (2) how it indicates differences in CKD staging; and (3) how it may affect kidney care delivery. Study Design Retrospective observational cohort study. Setting & Participants 1,783 inpatients and outpatients who had cystatin C and creatinine levels drawn within 24 hours at Brigham Health-affiliated clinical laboratories. Predictors Serum creatinine levels, basic clinical/sociodemographic variables, and reasons for ordering cystatin C from a structured partial chart review. Analytical Approach Univariate and multivariable linear and logistic regression. Results Cystatin C-based eGFR was very strongly correlated with creatinine-based eGFR (Spearman correlation ρ = 0.83). Cystatin C eGFR resulted in a change to a later CKD stage in 27%, an earlier stage in 7%, and no change in 66% of patients. Black race was associated with a lower likelihood of change to a later stage (OR, 0.53; 95% CI [0.36, 0.75]; P < 0.001), whereas age (OR per year OR, 1.03; 95% CI [1.02, 1.04]; P < 0.001) and Elixhauser score (OR per point OR, 1.22; 95% CI [1.10, 1.36]; P < 0.001) were associated with a higher likelihood of change to a later stage. Limitations Single center, no direct measurement of clearance for comparison, and inconsistent self-identification of race/ethnicity. Conclusions Cystatin C eGFR correlates strongly with creatinine eGFR but can have a substantial effect on CKD staging. As cystatin C is adopted, clinicians must be informed on this impact.
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Affiliation(s)
- Eric Raphael Gottlieb
- Department of Medicine, Mount Auburn Hospital, Cambridge, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Christopher Estiverne
- Harvard Medical School, Boston, Massachusetts.,Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nicole V Tolan
- Harvard Medical School, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stacy E F Melanson
- Harvard Medical School, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mallika L Mendu
- Harvard Medical School, Boston, Massachusetts.,Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Lucas F, Connell NT, Tolan NV. Correctly Establishing and Interpreting Oxygenation Status in Sickle Cell Disease. J Appl Lab Med 2023; 8:583-597. [PMID: 36592159 DOI: 10.1093/jalm/jfac096] [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: 06/22/2022] [Accepted: 09/06/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND As hypoxemia and hypoxia are central elements of disease pathophysiology and disease-related morbidity and mortality in individuals affected by sickle cell disease (SCD), clinical management aims to optimize oxygenation. CONTENT Hypoxemia is primarily screened for with pulse oximetry. However, in SCD pulse oximetry can inaccurately reflect arterial saturation, posing the risk of undetected (occult) hypoxemia. Solely relying on pulse oximetry might therefore lead to misdiagnosis or mismanagement, with devastating effects on tissue oxygenation. The interpretation of oxygenation status is multifaceted, and "oxygen saturation" is often used as an umbrella term to refer to distinctly different measured quantities-estimated oxygen saturation (O2Sat), hemoglobin oxygen saturation (SO2) by either pulse oximetry or co-oximetry, and fractional oxyhemoglobin (FO2Hb). While in many clinical situations this ambiguous use is of little consequence, O2Sat, SO2, and FO2Hb cannot be used interchangeably in the setting of SCD, as dyshemoglobins, anemia, cardiopulmonary comorbidities, concomitant medications, and frequent transfusions need to be accounted for. This article describes the parameters that determine blood and tissue oxygen concentration, discusses laboratory method performance characteristics and the correct interpretation of currently available clinical laboratory testing, and reviews the literature on noninvasive vs invasive oxygenation measurements in SCD. SUMMARY By correctly establishing and interpreting oxygenation parameters, clinical and laboratory teams can ensure high-quality, equitable healthcare, counteracting systemic exacerbations of health disparities frequently experienced by individuals with SCD.
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Affiliation(s)
- Fabienne Lucas
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nathan T Connell
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicole V Tolan
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Tolan NV, Horowitz GL. Innovations in Infectious Disease Diagnostics. Clin Biochem 2022; 117:74. [PMID: 36241059 PMCID: PMC9554316 DOI: 10.1016/j.clinbiochem.2022.10.006] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Tolan NV, Sherman AC, Zhou G, Nabel KG, Desjardins M, Melanson S, Kanjilal S, Moheed S, Kupelian J, Kaufman RM, Ryan ET, LaRocque RC, Branda JA, Dighe AS, Abraham J, Baden LR, Charles RC, Turbett SE. The Effect of Vaccine Type and SARS-CoV-2 Lineage on Commercial SARS-CoV-2 Serologic and Pseudotype Neutralization Assays in mRNA Vaccine Recipients. Microbiol Spectr 2022; 10:e0021122. [PMID: 35311584 PMCID: PMC9045317 DOI: 10.1128/spectrum.00211-22] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/20/2022] [Indexed: 12/24/2022] Open
Abstract
The use of anti-spike (S) serologic assays as surrogate measurements of SARS-CoV-2 vaccine induced immunity will be an important clinical and epidemiological tool. The characteristics of a commercially available anti-S antibody assay (Roche Elecsys anti-SARS-CoV-2 S) were evaluated in a cohort of vaccine recipients. Levels were correlated with pseudotype neutralizing antibodies (NAb) across SARS-CoV-2 variants. We recruited adults receiving a two-dose series of mRNA-1273 or BNT162b2 and collected serum at scheduled intervals up to 8 months post-first vaccination. Anti-S and NAb levels were measured, and correlation was evaluated by (i) vaccine type and (ii) SARS-CoV-2 variant (wild-type, Alpha, Beta, Gamma, and three constructs Day 146*, Day 152*, and RBM-2). Forty-six mRNA vaccine recipients were enrolled. mRNA-1273 vaccine recipients had higher peak anti-S and NAb levels compared with BNT162b2 (P < 0.001 for anti-S levels; P < 0.05 for NAb levels). When anti-S and NAb levels were compared, there was good correlation (all r values ≥ 0.85) in both BNT162b2 and mRNA-1273 vaccine recipients across all evaluated variants; however, these correlations were nonlinear in nature. Lower correlation was identified between anti-S and NAb for the Beta variant (r = 0.88) compared with the wild-type (WT) strain (r = 0.94). Finally, the degree of neutralizing activity at any given anti-S level was lower for each variant compared with that of the WT strain, (P < 0.001). Although the Roche anti-S assay correlates well with NAb levels, this association is affected by vaccine type and SARS-CoV-2 variant. These variables must be considered when interpreting anti-S levels. IMPORTANCE We evaluated anti-spike antibody concentrations in healthy mRNA vaccinated individuals and compared these concentrations to values obtained from pseudotype neutralization assays targeting SARS-CoV-2 variants of concern to determine how well anti-spike antibodies correlate with neutralizing titers, which have been used as a marker of immunity from COVID-19 infection. We found high peak anti-spike concentrations in these individuals, with significantly higher levels seen in mRNA-1273 vaccine recipients. When we compared anti-spike and pseudotype neuralization titers, we identified good correlation; however, this correlation was affected by both vaccine type and variant, illustrating the difficulty of applying a "one size fits all" approach to anti-spike result interpretation. Our results support CDC recommendations to discourage anti-spike antibody testing to assess for immunity after vaccination and cautions providers in their interpretations of these results as a surrogate of protection in COVID-vaccinated individuals.
