1
|
Barakauskas VE, Bohn MK, Branch E, Boutin A, Albert A, Luke S, Dittrick M, Higgins V, Adeli K, Vallance H, Jung B, Dooley K, Dahlgren-Scott L, Chan WS. Mining the Gap: Deriving Pregnancy Reference Intervals for Hematology Parameters Using Clinical Datasets. Clin Chem 2023; 69:1374-1384. [PMID: 37947280 DOI: 10.1093/clinchem/hvad167] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/27/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Physiological changes during pregnancy invalidate use of general population reference intervals (RIs) for pregnant people. The complete blood count (CBC) is commonly ordered during pregnancy, but few studies have established pregnancy RIs suitable for contemporary Canadian mothers. Prospective RI studies are challenging to perform during pregnancy while retrospective techniques fall short as pregnancy and health status are not readily available in the laboratory information system (LIS). This study derived pregnancy RIs retrospectively using LIS data linked to provincial perinatal registry data. METHODS A 5-year healthy pregnancy cohort was defined from the British Columbia Perinatal Data Registry and linked to laboratory data from two laboratories. CBC and differential RIs were calculated using direct and indirect approaches. Impacts of maternal and pregnancy characteristics, such as age, body mass index, and ethnicity, on laboratory values were also assessed. RESULTS The cohort contained 143 106 unique term singleton pregnancies, linked to >972 000 CBC results. RIs were calculated by trimester and gestational week. Result trends throughout gestation aligned with previous reports in the literature, although differences in exact RI limits were seen for many tests. Trimester-specific bins may not be appropriate for several CBC parameters that change rapidly within trimesters, including red blood cells (RBCs), some leukocyte parameters, and platelet counts. CONCLUSIONS Combining information from comprehensive clinical databases with LIS data provides a robust and reliable means for deriving pregnancy RIs. The present analysis also illustrates limitations of using conventional trimester bins during pregnancy, supporting use of gestational age or empirically derived bins for defining CBC normal values during pregnancy.
Collapse
Affiliation(s)
- Vilte E Barakauskas
- Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mary Kathryn Bohn
- Clinical Biochemistry, Pediatric Laboratory Medicine, The Hospital for Sick Children and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Emma Branch
- Women's Health Research Institute, BC Women's Hospital, Vancouver, BC, Canada
| | - Amelie Boutin
- Department of Pediatrics, Université Laval, and Reproduction, Mother and Youth Health Unit, CHU de Quebec-Université Laval Research Center, Quebec City, QC, Canada
| | - Arianne Albert
- Women's Health Research Institute, BC Women's Hospital, Vancouver, BC, Canada
| | - Sabrina Luke
- Women's Health Research Institute, BC Women's Hospital, Vancouver, BC, Canada
- Research and Surveillance Group, Perinatal Services British Columbia, Vancouver, BC, Canada
| | - Michelle Dittrick
- Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital, Vancouver, BC, Canada
| | - Victoria Higgins
- Clinical Biochemistry, DynaLIFE Medical Labs and Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Khosrow Adeli
- Clinical Biochemistry, Pediatric Laboratory Medicine, The Hospital for Sick Children and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Hilary Vallance
- Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Benjamin Jung
- Clinical Biochemistry, Pediatric Laboratory Medicine, The Hospital for Sick Children and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Kent Dooley
- Clinical Biochemistry, LifeLabs Medical Laboratories, Victoria, BC, Canada
| | - Leanne Dahlgren-Scott
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Wee-Shian Chan
- Department of Medicine, BC Women's Hospital and Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
2
|
Watts AW, Mâsse LC, Goldfarb DM, Irvine MA, Hutchison SM, Muttucomaroe L, Poon B, Barakauskas VE, O'Reilly C, Bosman E, Reicherz F, Coombs D, Pitblado M, O'Brien SF, Lavoie PM. SARS-CoV-2 cross-sectional seroprevalence study among public school staff in Metro Vancouver after the first Omicron wave in British Columbia, Canada. BMJ Open 2023; 13:e071228. [PMID: 37308276 DOI: 10.1136/bmjopen-2022-071228] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVE To determine the SARS-CoV-2 seroprevalence among school workers within the Greater Vancouver area, British Columbia, Canada, after the first Omicron wave. DESIGN Cross-sectional study by online questionnaire, with blood serology testing. SETTING Three main school districts (Vancouver, Richmond and Delta) in the Vancouver metropolitan area. PARTICIPANTS Active school staff enrolled from January to April 2022, with serology testing between 27 January and 8 April 2022. Seroprevalence estimates were compared with data obtained from Canadian blood donors weighted over the same sampling period, age, sex and postal code distribution. PRIMARY AND SECONDARY OUTCOMES SARS-CoV-2 nucleocapsid antibody testing results adjusted for test sensitivity and specificity, and regional variation across school districts using Bayesian models. RESULTS Of 1850 school staff enrolled, 65.8% (1214/1845) reported close contact with a COVID-19 case outside the household. Of those close contacts, 51.5% (625/1214) were a student and 54.9% (666/1214) were a coworker. Cumulative incidence of COVID-19 positive testing by self-reported nucleic acid or rapid antigen testing since the beginning of the pandemic was 15.8% (291/1845). In a representative sample of 1620 school staff who completed serology testing (87.6%), the adjusted seroprevalence was 26.5% (95% CrI 23.9% to 29.3%), compared with 32.4% (95% CrI 30.6% to 34.5%) among 7164 blood donors. CONCLUSION Despite frequent COVID-19 exposures reported, SARS-CoV-2 seroprevalence among school staff in this setting remained no greater than the community reference group. Results are consistent with the premise that many infections were acquired outside the school setting, even with Omicron.