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Affiliation(s)
- Nicole V. Tolan
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Amy C. Sherman
- Department of Medicine, Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Guohai Zhou
- Department of Medicine, Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Michaël Desjardins
- Department of Medicine, Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Stacy Melanson
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Sanjat Kanjilal
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Serina Moheed
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John Kupelian
- Department of Medicine, Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Richard M. Kaufman
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Edward T. Ryan
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Regina C. LaRocque
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - John A. Branda
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Anand S. Dighe
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan Abraham
- Department of Medicine, Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lindsey R. Baden
- Department of Medicine, Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Richelle C. Charles
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sarah E. Turbett
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Tolan NV, Melanson SEF, Kane G, Ryan Avery K, Fitzsimons D, Gregory K, Goonan EM, Lewandrowski KB, Tanasijevic MJ. Glucose Meter Standardization Across a Large Academic Hospital System. Clin Chim Acta 2022; 531:204-211. [PMID: 35341764 DOI: 10.1016/j.cca.2022.03.019] [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: 02/03/2022] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND To select and standardize point-of-care (POC) glucose meters across a multi-hospital system. METHODS We formed a multidisciplinaryPOC glucose standardization working group includingkey stakeholders from each site. A set ofselectioncriteria: usability, clinical and laboratory performance, indications for use, interface connectivity, ease of implementation and ongoing operational costs were used to develop ascoring schemato facilitate a consensus-driven selection process. RESULTS Method comparison and consensus error grid evaluation against the clinically validated reference methods demonstrated that the analytical performance for all candidate meters was comparable for both the laboratory and clinical evaluation. However, Meter 1 ranked highest in usability evaluations, implementation and streamlined interface connectivity. The meter selection process and implementation were staggered across sites due to complexity of transitioning to a new manufacturer's meter and limitations in vendor support for training and ongoing troubleshooting of interface connectivity. CONCLUSIONS Standardization of POC glucose meters in a large multi-hospital system is a complex undertaking requiring robust, multidisciplinary organizational structure both system-wide and locally, development of consensus-driven selection tools, usability evaluation by end-users, laboratory and clinical evaluation of the analytical performance, and a strong vendor-laboratory partnership during the implementation process.
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Affiliation(s)
- Nicole V Tolan
- Department of Pathology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Stacy E F Melanson
- Department of Pathology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Gregory Kane
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | | | | | - Kim Gregory
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Ellen M Goonan
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - Kent B Lewandrowski
- Harvard Medical School, Boston, MA; Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Milenko J Tanasijevic
- Department of Pathology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
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10
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Affiliation(s)
- Nicole V Tolan
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Cotran 2, Boston, MA 01752, USA.
| | - Gary L Horowitz
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street, Boston, MA 02111, USA
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11
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Nabel KG, Clark SA, Shankar S, Pan J, Clark LE, Yang P, Coscia A, McKay LGA, Varnum HH, Brusic V, Tolan NV, Zhou G, Desjardins M, Turbett SE, Kanjilal S, Sherman AC, Dighe A, LaRocque RC, Ryan ET, Tylek C, Cohen-Solal JF, Darcy AT, Tavella D, Clabbers A, Fan Y, Griffiths A, Correia IR, Seagal J, Baden LR, Charles RC, Abraham J. Structural basis for continued antibody evasion by the SARS-CoV-2 receptor binding domain. Science 2022; 375:eabl6251. [PMID: 34855508 PMCID: PMC9127715 DOI: 10.1126/science.abl6251] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/29/2021] [Indexed: 12/19/2022]
Abstract
Many studies have examined the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants on neutralizing antibody activity after they have become dominant strains. Here, we evaluate the consequences of further viral evolution. We demonstrate mechanisms through which the SARS-CoV-2 receptor binding domain (RBD) can tolerate large numbers of simultaneous antibody escape mutations and show that pseudotypes containing up to seven mutations, as opposed to the one to three found in previously studied variants of concern, are more resistant to neutralization by therapeutic antibodies and serum from vaccine recipients. We identify an antibody that binds the RBD core to neutralize pseudotypes for all tested variants but show that the RBD can acquire an N-linked glycan to escape neutralization. Our findings portend continued emergence of escape variants as SARS-CoV-2 adapts to humans.
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MESH Headings
- Angiotensin-Converting Enzyme 2/chemistry
- Angiotensin-Converting Enzyme 2/metabolism
- Antibodies, Neutralizing/immunology
- Antibodies, Viral/immunology
- BNT162 Vaccine/immunology
- Betacoronavirus/immunology
- COVID-19/immunology
- COVID-19/virology
- Cross Reactions
- Cryoelectron Microscopy
- Crystallography, X-Ray
- Epitopes
- Evolution, Molecular
- Humans
- Immune Evasion
- Models, Molecular
- Mutation
- Polysaccharides/analysis
- Protein Binding
- Protein Domains
- Receptors, Coronavirus/chemistry
- Receptors, Coronavirus/metabolism
- SARS-CoV-2/genetics
- SARS-CoV-2/immunology
- Spike Glycoprotein, Coronavirus/chemistry
- Spike Glycoprotein, Coronavirus/genetics
- Spike Glycoprotein, Coronavirus/immunology
- Viral Pseudotyping
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Affiliation(s)
- Katherine G. Nabel
- Department of Microbiology, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Sarah A. Clark
- Department of Microbiology, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Sundaresh Shankar
- Department of Microbiology, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Junhua Pan
- Department of Microbiology, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Lars E. Clark
- Department of Microbiology, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Pan Yang
- Department of Microbiology, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Adrian Coscia
- Department of Microbiology, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Lindsay G. A. McKay
- Department of Microbiology and National Emerging Infectious Diseases Laboratories, Boston University School of Medicine, Boston, MA 02118, USA
| | - Haley H. Varnum
- Department of Microbiology, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Vesna Brusic
- Department of Microbiology, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA
| | - Nicole V. Tolan
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Guohai Zhou
- Center for Clinical Investigation, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Michaël Desjardins
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Division of Infectious Diseases, Department of Medicine, Centre Hospitalier de l’Université de Montréal, Montreal QC H2X 0C1, Canada
| | - Sarah E. Turbett
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sanjat Kanjilal
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA 02215, USA
| | - Amy C. Sherman
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Anand Dighe
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Regina C. LaRocque
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Edward T. Ryan
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02215, USA
| | - Casey Tylek
- AbbVie Bioresearch Center, Worcester, MA 01605, USA
| | | | | | | | | | - Yao Fan
- AbbVie Bioresearch Center, Worcester, MA 01605, USA
| | - Anthony Griffiths
- Department of Microbiology and National Emerging Infectious Diseases Laboratories, Boston University School of Medicine, Boston, MA 02118, USA
| | | | - Jane Seagal
- AbbVie Bioresearch Center, Worcester, MA 01605, USA
| | - Lindsey R. Baden
- Center for Clinical Investigation, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Massachusetts Consortium on Pathogen Readiness, Boston, MA, USA
| | - Richelle C. Charles
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jonathan Abraham
- Department of Microbiology, Blavatnik Institute, Harvard Medical School, Boston, MA 02115, USA
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Massachusetts Consortium on Pathogen Readiness, Boston, MA, USA
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
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12
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Tolan NV, Terebo T, Chai PR, Erickson TB, Hayes BD, Uljon SN, Petrides AK, Demetriou CA, Melanson SEF. Impact of marijuana legalization on cannabis-related visits to the emergency department. Clin Toxicol (Phila) 2021; 60:585-595. [DOI: 10.1080/15563650.2021.2012576] [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] [Indexed: 10/19/2022]
Affiliation(s)
- Nicole V. Tolan
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tolumofe Terebo
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, 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
| | - 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
| | - Bryan D. Hayes
- Harvard Medical School, Boston, MA, USA
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Sacha N. Uljon
- Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Athena K. Petrides
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Christiana A. Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - 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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Tolan NV, Ahmed S, Terebo T, Virk ZM, Petrides AK, Ransohoff JR, Demetriou CA, Kelly YP, Melanson SE, Mendu ML. The Impact of Outpatient Laboratory Alerting Mechanisms in Patients with AKI. Kidney360 2021; 2:1560-1568. [PMID: 35372977 PMCID: PMC8785781 DOI: 10.34067/kid.0003312021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/14/2021] [Indexed: 02/04/2023]
Abstract
Background AKI is an abrupt decrease in kidney function associated with significant morbidity and mortality. Electronic notifications of AKI have been utilized in patients who are hospitalized, but their efficacy in the outpatient setting is unclear. Methods We evaluated the effect of two outpatient interventions: an automated comment on increasing creatinine results (intervention I; 6 months; n=159) along with an email to the provider (intervention II; 3 months; n=105), compared with a control (baseline; 6 months; n=176). A comment was generated if a patient's creatinine increased by >0.5 mg/dl (previous creatinine ≤2.0 mg/dl) or by 50% (previous creatinine >2.0 mg/dl) within 180 days. Process measures included documentation of AKI and clinical actions. Clinical outcomes were defined as recovery from AKI within 7 days, prolonged AKI from 8 to 89 days, and progression to CKD with in 120 days. Results Providers were more likely to document AKI in interventions I (P=0.004; OR, 2.80; 95% CI, 1.38 to 5.67) and II (P=0.01; OR, 2.66; 95% CI, 1.21 to 5.81). Providers were also more likely to discontinue nephrotoxins in intervention II (P<0.001; OR, 4.88; 95% CI, 2.27 to 10.50). The median time to follow-up creatinine trended shorter among patients with AKI documented (21 versus 42 days; P=0.11). There were no significant differences in clinical outcomes. Conclusions An automated comment was associated with improved documented recognition of AKI and the additive intervention of an email alert was associated with increased discontinuation of nephrotoxins, but neither improved clinical outcomes. Translation of these findings into improved outcomes may require corresponding standardization of clinical practice protocols for managing AKI.