Collapse
Affiliation(s)
- Allison W Watts
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Louise C Mâsse
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - David M Goldfarb
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mike A Irvine
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Sarah M Hutchison
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Lauren Muttucomaroe
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Bethany Poon
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Vilte E Barakauskas
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Else Bosman
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Frederic Reicherz
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Daniel Coombs
- Department of Mathematics and Institute of Applied Mathematics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Pitblado
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Sheila F O'Brien
- Canadian Blood Services, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Pascal M Lavoie
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| |
Collapse
|
3
|
Silva C, Fung AWS, Masson V, Assen K, Ward V, McKenzie J, Blydt-Hansen TD, Cosme J, van der Gugten G, Barakauskas VE, Fox DA. Vitamin D toxicity from an unusual and unexpected source: a report of 2 cases. Horm Res Paediatr 2022:000526755. [PMID: 36030768 DOI: 10.1159/000526755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/16/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Hypervitaminosis D is a relatively uncommon etiology of hypercalcemia. Toxicity is usually caused by very high doses, mostly secondary to erroneous prescription or administration of Vitamin D, and less commonly, contaminated foods or manufacturing errors of vitamin D-containing supplements. CASE DESCRIPTION 16 year old male, previously healthy, presented with 2-week history of non specific symptoms (fatigue, gastrointestinal complaints). Investigations showed acute kidney injury and hypercalcemia (total calcium 3.81 mmol/L). Further diagnostic workup revealed markedly elevated 25-hydroxy-vitamin D levels (1910 nmol/L). He denied taking any vitamin D supplements; however, he reported consumption of creatine and protein supplements. Mass spectrometry analysis of the creatine supplement estimated a vitamin D content of 425,000 IU per serving (100 times the upper tolerable daily dose). A few months later, another previously healthy adolescent presented with severe hypercalcemia and acute kidney injury secondary to hypervitaminosis D. He was also using a creatine supplement from the same manufacturer brand and lot. Both patients were treated with IV hydration, calcitonin and pamidronate. They maintained normocalcemia after their initial presentation but required low-calcium diets and laboratory testing for months after this exposure. DISCUSSION We present 2 cases of hypervitaminosis D caused by a manufacturing error of a natural health product which did not claim to contain vitamin D. The use of dietary supplements is highly prevalent; their use should be incorporated in anamnesis and considered a potential source of toxicity when an alternative source cannot be found, regardless of the product label.