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Affiliation(s)
- Nicole V. Tolan
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Salman Ahmed
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Tolumofe Terebo
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Athena K. Petrides
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jaime R. Ransohoff
- Department of Epidemiology, Bloomberg School of Public Health, Baltimore, Maryland
| | - Christiana A. Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Yvelynne P. Kelly
- Department of Critical Care Medicine, St. James Hospital, Dublin, Ireland
| | - Stacy E.F. Melanson
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Mallika L. Mendu
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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14
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Torres Yordán NC, Lewis AG, McElrath TF, Tolan NV, Greenberg JA. Point-of-care assessment of combined umbilical arterial and venous lactate: A potential screening test for neonatal acidosis. Int J Gynaecol Obstet 2021; 158:86-92. [PMID: 34610142 DOI: 10.1002/ijgo.13968] [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: 05/25/2021] [Revised: 09/18/2021] [Accepted: 10/04/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the relationship between point-of-care (POC) measurement of combined umbilical arterial and venous (CUAV) lactate and umbilical artery (UA) lactate to determine whether POC assessment of this sample could be an alternative screening modality for neonatal acidosis and aid prediction of neonatal morbidity. METHODS In this cross-sectional pilot study, UA and CUAV cord blood samples were collected from live, singleton neonates delivered between June and August 2019, at a tertiary care center. UA samples were analyzed for pH and lactate using a blood gas analyzer. CUAV lactate was also assessed on a blood gas analyzer and at the POC. Linear regression was used to determine the correlation between these samples. RESULTS A total of 152 neonates were included. There was a statistically significant correlation between CUAV lactate concentrations and UA lactate concentrations (R2 = 0.744). Additionally, CUAV lactate concentration measured at the POC was significantly correlated with that measured on a traditional blood gas analyzer (R2 = 0.928). CONCLUSION POC testing of CUAV lactate is reliable and closely correlated with UA lactate concentrations, making POC testing of CUAV lactate a potential screening test for neonatal acidosis. More data are needed to establish standardization of this test relative to its predictive value in clinical neonatal outcomes.
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Affiliation(s)
- Nora C Torres Yordán
- Department of Obstetrics and Gynecology, University of Chicago Medicine, Chicago, Illinois, USA
| | | | - Thomas F McElrath
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole V Tolan
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - James A Greenberg
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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15
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El-Khoury JM, Hoenig MP, Jones GRD, Lamb EJ, Parikh CR, Tolan NV, Wilson FP. AACC Guidance Document on Laboratory Investigation of Acute Kidney Injury. J Appl Lab Med 2021; 6:1316-1337. [PMID: 33973621 DOI: 10.1093/jalm/jfab020] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a sudden episode of kidney damage or failure affecting up to 15% of hospitalized patients and is associated with serious short- and long-term complications, mortality, and health care costs. Current practices to diagnose and stage AKI are variable and do not factor in our improved understanding of the biological and analytical variability of creatinine. In addition, the emergence of biomarkers, for example, cystatin C, insulin-like growth factor binding protein 7, and tissue inhibitor of metalloproteinases 2, and electronic notification tools for earlier detection of AKI, highlights the need for updated recommendations to address these developments. CONTENT This AACC Academy guidance document is intended to provide laboratorians and clinicians up-to-date information regarding current best practices for the laboratory investigation of AKI. Topics covered include: clinical indications for further investigating potential AKI, analytical considerations for creatinine assays, the impact of biological variability on diagnostic thresholds, defining "baseline" creatinine, role of traditional markers (urine sodium, fractional excretion of sodium, fractional excretion of urea, and blood urea-to-creatinine ratio), urinary microscopic examination, new biomarkers, improving AKI-associated test utilization, and the utility of automated AKI alerts. SUMMARY The previous decade brought us a significant number of new studies characterizing the performance of existing and new biomarkers, as well as potential new tools for early detection and notification of AKI. This guidance document is intended to inform clinicians and laboratorians on the best practices for the laboratory investigation of AKI, based on expert recommendations where the preponderance of evidence is available.
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Affiliation(s)
- Joe M El-Khoury
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Melanie P Hoenig
- Renal Division, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Edmund J Lamb
- Department of Pathology, East Kent Hospitals University NHS Foundation Trust, Kent, UK
| | - Chirag R Parikh
- Division of Nephrology, Johns Hopkins University, Baltimore, MD, USA
| | - Nicole V Tolan
- Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - F Perry Wilson
- Program of Applied Translational Research, Yale School of Medicine, New Haven, CT, USA
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16
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Abstract
With the ever-increasing market share of direct-to-consumer (DTC) testing, projected to surpass $350 million this year, health care professionals must address the health literacy gap that exists between what the clinician knows and what the general public understands about clinical laboratory testing. Health literacy is lowest among people with lower socioeconomic status and results in poorer outcomes. However, these individuals represent those that would benefit most from valuable DTC testing. There is a need for unbiased and universally accessible tools to help improve consumers' understanding of test utility, limitations to the accuracy of results, and result interpretation.
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Affiliation(s)
- Nicole V Tolan
- Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Cotran 2, Boston, MA 02115, USA.
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17
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Affiliation(s)
- Nicole V Tolan
- Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Cotran 2, Boston, MA 02115, USA.
| | - Robert D Nerenz
- Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Department of Pathology and Laboratory Medicine, 1 Medical Center Drive, Lebanon, NH 03756, USA.
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18
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Abstract
Please verify edtis, "This article provides a brief introduction to some of the challenges associated with DTC testing, including: the concerns for overall limited healthcare value and unsubstantiated excessive monitoring of health and wellness markers, risks for reduced test quality from DTC testing companies claiming regulatory exemption, the impact of communication breakdown with a qualified healthcare professional leading to unnecessary worry and inappropriate self-management, and the downstream effects DTC testing has placed on our already overburdened healthcare system.
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Affiliation(s)
- Nicole V Tolan
- Department of Pathology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Cotran 2, Boston, MA 02115, USA.
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19
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Nilles EJ, Karlson EW, Norman M, Gilboa T, Fischinger S, Atyeo C, Zhou G, Bennett CL, Tolan NV, Oganezova K, Walt DR, Alter G, Simmons DP, Schur P, Jarolim P, Woolley AE, Baden LR. Evaluation of Three Commercial and Two Non-Commercial Immunoassays for the Detection of Prior Infection to SARS-CoV-2. J Appl Lab Med 2021; 6:1561-1570. [PMID: 34196711 PMCID: PMC8420636 DOI: 10.1093/jalm/jfab072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/03/2021] [Accepted: 06/15/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Serological testing provides a record of prior infection with SARS-CoV-2, but assay performance requires independent assessment. METHODS We evaluated 3 commercial (Roche Diagnostics pan-IG, and Epitope Diagnostics IgM and IgG) and 2 non-commercial (Simoa and Ragon/MGH IgG) immunoassays against 1083 unique samples that included 251 PCR-positive and 832 prepandemic samples. RESULTS The Roche assay registered the highest specificity 99.6% (3/832 false positives), the Ragon/MGH assay 99.5% (4/832), the primary Simoa assay model 99.0% (8/832), and the Epitope IgG and IgM 99.0% (8/830) and 99.5% (4/830), respectively. Overall sensitivities for the Simoa, Roche pan-IG, Epitope IgG, Ragon/MGH IgG, and Epitope IgM were 92.0%, 82.9%, 82.5%, 64.5% and 47.0%, respectively. The Simoa immunoassay demonstrated the highest sensitivity among samples stratified by days postsymptom onset (PSO), <8 days PSO (57.69%) 8-14 days PSO (93.51%), 15-21 days PSO (100%), and > 21 days PSO (95.18%). CONCLUSIONS All assays demonstrated high to very high specificities while sensitivities were variable across assays.
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Affiliation(s)
- Eric J Nilles
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Elizabeth W Karlson
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA,Address correspondence to this author at: Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115, USA. Fax 508-785-0351; e-mail
| | - Maia Norman
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA,Tufts University School of Medicine, Boston, MA,Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| | - Tal Gilboa
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA,Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| | | | | | - Guohai Zhou
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Christopher L Bennett
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA,Massachusetts General Hospital, Boston, MA
| | - Nicole V Tolan
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | | | - David R Walt
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA,Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| | - Galit Alter
- Harvard Medical School, Boston, MA,Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA,Harvard T.H. Chan School of Public Health, Boston, MA
| | - Daimon P Simmons
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Peter Schur
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Petr Jarolim
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Ann E Woolley
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Lindsey R Baden
- Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
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20
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Tonellato DJ, Ransohoff JR, Nash C, Melanson SEF, Petrides AK, Tolan NV, Goldberg SA, Boyer EW, Chai PR, Erickson TB. Traumatic pedestrian and bicyclist injuries associated with intoxication. Am J Emerg Med 2021; 45:192-195. [PMID: 33046308 PMCID: PMC7884480 DOI: 10.1016/j.ajem.2020.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Drug and alcohol use are risk factors for trauma among operators of motor vehicles and contribute to trauma in pedestrians and bicyclists. We describe the prevalence of drug and alcohol use and clinical consequences in a cohort of pedestrians and bicyclists with trauma. METHODS We analyzed a 25-month data set of 916 trauma team activations from January 2017-January 2019 at an urban, level I trauma center. Blood ethanol levels and urine toxicology screens were obtained in 94 pedestrian and bicyclist trauma activations. We compared pedestrians or bicyclists with a positive urine or blood screen (n = 69) to those with negative screens (n = 25). We conducted a retrospective chart review to determine mechanism of injury, injury pattern, and disposition from the emergency department (ED). RESULTS Overall, 38 (55%) of injured patients with positive screen were pedestrians and 31 (45%) were bicyclists. Fentanyl was the most commonly detected drug (n = 38; 40%), followed by opiates (n = 27; 29%), and tetrahydrocannabiol (THC) (n = 23; 25%). Twenty-one patients were positive for ethanol. Pedestrians and bicyclists with positive toxicology screens were significantly more likely to sustain fractures (p < .01), require an operative procedure (p < .05), or intensive care unit admission (p < .05). CONCLUSION Our study builds on previous literature which suggests that intoxicated bicyclists and pedestrians suffer frequent and more severe injury than their sober counterparts. Public health campaigns should educate bicyclists and pedestrians about the risks of cycling or walking in areas of road traffic while under the influence of alcohol or illicit drugs.
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Affiliation(s)
- D J Tonellato
- Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - J R Ransohoff
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - C Nash
- Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - S E F Melanson
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - A K Petrides
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - N V Tolan
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - S A Goldberg
- Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - E W Boyer
- Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; The Fenway Institute, Boston, MA, United States of America
| | - P R Chai
- Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; The Fenway Institute, Boston, MA, United States of America; Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States of America; Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, United States of America
| | - T B Erickson
- Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, United States of America
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21
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Bunch DR, El-Khoury JM, Colby J, Colon-Franco J, Hackenmueller SA, Olson KN, Cotten SW, Kampfrath T, Chittiprol S, Suh-Lailam B, French D, Isbell TS, Nerenz RD, Parnas ML, Tolan NV. The 2018 AACC/SYCL PhD Clinical Chemist Compensation Survey. J Appl Lab Med 2021; 5:377-387. [PMID: 32445390 DOI: 10.1093/jalm/jfaa001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 10/28/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Doctoral level board-certified clinical chemists play an invaluable role in many facets of laboratory medicine and healthcare. However, information concerning their total compensation is sparse. CONTENT A confidential self-reported compensation survey was conducted by the American Association for Clinical Chemistry's Society for Young Clinical Laboratorians (AACC SYCL) Core Committee from April 1 to April 17, 2018. Respondents provided information on geographic location, employment sector, gender, and years of experience to account for the influence of these variables on compensation. There were 199 respondents in total from the United States and Canada, however, only respondents employed in the United States with an earned doctoral degree and certification by the American Board of Clinical Chemistry (n = 133), were included in the full analysis. In comparison to compensation reported in AACC SYCL salary surveys conducted in 2010 and 2013, early career median salaries are trending upwards after correction for inflation. SUMMARY This survey is the first to collect the gender of respondents, and identify a pay gap for some geographic groups. However, this gap could be due in part to a difference in the years of experience, since males were highly represented in the group with >20 years of experience (25 out of 35, 71%). Future studies on compensation trends within clinical chemistry that do not rely on self-report are needed to ensure accuracy and completeness of the dataset.