Collapse
|
4
|
Goldfarb DM, Mâsse LC, Watts AW, Hutchison SM, Muttucomaroe L, Bosman ES, Barakauskas VE, Choi A, Dhillon N, Irvine MA, Reicherz F, O'Reilly C, Sediqi S, Xu RY, Razzaghian HR, Sadarangani M, Coombs D, O'Brien SF, Lavoie PM. SARS-CoV-2 seroprevalence among Vancouver public school staff in British Columbia, Canada: a cross-sectional study. BMJ Open 2022; 12:e057846. [PMID: 35383082 PMCID: PMC8983418 DOI: 10.1136/bmjopen-2021-057846] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Few studies reported COVID-19 cases in schools during the 2020/21 academic year in a setting of uninterrupted in-person schooling. The main objective was to determine the SARS-CoV-2 seroprevalence among school staff in Vancouver public schools. DESIGN Cumulative incident COVID-19 cases among all students and school staff based on public health data, with an embedded cross-sectional serosurvey among a school staff sample that was compared to period, age, sex and geographical location-weighted data from blood donors. SETTING Vancouver School District (British Columbia, Canada) from kindergarten to grade 12. PARTICIPANTS Active school staff enrolled from 3 February to 23 April 2021 with serology testing from 10 February to 15 May 2021. MAIN OUTCOME MEASURES SARS-CoV-2 seroprevalence among school staff, based on spike (S)-based (unvaccinated staff) or N-based serology testing (vaccinated staff). RESULTS Public health data showed the cumulative incidence of COVID-19 among students attending in-person was 9.8 per 1000 students (n=47 280), and 13 per 1000 among school staff (n=7071). In a representative sample of 1689 school staff, 78.2% had classroom responsibilities, and spent a median of 17.6 hours in class per week (IQR: 5.0-25 hours). Although 21.5% (363/1686) of surveyed staff self-reported close contact with a COVID-19 case outside of their household (16.5% contacts were school-based), 5 cases likely acquired the infection at school based on viral testing. Sensitivity/Specificity-adjusted seroprevalence in 1556/1689 staff (92.1%) was 2.3% (95% CI: 1.6% to 3.2%), comparable to a sex, age, date and residency area-weighted seroprevalence of 2.6% (95% CI: 2.2% to 3.1%) among 5417 blood donors. CONCLUSION Seroprevalence among staff was comparable to a reference group of blood donors from the same community. These data show that in-person schooling could be safely maintained during the 2020/21 school year with mitigation measures, in a large school district in Vancouver, Canada.
Collapse
Affiliation(s)
- David M Goldfarb
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Louise C Mâsse
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allison W Watts
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah M Hutchison
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lauren Muttucomaroe
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Else S Bosman
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vilte E Barakauskas
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Alexandra Choi
- Office of the Medical Health Officer, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Nalin Dhillon
- Office of the Medical Health Officer, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Michael A Irvine
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Frederic Reicherz
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sadaf Sediqi
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Rui Yang Xu
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hamid R Razzaghian
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manish Sadarangani
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Daniel Coombs
- Department of Mathematics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheila F O'Brien
- Epidemiology & Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Pascal M Lavoie
- British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
5
|
Sekirov I, Barakauskas VE, Simons J, Cook D, Bates B, Burns L, Masud S, Charles M, McLennan M, Mak A, Chahil N, Vijh R, Hayden A, Goldfarb D, Levett PN, Krajden M, Morshed M. SARS-CoV-2 serology: Validation of high-throughput chemiluminescent immunoassay (CLIA) platforms and a field study in British Columbia. J Clin Virol 2021; 142:104914. [PMID: 34304088 PMCID: PMC8282439 DOI: 10.1016/j.jcv.2021.104914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/01/2021] [Revised: 06/25/2021] [Accepted: 07/04/2021] [Indexed: 12/29/2022]
Abstract
Background SARS-CoV-2 antibody testing is required for estimating population seroprevalence and vaccine response studies. It may also increase case identification when used as an adjunct to routine molecular testing. We performed a validation study and evaluated the use of automated high-throughput assays in a field study of COVID-19-affected care facilities. Methods Six automated assays were assessed: 1) DiaSorin LIAISONTM SARS-CoV-2 S1/S2 IgG; 2) Abbott ARCHITECTTM SARS-CoV-2 IgG; 3) Ortho VITROSTM Anti-SARS-CoV-2 Total; 4) VITROSTM Anti-SARS-CoV-2 IgG; 5) Siemens SARS-CoV-2 Total Assay; and 6) Roche ElecsysTM Anti-SARS-CoV-2. The validation study included 107 samples (42 known positive; 65 presumed negative). The field study included 296 samples (92 PCR positive; 204 PCR negative or not PCR tested). All samples were tested by the six assays. Results All assays had sensitivities >90% in the field study, while in the validation study, 5/6 assays were >90% sensitive and DiaSorin was 79% sensitive. Specificities and negative predictive values were >95% for all assays. Field study estimated positive predictive values at 1–10% disease prevalence were 100% for Siemens, Abbott and Roche, while DiaSorin and Ortho assays had lower PPVs at 1% prevalence, but PPVs increased at 5–10% prevalence. In the field study, addition of serology increased diagnoses by 16% compared to PCR testing alone. Conclusions All assays evaluated in this study demonstrated high sensitivity and specificity for samples collected at least 14 days post-symptom onset, while sensitivity was variable 0–14 days after infection. The addition of serology to the outbreak investigations increased case detection by 16%.