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Affiliation(s)
- Dustin R Bunch
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
| | - Joe M El-Khoury
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT.,Society for Young Clinical Laboratorians (SYCL) Core Committee, American Association for Clinical Chemistry, 900 Seventh Street, NW Suite 400, Washington, DC
| | - Jennifer Colby
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN.,Society for Young Clinical Laboratorians (SYCL) Core Committee, American Association for Clinical Chemistry, 900 Seventh Street, NW Suite 400, Washington, DC
| | - Jessica Colon-Franco
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH.,Society for Young Clinical Laboratorians (SYCL) Core Committee, American Association for Clinical Chemistry, 900 Seventh Street, NW Suite 400, Washington, DC
| | - Sarah A Hackenmueller
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI.,Society for Young Clinical Laboratorians (SYCL) Core Committee, American Association for Clinical Chemistry, 900 Seventh Street, NW Suite 400, Washington, DC
| | - Kalen N Olson
- Siemens Healthineers, Tarrytown, NY.,Society for Young Clinical Laboratorians (SYCL) Core Committee, American Association for Clinical Chemistry, 900 Seventh Street, NW Suite 400, Washington, DC
| | - Steven W Cotten
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Society for Young Clinical Laboratorians (SYCL) Core Committee, American Association for Clinical Chemistry, 900 Seventh Street, NW Suite 400, Washington, DC
| | | | | | - Brenda Suh-Lailam
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL and Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL.,Society for Young Clinical Laboratorians (SYCL) Core Committee, American Association for Clinical Chemistry, 900 Seventh Street, NW Suite 400, Washington, DC
| | - Deborah French
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA.,Society for Young Clinical Laboratorians (SYCL) Core Committee, American Association for Clinical Chemistry, 900 Seventh Street, NW Suite 400, Washington, DC
| | - T Scott Isbell
- Department of Pathology, Saint Louis University, St. Louis, MO.,Society for Young Clinical Laboratorians (SYCL) Core Committee, American Association for Clinical Chemistry, 900 Seventh Street, NW Suite 400, Washington, DC
| | - Robert D Nerenz
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.,Society for Young Clinical Laboratorians (SYCL) Core Committee, American Association for Clinical Chemistry, 900 Seventh Street, NW Suite 400, Washington, DC
| | - M Laura Parnas
- Roche Diagnostics, Indianapolis, IN.,Society for Young Clinical Laboratorians (SYCL) Core Committee, American Association for Clinical Chemistry, 900 Seventh Street, NW Suite 400, Washington, DC
| | - Nicole V Tolan
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Society for Young Clinical Laboratorians (SYCL) Core Committee, American Association for Clinical Chemistry, 900 Seventh Street, NW Suite 400, Washington, DC
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22
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Tsai JM, Tolan NV, Petrides AK, Kanjilal S, Brigl M, Lindeman NI, Li YD, Tanasijevic MJ, Basu SS, Melanson SEF. How SARS-CoV-2 Transformed the Clinical Laboratory: Challenges and Lessons Learned. J Appl Lab Med 2021; 6:1338-1354. [PMID: 33822967 PMCID: PMC8083381 DOI: 10.1093/jalm/jfab034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/22/2021] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic has made a devastating impact on global health and continues to challenge healthcare infrastructure and delivery. The clinical laboratories were no exception as they are responsible for diagnostic testing that dictates many clinical, infection control and public health decisions. Information technology and laboratory management tools are critical assets for maintaining and adapting operations in response to crises and when utilized effectively, promote the integration between the clinical laboratory specialties (e.g., chemistry, hematology, microbiology, and molecular pathology). During the COVID-19 pandemic, our systems and processes were strained due to high testing volumes, demand for rapid turnaround times, supply chain constraints, and constantly evolving testing algorithms and result interpretations as our knowledge of the virus and of diagnostics increased over time. In this report, we describe those challenges and subsequent adaptations made by each clinical laboratory section. We hope these details help provide potential solutions and approaches for other hospitals facing COVID-19 surges or other future pandemics.
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Affiliation(s)
- Jonathan M Tsai
- Department of Pathology, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Nicole V Tolan
- Department of Pathology, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Athena K Petrides
- Department of Pathology, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Sanjat Kanjilal
- Department of Pathology, Brigham and Women's Hospital, Boston, MA.,Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute
| | - Manfred Brigl
- Department of Pathology, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Neal I Lindeman
- Department of Pathology, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Yen-Der Li
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.,Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA
| | - Milenko J Tanasijevic
- Department of Pathology, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Sankha S Basu
- Department of Pathology, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Stacy E F Melanson
- Department of Pathology, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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23
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Chambliss AB, Tolan NV. Contingency Planning in the Clinical Laboratory: Lessons Learned Amidst COVID-19. J Appl Lab Med 2020; 5:832-836. [PMID: 32603440 PMCID: PMC7188123 DOI: 10.1093/jalm/jfaa068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/14/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Allison B Chambliss
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, CA.,Department of Pathology, Los Angeles County + University of Southern California (LAC+USC) Medical Center, Los Angeles, CA
| | - Nicole V Tolan
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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24
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Nilles EJ, Karlson EW, Norman M, Gilboa T, Fischinger S, Atyeo C, Zhou G, Bennett CL, Tolan NV, Oganezova K, Walt DR, Alter G, Simmons DP, Schur P, Jarolim P, Baden LR. Evaluation of two commercial and two non-commercial immunoassays for the detection of prior infection to SARS-CoV-2. medRxiv 2020:2020.06.24.20139006. [PMID: 32607518 PMCID: PMC7325183 DOI: 10.1101/2020.06.24.20139006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Seroepidemiology is an important tool to characterize the epidemiology and immunobiology of SARS-CoV-2 but many immunoassays have not been externally validated raising questions about reliability of study findings. To ensure meaningful data, particularly in a low seroprevalence population, assays need to be rigorously characterized with high specificity. Methods We evaluated two commercial (Roche Diagnostics and Epitope Diagnostics IgM/IgG) and two non-commercial (Simoa and Ragon/MGH IgG) immunoassays against 68 confirmed positive and 232 pre-pandemic negative controls. Sensitivity was stratified by time from symptom onset. The Simoa multiplex assay applied three pre-defined algorithm models to determine sample result. Results The Roche and Ragon/MGH IgG assays each registered 1/232 false positive, the primary Simoa model registered 2/232 false positives, and the Epitope registered 2/230 and 3/230 false positives for the IgG and IgM assays respectively. Sensitivity >21 days post symptom-onset was 100% for all assays except Epitope IgM, but lower and/or with greater variability between assays for samples collected 9-14 days (67-100%) and 15-21 days (69-100%) post-symptom onset. The Simoa and Epitope IgG assays demonstrated excellent sensitivity earlier in the disease course. The Roche and Ragon/MGH IgG assays were less sensitive during early disease, particularly among immunosuppressed individuals. Conclusions The Epitope IgG demonstrated good sensitivity and specificity. The Roche and Ragon/MGH IgG assays registered rare false positives with lower early sensitivity. The Simoa assay primary model had excellent sensitivity and few false positives.