Collapse
Affiliation(s)
- Inna Sekirov
- BCCDC Public Health Laboratory, BC Centre for Disease Control, Vancouver BC, Canada; Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC, Canada
| | - Vilte E Barakauskas
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC, Canada; BC Children's and Women's Hospital, Vancouver BC, Canada
| | - Janet Simons
- BC Children's and Women's Hospital, Vancouver BC, Canada; Department of Laboratory Medicine, Providence Health Care, Vancouver BC, Canada
| | - Darrel Cook
- BCCDC Public Health Laboratory, BC Centre for Disease Control, Vancouver BC, Canada
| | - Brandon Bates
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC, Canada; BC Children's and Women's Hospital, Vancouver BC, Canada
| | - Laura Burns
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC, Canada; BC Children's and Women's Hospital, Vancouver BC, Canada
| | - Shazia Masud
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC, Canada; Surrey Memorial Hospital, Surrey BC, Canada
| | - Marthe Charles
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC, Canada; Vancouver General Hospital, Vancouver BC, Canada
| | | | - Annie Mak
- BCCDC Public Health Laboratory, BC Centre for Disease Control, Vancouver BC, Canada
| | - Navdeep Chahil
- BCCDC Public Health Laboratory, BC Centre for Disease Control, Vancouver BC, Canada
| | - Rohit Vijh
- Vancouver Coastal Health, Vancouver BC, Canada
| | | | - David Goldfarb
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC, Canada; BC Children's and Women's Hospital, Vancouver BC, Canada
| | - Paul N Levett
- BCCDC Public Health Laboratory, BC Centre for Disease Control, Vancouver BC, Canada; Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC, Canada
| | - Mel Krajden
- BCCDC Public Health Laboratory, BC Centre for Disease Control, Vancouver BC, Canada; Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC, Canada
| | - Muhammad Morshed
- BCCDC Public Health Laboratory, BC Centre for Disease Control, Vancouver BC, Canada; Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC, Canada.
| |
Collapse
|
6
|
Estey MP, Tahooni T, Nelson TN, Parker ML, Agbor TA, Yang HM, Jen R, Barakauskas VE, Lam GY, Matthews A, Mattman A. Is the diagnostic rate for the common subtypes of A1AT deficiency consistent across two Canadian Provinces? Clin Biochem 2021; 95:84-88. [PMID: 33964271 DOI: 10.1016/j.clinbiochem.2021.05.002] [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: 02/18/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The diagnosis of alpha-1-antitrypsin (A1AT) deficiency has been hindered by obscurity concerning the testing process and treatment implications. In this study, we aimed to identify regional differences in the diagnostic rates for A1AT deficiency in the western Canadian provinces of British Columbia (BC) and Alberta (AB). METHODS The number of A1AT deficiency variant genotype (ZZ, SZ, MZ, SS, and MS) diagnoses were reviewed for BC and AB. The regional diagnostic rates for A1AT deficiency variants in these two provinces, normalized for the predicted population prevalence of each variant genotype, was defined as the annual provincial diagnostic rate (APDR) for a given variant genotype. Sex specific variations in the mean age at diagnosis for the five variant genotypes were compared both within and between provinces. RESULTS The SZ and MZ genotype APDRs were significantly increased in the AB population compared to the BC population. The SS and MS APDRs were similar between AB and BC. There was a significantly decreased mean age of diagnosis for AB males, as compared to BC males (for the SZ, MS, and MZ genotypes) and as compared to AB females (for the MS, MZ, and SS genotypes). There were no significant differences in the mean age of diagnosis between the females and males in BC, or between females in AB and BC, for any genotype. CONCLUSION The notably higher APDR for more severe A1AT deficiency genotypes, and lower mean age of diagnosis for most variant genotypes in AB males, deserves further investigation to determine the explanation(s) for these differences.
Collapse
Affiliation(s)
- Mathew P Estey
- DynaLIFE Medical Labs, 200, 10150 102 St, Edmonton, AB T5J 5E2, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, 5B4.02 Walter C. Mackenzie Health Sciences Centre, Edmonton, AB T6G 2R7, Canada.
| | - Tania Tahooni
- Department of Pathology and Laboratory Medicine, St Paul's Hospital, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada
| | - Tanya N Nelson
- Department of Pathology and Laboratory Medicine, BC Children's & BC Women's Hospitals, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Room 2J10, Vancouver, BC V6H 3V4, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Rm. G227 - 2211 Westbrook Mall, Vancouver, BC V6T 2B5, Canada.
| | - Michelle L Parker
- DynaLIFE Medical Labs, 200, 10150 102 St, Edmonton, AB T5J 5E2, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, 5B4.02 Walter C. Mackenzie Health Sciences Centre, Edmonton, AB T6G 2R7, Canada.
| | - Terence A Agbor
- DynaLIFE Medical Labs, 200, 10150 102 St, Edmonton, AB T5J 5E2, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, 5B4.02 Walter C. Mackenzie Health Sciences Centre, Edmonton, AB T6G 2R7, Canada.
| | - Hui-Min Yang
- Department of Pathology and Laboratory Medicine, University of British Columbia, Rm. G227 - 2211 Westbrook Mall, Vancouver, BC V6T 2B5, Canada; Department of Pathology and Laboratory Medicine, Vancouver General Hospital, 910 W 10th Ave., Vancouver, BC V5Z 1M9, Canada
| | - Rachel Jen
- Department of Medicine, Division of Respiratory Medicine, University of British Columbia, 7th Floor, 2775 Laurel Street, BC V5Z 1M9, Canada; Department of Medicine, Division of Pulmonary Medicine, University of Alberta, 11302 83 Ave NW, Edmonton, AB T6G 2G3, Canada
| | - Vilte E Barakauskas
- Department of Pathology and Laboratory Medicine, BC Children's & BC Women's Hospitals, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Room 2J10, Vancouver, BC V6H 3V4, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Rm. G227 - 2211 Westbrook Mall, Vancouver, BC V6T 2B5, Canada.
| | - Grace Y Lam
- Department of Medicine, Division of Pulmonary Medicine, University of Alberta, 11302 83 Ave NW, Edmonton, AB T6G 2G3, Canada.
| | - Allison Matthews
- Department of Pathology and Laboratory Medicine, BC Children's & BC Women's Hospitals, Children's and Women's Health Centre of British Columbia, 4480 Oak Street, Room 2J10, Vancouver, BC V6H 3V4, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Rm. G227 - 2211 Westbrook Mall, Vancouver, BC V6T 2B5, Canada
| | - Andre Mattman
- Department of Pathology and Laboratory Medicine, St Paul's Hospital, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Rm. G227 - 2211 Westbrook Mall, Vancouver, BC V6T 2B5, Canada.
| |
Collapse
|
7
|
Majdoubi A, Michalski C, O'Connell SE, Dada S, Narpala S, Gelinas J, Mehta D, Cheung C, Winkler DF, Basappa M, Liu AC, Görges M, Barakauskas VE, Irvine M, Mehalko J, Esposito D, Sekirov I, Jassem AN, Goldfarb DM, Pelech S, Douek DC, McDermott AB, Lavoie PM. A majority of uninfected adults show preexisting antibody reactivity against SARS-CoV-2. JCI Insight 2021; 6:146316. [PMID: 33720905 PMCID: PMC8119195 DOI: 10.1172/jci.insight.146316] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/12/2021] [Indexed: 12/24/2022] Open
Abstract
Preexisting cross-reactivity to SARS-CoV-2 occurs in the absence of prior viral exposure. However, this has been difficult to quantify at the population level due to a lack of reliably defined seroreactivity thresholds. Using an orthogonal antibody testing approach, we estimated that about 0.6% of nontriaged adults from the greater Vancouver, Canada, area between May 17 and June 19, 2020, showed clear evidence of a prior SARS-CoV-2 infection, after adjusting for false-positive and false-negative test results. Using a highly sensitive multiplex assay and positive/negative thresholds established in infants in whom maternal antibodies have waned, we determined that more than 90% of uninfected adults showed antibody reactivity against the spike protein, receptor-binding domain (RBD), N-terminal domain (NTD), or the nucleocapsid (N) protein from SARS-CoV-2. This seroreactivity was evenly distributed across age and sex, correlated with circulating coronaviruses' reactivity, and was partially outcompeted by soluble circulating coronaviruses' spike. Using a custom SARS-CoV-2 peptide mapping array, we found that this antibody reactivity broadly mapped to spike and to conserved nonstructural viral proteins. We conclude that most adults display preexisting antibody cross-reactivity against SARS-CoV-2, which further supports investigation of how this may impact the clinical severity of COVID-19 or SARS-CoV-2 vaccine responses.