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Affiliation(s)
- Eric J Nilles
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Maia Norman
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Tufts University School of Medicine, Boston, MA
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, MA
| | - Tal Gilboa
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, MA
| | | | | | - Guohai Zhou
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Christopher L Bennett
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Massachusetts General Hospital, Boston, MA
| | - Nicole V Tolan
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - David R Walt
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, MA
| | - Galit Alter
- Harvard Medical School, Boston, MA
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
- Harvard T.H. Chan School of Public Health
| | - Daimon P Simmons
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Peter Schur
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Petr Jarolim
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Lindsey R Baden
- Brigham and Women's Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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25
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Geno KA, Tolan NV, Singh RJ, Nerenz RD. Improved Recognition of 25-Hydroxyvitamin D2 by 2 Automated Immunoassays. J Appl Lab Med 2020; 5:1287-1295. [PMID: 32529210 DOI: 10.1093/jalm/jfaa070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/03/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Despite recommendations to limit vitamin D testing to specific clinical scenarios, test volume remains high in many clinical laboratories. Automated total vitamin D immunoassays frequently under- or over-recover 25-hydroxyvitamin D2 [25(OH)D2], making accurate assessment of vitamin D status difficult in patients taking high-dose 25(OH)D2 supplements. Mass spectrometry-based methods offer excellent recovery of 25(OH)D2 but are not practical for use in all laboratories. In this study, we evaluated 2 automated immunoassays against an LC-MS/MS method performed at a national reference laboratory. METHODS A method comparison against LC-MS/MS was performed for the Roche Elecsys Vitamin D total II assay and the IDS-iSYS 25 VitDS immunoassays using 49 patient specimens submitted for clinical 25(OH)D measurement. Mean bias was calculated, and vitamin D status was determined for each specimen according to the 2011 Endocrine Society clinical practice guidelines. RESULTS Theil-Sen regression lines relative to LC-MS/MS were y = 0.88x + 2.94 for Roche and y = 1.03x + 2.48 for IDS. Mean bias (±SD) in samples with 25(OH)D2 concentrations less than 5 ng/mL was -0.25 ng/mL (±6.30) for Roche and -1.45 ng/mL (±6.82) for the IDS. Mean bias (±SD) in samples with 25(OH)D2 concentrations greater than 5 ng/mL was -3.19 ng/mL (±6.61) for Roche and 5.52 ng/mL (±6.36) for IDS. Median percentage recovery of 25(OH)D2 was 87.1% (interquartile range 76.0-111.3) for Roche and 120.6% (interquartile range: 105.3-133.4) for IDS. Vitamin D status was misclassified in 7 samples by the Roche assay and 3 by the IDS assay. For all but one of the discordant pairs, the immunoassay result was within 1.7 ng/mL of the diagnostic cutoff. CONCLUSIONS The automated immunoassays evaluated here demonstrate improved recovery of 25(OH)D2 relative to previous generations. Both are acceptable for use in the determination of vitamin D status.
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Affiliation(s)
- K Aaron Geno
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Health System, Lebanon, NH; The Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Nicole V Tolan
- Department of Pathology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Ravinder J Singh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Robert D Nerenz
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Health System, Lebanon, NH; The Geisel School of Medicine at Dartmouth, Hanover, NH
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26
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Tolan NV, Nerenz RD. Direct-to-Consumer Testing: The Role of Laboratory Medicine. Clin Lab Med 2020. [DOI: 10.1016/s0272-2712(20)30003-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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27
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Tanasijevic MJ, Melanson SEF, Tolan NV, Ransohoff JR, Conrad MJ, Paik HI, Petrides AK. Significant Operational Improvements with Implementation of Next Generation Laboratory Automation. Lab Med 2020; 52:329-337. [PMID: 33438745 DOI: 10.1093/labmed/lmaa108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To investigate the benefits and challenges of introducing next generation chemistry and coagulation automation. METHODS We replaced the Roche modular preanalytic system attached to Roche Cobas 6000 analyzers with the Roche 8100 preanalytical line attached to the Roche Cobas 8000 and Stago STA R Max analyzers. The system included 2 add-on buffers (AOBs) for automated specimen archival and retrieval and primary-tube specimen processing. We measured turnaround time (TAT) from specimen receipt to result for chemistry and coagulation tests before, during, and after system implementation. TAT for add-on tests was also measured. RESULTS We completed the system implementation during a 17-month period using existing laboratory space. The TAT for chemistry, coagulation, and add-on tests decreased significantly (P <.005, P <.001, and P <.005, respectively). We encountered several challenges, including barcode-label errors, mechanical problems, and workflow issues due to lack of bidirectional track for coagulation testing. CONCLUSIONS Next generation laboratory automation yielded significantly shortened and less-variable TAT, particularly for add-on testing. Our approach could help other laboratories in the process of implementing and configuring automated systems.
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Affiliation(s)
- Milenko J Tanasijevic
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Stacy E F Melanson
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Nicole V Tolan
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jaime R Ransohoff
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael J Conrad
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Hyun-Il Paik
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Athena K Petrides
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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28
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Tolan NV. Development of a 25-Hydroxyvitamin D Liquid Chromatography–Tandem Mass Spectrometry Assay, Cleared by the Food and Drug Administration, via the De Novo Pathway. Clin Lab Med 2018; 38:553-564. [DOI: 10.1016/j.cll.2018.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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29
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Tolan NV. Laboratory Data Connectivity and Management: the Intersection of Laboratory Information Management Systems, Ancillary Open-Source Software, and Consumer Technologies. ACTA ACUST UNITED AC 2017; 2:461-463. [DOI: 10.1373/jalm.2016.021899] [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: 11/15/2016] [Accepted: 03/07/2017] [Indexed: 11/06/2022]
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30
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Tolan NV, Yoon EJ, Brady AR, Horowitz GL. Price of High-Throughput 25-Hydroxyvitamin D Immunoassays: Frequency of Inaccurate Results. ACTA ACUST UNITED AC 2017; 2:868-879. [DOI: 10.1373/jalm.2017.024323] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 09/18/2017] [Indexed: 11/06/2022]
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31
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Tolan NV, Horowitz GL, Graham CS, Hillyard D, Osburn W, Ray S. New Therapies for Treating Hepatitis C Virus: Impact on Laboratory Testing Recommendations and Clinical Management. Clin Chem 2017; 63:1799-1805. [PMID: 29018029 DOI: 10.1373/clinchem.2016.266569] [Citation(s) in RCA: 2] [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: 08/17/2017] [Accepted: 08/28/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Nicole V Tolan
- Department of Laboratory Medicine and Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA;
| | - Gary L Horowitz
- Department of Pathology and Laboratory Medicine, Tufts Medical Center and Tufts University School of Medicine, Boston, MA
| | - Camilla S Graham
- Assistant Professor of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA
| | - David Hillyard
- Professor of Pathology, University of Utah; Medical Director of the Molecular Hepatitis and Retrovirus and Molecular Infectious Diseases laboratories and the Molecular Infectious Diseases and Molecular Hepatitis/Retrovirus sections, ARUP, Salt Lake City, UT
| | - William Osburn
- Assistant Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stuart Ray
- Professor of Medicine and Vice-Chair of Medicine for Data Integrity and Analytics, Johns Hopkins University School of Medicine, Baltimore, MD
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32
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Cederroth TA, Horowitz GL, Tolan NV. Clinical Laboratory Investigation of a Patient with Extreme Hypercalcemia. Clin Chem 2017; 63:459-462. [PMID: 28130478 DOI: 10.1373/clinchem.2016.261024] [Citation(s) in RCA: 2] [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: 05/24/2016] [Accepted: 08/09/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Terra A Cederroth
- Department of Pathology and Laboratory Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Gary L Horowitz
- Department of Pathology and Laboratory Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Nicole V Tolan
- Department of Pathology and Laboratory Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
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33
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Tolan NV, Kaleta EJ, Fang JL, Colby CE, Carey WA, Karon BS, Baumann NA. Neonatal Intensive Care Unit Quality Initiative: Identifying Preanalytical Variables Contributing to Specimen Hemolysis and Measuring the Impact of Evidence-Based Practice Interventions. Am J Clin Pathol 2016; 146:113-8. [PMID: 27357290 DOI: 10.1093/ajcp/aqw086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Blood specimen hemolysis is a major cause of sample recollection in the neonatal intensive care unit. We aimed to reduce the hemolysis rate from 6.3% at baseline to less than 4% within the 9 months' duration of the study. METHODS Intravenous infusion of lipid emulsion during sample collection, sample collection site, and blood sample transportation methods were investigated as possible contributors to hemolysis. Subsequently, two practice improvements were implemented: pausing lipid emulsion infusion prior to collection and slowing withdrawal rates through arterial catheters. RESULTS Samples were more likely to be hemolyzed if they were collected during lipid infusion and subsequently transported by pneumatic tube or collected through an arterial catheter. Retrospective analysis demonstrated a decreased number of tests cancelled due to specimen hemolysis (3.5%) after our interventions. CONCLUSIONS We identified three variables contributing to hemolysis and instituted two clinical practice interventions to significantly reduce test cancellations due to hemolysis.