Collapse
Affiliation(s)
- Abdelilah Majdoubi
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christina Michalski
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah E O'Connell
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Sarah Dada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sandeep Narpala
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Jean Gelinas
- Department of Anesthesiology, Surrey Memorial Hospital (SMH), Surrey, British Columbia, Canada.,Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Disha Mehta
- Department of Anesthesiology, Surrey Memorial Hospital (SMH), Surrey, British Columbia, Canada.,Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Claire Cheung
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dirk Fh Winkler
- Kinexus Bioinformatics Corporation, Vancouver, British Columbia, Canada
| | - Manjula Basappa
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Aaron C Liu
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Vaccine Evaluation Centre, BC Children's Hospital Research Institute, Vancouver, British Columbia
| | - Matthias Görges
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vilte E Barakauskas
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mike Irvine
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Jennifer Mehalko
- National Cancer Institute RAS Initiative, Cancer Research Technology Program, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, Maryland, USA
| | - Dominic Esposito
- National Cancer Institute RAS Initiative, Cancer Research Technology Program, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, Maryland, USA
| | - Inna Sekirov
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Centre for Disease Control (CDC) Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Agatha N Jassem
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Centre for Disease Control (CDC) Public Health Laboratory, Vancouver, British Columbia, Canada
| | - David M Goldfarb
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Medical Microbiology, Department of Pathology and Laboratory Medicine, and
| | - Steven Pelech
- Kinexus Bioinformatics Corporation, Vancouver, British Columbia, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Daniel C Douek
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Adrian B McDermott
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Pascal M Lavoie
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
8
|
Majdoubi A, Michalski C, O'Connell SE, Dada S, Narpala S, Gelinas J, Mehta D, Cheung C, Basappa M, Liu AC, Gorges M, Barakauskas VE, Mehalko J, Esposito D, Sekirov I, Jassem AN, Goldfarb DM, Douek DC, McDermott AB, Lavoie PM. Antibody reactivity to SARS-CoV-2 is common in unexposed adults and infants under 6 months. medRxiv 2020:2020.10.05.20206664. [PMID: 33052362 PMCID: PMC7553187 DOI: 10.1101/2020.10.05.20206664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Pre-existing antibody reactivity against SARS-CoV-2 in unexposed people is a potentially important consideration for COVID-19 severity and vaccine responses. However, it has been difficult to quantify due to a lack of reliable defined background titers in unexposed individuals. METHODS We measured IgG against multiple SARS-CoV-2 antigens, SARS-CoV and other circulating coronavirus spike proteins using a highly sensitive multiplex assay, and total SARS-CoV-2 spike-specific antibodies (IgG/M/A) using a commercial CLIA assay in 276 adults from the Vancouver area, Canada between May 17th and June 19th 2020. Reactivity threshold in unexposed individuals were defined comparing to pre-pandemic sera and to sera from infants under 6 months of age. RESULTS The seroprevalence from a SARS-CoV-2 exposure, adjusted for false-positive and false-negative test results, was 0.60% in our adult cohort. High antibody reactivity to circulating endemic coronaviruses was observed in all adults and was about 10-fold lower in infants under 6 months. Consistent with a waning of maternal antibodies, reactivity in infants decreased more than 50-fold eight months later. SARS-CoV-2 Spike, RBD, NTD or nucleocapsid antibody reactivity >100-fold above that of older infants was detected in the vast majority of unexposed adults and pre-pandemic sera. This antibody reactivity correlated with titers against circulating coronaviruses, but not with age, sex, or whether adults were healthcare workers. CONCLUSION A majority of unexposed adults have pre-existing antibody reactivity against SARS-CoV-2. The lack of similar antibody reactivity in infants where maternal antibodies have waned suggests that this cross-reactivity is acquired, likely from repeated exposures to circulating coronaviruses.
Collapse
|
9
|
Mattman A, Gilfix BM, Chen SX, DeMarco ML, Kyle BD, Parker ML, Agbor TA, Jung B, Selvarajah S, Barakauskas VE, Vaags AK, Estey MP, Nelson TN, Speevak MD. Alpha-1-antitrypsin molecular testing in Canada: A seven year, multi-centre comparison. Clin Biochem 2020; 81:27-33. [DOI: 10.1016/j.clinbiochem.2020.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022]
|
10
|
Gill J, Barakauskas VE, Thomas D, Rodriguez-Capote K, Higgins T, Zhang D, VanSpronsen A, Babenko O, Martindale R, Estey MP. Evaluation of thyroid test utilization through analysis of population-level data. Clin Chem Lab Med 2017; 55:1898-1906. [PMID: 28306523 DOI: 10.1515/cclm-2016-1049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/04/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Inappropriate laboratory test utilization can result in unnecessary patient testing and increased healthcare costs. While several thyroid function tests are available, thyroid-stimulating hormone (TSH) is recommended as the first-line test for investigating and monitoring thyroid dysfunction. We evaluate thyroid test utilization in Northern Alberta in terms of testing patterns, frequencies, and reflex cutpoints. METHODS This retrospective study analyzed thyroid test requests from January to December 2014. Each request was designated as appropriate or potentially inappropriate as per clinical practice guidelines and Choosing Wisely recommendations, and the frequencies of each testing pattern were calculated. Sub-analysis was performed to categorize testing patterns based on physician specialty. The number of test requests per patient was determined to assess the appropriateness of testing frequency. Receiver operating characteristic (ROC) curves were generated to define optimal TSH cutpoints for automatic reflex to FT4 testing. RESULTS Of 752,217 test requests, approximately 10% were potentially inappropriate in terms of testing patterns. Free thyroxine (FT4) and free triiodothyronine (FT3) requested with TSH accounted for 59% of all potentially inappropriate test requests, and 49% of requests from endocrinologists (ENDO) were potentially inappropriate, occurring most frequently among those with less experience. Excessive testing frequencies were observed in 869 patients, accounting for 9382 test requests. Adjustment of our TSH reflex cutpoint would significantly increase specificity for identifying a low FT4 without compromising sensitivity. CONCLUSIONS This study suggests that questionable testing patterns, excessive testing frequencies, and suboptimal reflexive testing cutpoints contribute to inappropriate thyroid test utilization.
Collapse
|
11
|
Walker BS, Barakauskas VE, Grenache DG, Schmidt RL. Effect of Preanalytical Factors on the Stability of Maternal Serum Biomarkers and Calculated Risk for Trisomy 21, Trisomy 18, and Open Neural Tube Defect. J Appl Lab Med 2017; 1:690-701. [PMID: 33379822 DOI: 10.1373/jalm.2016.022400] [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: 10/25/2016] [Accepted: 12/28/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Biochemical prenatal screening tests are used to determine the risk of fetal aneuploidy based on the concentration of several biomarkers. The concentration of these biomarkers could be affected by preanalytical factors (PAFs) such as sample type (whole blood vs serum), storage time, and storage temperature. The impact of these factors on posttest risk is unknown. METHODS Blood samples were collected from 25 pregnant patients. Each sample was divided into 24 aliquots, and each aliquot was subjected to 1 of 24 different treatments (2 sample types × 2 temperatures × 6 storage times). The impact of each PAF on calculated risk was estimated using mixed-effects regression and simulation analysis. RESULTS PAFs were associated with statistically significant changes in concentration for some analytes. Simulation studies showed that PAFs accounted for 6% of the variation in posttest risk, and analytical imprecision accounted for 94% of the variation. We estimated that the background misclassification rate due to analytical imprecision is approximately 1.37% for trisomy 21 and 0.12% for trisomy 18. Preanalytical factors increased the probability of misclassification by 0.46% and 0.06% for trisomies 21 and 18, respectively. CONCLUSIONS Relaxing sample specifications for biochemical prenatal serum screening tests to permit analysis of serum samples stored for up to 72 h at room temperature or 4 °C as well as serum obtained from whole blood stored similarly has a small impact in calculated posttest aneuploidy risk.
Collapse
Affiliation(s)
- Brandon S Walker
- ARUP Laboratories, Salt Lake City, UT.,Department of Pathology, Center for Effective Medical Testing, University of Utah, Salt Lake City, UT
| | - Vilte E Barakauskas
- ARUP Laboratories, Salt Lake City, UT.,Department of Pathology, University of Utah, Salt Lake City, UT
| | - David G Grenache
- ARUP Laboratories, Salt Lake City, UT.,Department of Pathology, University of Utah, Salt Lake City, UT
| | - Robert L Schmidt
- ARUP Laboratories, Salt Lake City, UT.,Department of Pathology, Center for Effective Medical Testing, University of Utah, Salt Lake City, UT
| |
Collapse
|
12
|
Barakauskas VE, Moradian A, Barr AM, Beasley CL, Rosoklija G, Mann JJ, Ilievski B, Stankov A, Dwork AJ, Falkai P, Morin GB, Honer WG. Quantitative mass spectrometry reveals changes in SNAP-25 isoforms in schizophrenia. Schizophr Res 2016; 177:44-51. [PMID: 26971072 PMCID: PMC5017887 DOI: 10.1016/j.schres.2016.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/02/2016] [Accepted: 03/04/2016] [Indexed: 11/24/2022]
Abstract
SNAP-25 and syntaxin are presynaptic terminal SNARE proteins altered in amount and function in schizophrenia. In the ventral caudate, we observed 32% lower SNAP-25 and 26% lower syntaxin, but greater interaction between the two proteins using an in vitro assay. SNAP-25 has two isoforms, SNAP-25A and B, differing by only 9 amino acids, but with different effects on neurotransmission. A quantitative mass spectrometry assay was developed to measure total SNAP-25, and proportions of SNAP-25A and B. The assay had a good linear range (50- to 150-fold) and coefficient of variation (4.5%). We studied ventral caudate samples from patients with schizophrenia (n=15) previously reported to have lower total SNAP-25 than controls (n=13). We confirmed 27% lower total SNAP-25 in schizophrenia, and observed 31% lower SNAP-25A (P=0.002) with 20% lower SNAP-25B amounts (P=0.10). Lower SNAP-25A amount correlated with greater SNAP-25-syntaxin protein-protein interactions (r=-0.41, P=0.03); the level of SNAP-25B did not. Administration of haloperidol or clozapine to rats did not mimic the changes found in schizophrenia. The findings suggest that lower levels of SNAP-25 in schizophrenia may represent a greater effect of the illness on the SNAP-25A isoform. This in turn could contribute to the greater interaction between SNAP25 and syntaxin, and possibly disturb neurotransmission in the illness.