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Affiliation(s)
- Nicole V Tolan
- From the Department of Laboratory Medicine and Pathology Department of Pathology and Laboratory Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Erin J Kaleta
- From the Department of Laboratory Medicine and Pathology Sonora Quest Laboratories, Tempe, AZ
| | | | | | | | - Brad S Karon
- From the Department of Laboratory Medicine and Pathology
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34
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Tolan NV, Parnas ML, Baudhuin LM, Cervinski MA, Chan AS, Holmes DT, Horowitz G, Klee EW, Kumar RB, Master SR. “Big Data” in Laboratory Medicine. Clin Chem 2015; 61:1433-40. [DOI: 10.1373/clinchem.2015.248591] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 09/10/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Nicole V Tolan
- Associate Director, Clinical Chemistry and Director, Point-of-Care Testing, Department of Pathology and Laboratory Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston MA
| | - M Laura Parnas
- Director, Clinical Science, Sutter Health Shared Laboratory, Livermore, CA
| | - Linnea M Baudhuin
- Co-director, Personalized Genomics Laboratory, and Clinical Genome Sequencing Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Mark A Cervinski
- Director, Clinical Chemistry and Point-of-Care Testing, Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center and the Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Albert S Chan
- VP and Chief, Digital Patient Experience, Sutter Health Office of Patient Experience, Sacramento, CA
| | - Daniel T Holmes
- Division Head, Clinical Chemistry, Department of Pathology and Laboratory Medicine, St. Paul's Hospital and University of British Columbia, Vancouver, BC
| | - Gary Horowitz
- Director, Clinical Chemistry, Department of Pathology and Laboratory Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston MA
| | - Eric W Klee
- Director of Bioinformatics, Clinical Genome Sequencing Laboratory and Associate Director of Bioinformatics, Center for Individualized Medicine, Department of Health Science Research, Mayo Clinic, Rochester, MN
| | - Rajiv B Kumar
- Medical Director of Clinical Informatics, Departments of Pediatrics and Clinical Informatics, Stanford School of Medicine and Stanford Children's Health, Palo Alto, CA
| | - Stephen R Master
- Director, Central Lab and Chief, Clinical Chemistry Laboratory Service, Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital and Weill Cornell Medical College, New York, NY
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35
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Karon BS, Tolan NV, Koch CD, Wockenfus AM, Miller RS, Lingineni RK, Pruthi RK, Chen D, Jaffe AS. Precision and Reliability of 5 Platelet Function Tests in Healthy Volunteers and Donors on Daily Antiplatelet Agent Therapy. Clin Chem 2014; 60:1524-31. [DOI: 10.1373/clinchem.2014.226332] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Anticoagulation protocols used during mechanical circulatory support call for titration of antiplatelet agents. We compared the precision and reliability of 5 platelet function tests in healthy volunteers and donors on daily antiplatelet therapy to distinguish their efficacy for titrating antiplatelet therapy.
METHODS
We assessed arachidonic acid–induced platelet function by light transmission aggregometry (LTA), Multiplate impedance aggregometry, VerifyNow, and platelet mapping by thromboelastography (TEG PM). We assessed ADP-induced platelet function by the same methods and flow cytometry. Forty healthy volunteers and 10–13 volunteers on daily aspirin and/or clopidogrel therapy were evaluated. We compared tests for intraassay precision, interassay precision (samples from 2 separate blood draws), and reliability coefficient.
RESULTS
For arachidonic acid–induced platelet aggregation in healthy volunteers, intra- and interassay CVs were ≤10% for all methods. Intra- and interassay precision among donors on daily aspirin was ≤30% for all methods except LTA (38% interassay CV) and TEG PM (95% intraassay and 104% interassay CV). For ADP-induced platelet function, intra- and interassay precision was ≤10% and ≤30% for all methods. Only Multiplate demonstrated moderate or greater (R > 0.40) reliability coefficients for arachidonic acid–induced platelet function among all subjects. All methods of ADP-induced platelet function, except TEG PM, demonstrated substantial or greater (R > 0.60) reliability among all subjects.
CONCLUSIONS
TEG PM is least suited to monitor effects of antiplatelet agents. Multiplate impedance aggregometry was the only method to demonstrate an acceptable reliability coefficient among healthy volunteers and donors on both aspirin and clopidogrel therapy.
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Affiliation(s)
- Brad S Karon
- Department of Laboratory Medicine and Pathology and
| | - Nicole V Tolan
- Current address: Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | | | | | | | - Ravi K Lingineni
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | - Dong Chen
- Department of Laboratory Medicine and Pathology and
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Tolan NV, Vidal-Folch N, Algeciras-Schimnich A, Singh RJ, Grebe SKG. Individualized correction of neuron-specific enolase (NSE) measurement in hemolyzed serum samples. Clin Chim Acta 2013; 424:216-21. [PMID: 23778024 DOI: 10.1016/j.cca.2013.06.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [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: 01/15/2013] [Revised: 05/22/2013] [Accepted: 06/06/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Accuracy of serum neuron-specific enolase (NSE) measurement is paramount, particularly in the context of neurological outcome prognostication. However, NSE measurements are compromised by even slight hemolysis, as it is abundant in red blood cells (RBCs). We derived and validated an individualized hemolysis correction equation in an attempt to reduce the current rejection rate of 14% at our institution. METHODS Intracellular NSE was measured in RBC lysates to determine concentration variability. A correction equation was derived, accounting for both RBC-derived NSE false-elevation and hemoglobin-derived signal quenching. The performance of this individualized correction was evaluated in intentionally hemolyzed samples and accuracy was compared to a generalized correction. RESULTS Significant inter-individual variability of RBC NSE was observed, with an almost two-fold range (15.7-28.5 ng NSE/mg Hb, p<0.001); intra-individual variability was insignificant. The individualized hemolysis correction equation derived: NSE(corr)=NSE(meas)-(Hb(serum))(NSE(RBCs/Hb))+0.0844(Hb(serum))+1.1 corrected 95% of the intentionally hemolyzed samples to within ±5 ng/ml of corresponding baseline NSE concentrations, compared to 74% using a generalized formula. CONCLUSIONS The individualized hemolysis correction provides increased accuracy in the estimation of true serum NSE concentrations for hemolyzed samples, compared to a generalized approach, by accounting for inter-individual RBC NSE variability. Incorporating this correction should reduce sample rejection rates and overall health care costs.
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Affiliation(s)
- Nicole V Tolan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
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Kaleta EJ, Tolan NV, Ness KA, O'Kane D, Algeciras-Schimnich A. CEA, AFP and CA 19-9 analysis in peritoneal fluid to differentiate causes of ascites formation. Clin Biochem 2013; 46:814-8. [PMID: 23454392 DOI: 10.1016/j.clinbiochem.2013.02.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 02/14/2013] [Accepted: 02/16/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Tumor marker analysis in ascites has been proposed as a measure to aid in the diagnosis of malignancy. The objectives of this study were to establish tumor marker cut-offs and determine the diagnostic performance of measuring CEA, CA 19-9 and AFP in ascites for differentiating between non-malignant and malignant etiologies. DESIGN AND METHODS Ascites from 137 patients (83 non-malignant, 54 malignant) was assayed for CEA, CA 19-9 and AFP concentrations by immunoassay. Diagnostic cut-offs were established via ROC curve analysis. Performance was compared to cytology findings and patient history following medical chart review. Analysis based on cytological findings in combination with tumor marker testing, as well as subset analysis by tumor marker secretion was also performed. RESULTS Concentrations of CEA, CA 19-9 and AFP were significantly higher in patients with malignant ascites versus non-malignant etiologies. The diagnostic cut-off, sensitivity and specificity for CEA were 3.5 ng/mL, 31% and 95%, respectively; for CA 19-9 were 72 U/mL, 30% and 95%; and for AFP were 5 ng/mL, 17% and 95%. Using cytological findings in conjunction with tumor marker results improved the sensitivity of CEA, CA 19-9 and AFP to 57.4%, 64.8%, and 59.3%, respectively. Improvement in sensitivity was seen when subset analysis by causative malignancy was performed. CONCLUSIONS Tumor marker analysis in ascites, especially in subset analysis by type of malignancy, demonstrated utility for differentiating non-malignant from malignant etiologies. This analysis should not replace cytology, but offers potential for differentiation in situations where cytology is inconclusive, or in patients with suspected malignancies known to secrete these markers.
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Affiliation(s)
- Erin J Kaleta
- Division of Clinical Biochemistry and Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Herman CT, Potts GK, Michael MC, Tolan NV, Bailey RC. Probing dynamic cell-substrate interactions using photochemically generated surface-immobilized gradients: application to selectin-mediated leukocyte rolling. Integr Biol (Camb) 2011; 3:779-91. [PMID: 21614364 PMCID: PMC3960975 DOI: 10.1039/c0ib00151a] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Model substrates presenting biochemical cues immobilized in a controlled and well-defined manner are of great interest for their applications in biointerface studies that elucidate the molecular basis of cell receptor-ligand interactions. Herein, we describe a direct, photochemical method to generate surface-immobilized biomolecular gradients that are applied to the study of selectin-mediated leukocyte rolling. The technique employs benzophenone-modified glass substrates, which upon controlled exposure to UV light (350-365 nm) in the presence of protein-containing solutions facilitate the generation of covalently immobilized protein gradients. Conditions were optimized to generate gradient substrates presenting P-selectin and PSGL-1 (P-selectin glycoprotein ligand-1) immobilized at site densities over a 5- to 10-fold range (from as low as ∼200 molecules μm(-2) to as high as 6000 molecules μm(-2)). The resulting substrates were quantitatively characterized via fluorescence analysis and radioimmunoassays before their use in the leukocyte rolling assays. HL-60 promyelocytes and Jurkat T lymphocytes were assessed for their ability to tether to and roll on substrates presenting immobilized P-selectin and PSGL-1 under conditions of physiologically relevant shear stress. The results of these flow assays reveal the combined effect of immobilized protein site density and applied wall shear stress on cell rolling behavior. Two-component substrates presenting P-selectin and ICAM-1 (intercellular adhesion molecule-1) were also generated to assess the interplay between these two proteins and their effect on cell rolling and adhesion. These proof-of-principle studies verify that the described gradient generation approach yields well-defined gradient substrates that present immobilized proteins over a large range of site densities that are applicable for investigation of cell-materials interactions, including multi-parameter leukocyte flow studies. Future applications of this enabling methodology may lead to new insights into the biophysical phenomena and molecular mechanism underlying complex biological processes such as leukocyte recruitment and the inflammatory response.
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Affiliation(s)
- Christine T. Herman
- Department of Chemistry, University of Illinois at Urbana-Champaign, 600 South Mathews Avenue, Urbana, IL 61801, USA. Tel: 217-333-0676
| | - Gregory K. Potts
- Department of Chemistry, University of Illinois at Urbana-Champaign, 600 South Mathews Avenue, Urbana, IL 61801, USA. Tel: 217-333-0676
| | - Madeline C. Michael
- Department of Chemistry, University of Illinois at Urbana-Champaign, 600 South Mathews Avenue, Urbana, IL 61801, USA. Tel: 217-333-0676
| | - Nicole V. Tolan
- Department of Chemistry, University of Illinois at Urbana-Champaign, 600 South Mathews Avenue, Urbana, IL 61801, USA. Tel: 217-333-0676
| | - Ryan C. Bailey
- Department of Chemistry, University of Illinois at Urbana-Champaign, 600 South Mathews Avenue, Urbana, IL 61801, USA. Tel: 217-333-0676
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Tolan NV, Genes LI, Subasinghe W, Raththagala M, Spence DM. Personalized metabolic assessment of erythrocytes using microfluidic delivery to an array of luminescent wells. Anal Chem 2009; 81:3102-8. [PMID: 19301907 DOI: 10.1021/ac900084g] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The metabolic syndrome is often described as a group of risk factors associated with diabetes. These risk factors include, but are not limited to, such conditions as insulin resistance, obesity, high blood pressure, and oxidant stress. Here, we report on a tool that may provide some clarity on the relationship between some of these associated risk factors, especially oxidant stress and hypertension. Specifically, we describe the ability to simultaneously monitor nicotinamide dinucleotide phosphate (NADPH), reduced glutathione (GSH), and shear-induced adenosine triphosphate (ATP) release from erythrocytes using luminescence detection on a microfabricated device. The measurements are performed by delivering erythrocyte lysate (for the NADPH and GSH measurements, two analytes indicative of oxidative stress) or whole red blood cells (RBCs) (for the determination of ATP release from the cells) to an array of wells that contain the necessary reagents to generate a luminescence emission that is proportional to analyte concentration. A fluorescence macrostereomicroscope enables whole-chip imaging of the resultant emission. The concentrations of each NADPH and GSH contained within a 0.7% erythrocyte solution were determined to be 31.06 +/- 4.12 and 22.55 +/- 2.47 microM, respectively, and the average ATP released from a nonlysed 7% erythrocyte solution was determined to be 0.54 +/- 0.04 microM. Collectively, the device represents a precursor to subsequent merging of microfluidics and microtiter-plate technology for high-throughput assessment of metabolite profiles in the diabetic erythrocyte.
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Affiliation(s)
- Nicole V Tolan
- Chemistry Department, Michigan State University, East Lansing, Michigan 48824, USA
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Abstract
Detecting multiple components from a single red blood cell (RBC) sample within a flow-based system and in less than 20 minutes will enable improved in vitro determinations of drug efficacy and cellular response to administered drugs. Here, an example of an improved in vitro measurement involving iloprost, a pharmaceutical reported to improve blood flow, has been determined by incorporating multiple cell types onto a single device. The method allows fluid flow to address individual rows of wells contained within an 18-well microfluidic array that serves as a precursor to a 96-well micro-titre plate device. The ability to better mimic the in vivo circulation by incorporating the flow of blood components, coupled with simultaneous detection and laboratory automation in place for micro-titre plates, suggests that the microfluidic array presented here will allow for improved mechanistic drug research studies. Utilizing fluorescence microscopy, concentrations of multiple metabolites present within the RBC can also be determined using the microfluidic array. The current progress towards using this device for personalized medicine is presented here.
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Genes LI, V Tolan N, Hulvey MK, Martin RS, Spence DM. Addressing a vascular endothelium array with blood components using underlying microfluidic channels. Lab Chip 2007; 7:1256-9. [PMID: 17896007 DOI: 10.1039/b712619k] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Here, we show that an array of endothelial cells, addressable by an underlying microfluidic network of channels containing red blood cells, can be employed as an in vitro model of in vivo circulation to monitor cellular communication between different cell types in the drug discovery process.
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Affiliation(s)
- Luiza I Genes
- Department of Chemistry, Michigan State University, East Lansing, MI 48824, USA
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