Collapse
Affiliation(s)
- Vilte E Barakauskas
- BC Mental Health and Addictions Research Institute, Vancouver, BC,Department of Psychiatry, University of British Columbia, Vancouver, BC
| | - Annie Moradian
- Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC
| | - Alasdair M. Barr
- BC Mental Health and Addictions Research Institute, Vancouver, BC,Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC
| | - Clare L Beasley
- BC Mental Health and Addictions Research Institute, Vancouver, BC,Department of Psychiatry, University of British Columbia, Vancouver, BC
| | - Gorazd Rosoklija
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute; and Department of Psychiatry, Columbia University, New York, NY, USA,Macedonian Academy of Sciences and Arts, University “SS. Cyril and Methodius,” Skopje, Macedonia
| | - J John Mann
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute; and Department of Psychiatry, Columbia University, New York, NY, USA
| | - Boro Ilievski
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute; and Department of Psychiatry, Columbia University, New York, NY, USA,Institute for Pathology, University “SS. Cyril and Methodius,” Skopje, Macedonia
| | - Aleksandar Stankov
- Institute of Forensic Medicine, Criminology and Medical Deontology, University “SS. Cyril and Methodius,” Skopje, Macedonia
| | - Andrew J Dwork
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute; and Department of Psychiatry, Columbia University, New York, NY, USA,Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Gregg B Morin
- Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.
| | - William G Honer
- BC Mental Health and Addictions Research Institute, Vancouver, BC, Canada; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
13
|
Barakauskas VE, Bradshaw TA, Smith LD, Lehman CM, Johnson-Davis KL. Process Optimization to Improve Immunosuppressant Drug Testing Turnaround Time. Am J Clin Pathol 2016; 146:182-90. [PMID: 27453440 DOI: 10.1093/ajcp/aqw087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 11/13/2022] Open
Abstract
OBJECTIVES Timely reporting of immunosuppressant (ISP) drug level results is needed for transplant patient management. This study characterized the local ISP testing process, identified bottlenecks and implemented process improvements to meet turnaround time requirements. METHODS Laboratory information time stamps, direct observation and discussion with staff were used to construct a value stream map of the ISP testing process to identify process bottlenecks. Improvements were implemented to attain the required turnaround time. RESULTS Baseline performance of the existing ISP process (seven weeks, n = 272 samples) indicated that only 28% of samples were reported by 2:00 pm Major bottlenecks were identified to be the analytical run schedule, instrument delays, difficulty identifying ISP samples at intake, and difficulty collecting specimens. Process changes resulted in a median of 76% samples reported by 2:00 pm CONCLUSIONS : Adjusting ISP collection and analysis processes improved the laboratory's ability to meet physician requested result reporting time of 2:00 pm.
Collapse
Affiliation(s)
- Vilte E Barakauskas
- From the Department of Pathology and Laboratory Medicine, Children's and Women's Health Centre of British Columbia, Vancouver, Canada Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | | | - Lonnie D Smith
- University of Utah Health Care, Pharmacy Transplant Services, Salt Lake City
| | - Christopher M Lehman
- Department of Pathology, University of Utah Health Sciences Center, Salt Lake City
| | - Kamisha L Johnson-Davis
- Department of Pathology, University of Utah Health Sciences Center, Salt Lake City ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT.
| |
Collapse
|
14
|
Turley E, Rodríguez-Capote K, Estey MP, Barakauskas VE, Bailey GR, McKenzie LM, Higgins TN. Erroneous diabetes diagnosis: a case of HbA1c interference. Diabetes Care 2015; 38:e154-5. [PMID: 26294665 DOI: 10.2337/dc15-0733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/14/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Elona Turley
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Karina Rodríguez-Capote
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada Department of Clinical Chemistry, DynaLIFEDx, Edmonton, Alberta, Canada
| | - Mathew P Estey
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada Department of Clinical Chemistry, DynaLIFEDx, Edmonton, Alberta, Canada
| | - Vilte E Barakauskas
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada Department of Clinical Chemistry, DynaLIFEDx, Edmonton, Alberta, Canada
| | | | | | - Trefor N Higgins
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada Department of Clinical Chemistry, DynaLIFEDx, Edmonton, Alberta, Canada
| |
Collapse
|
15
|
Andreazza AC, Barakauskas VE, Fazeli S, Feresten A, Shao L, Wei V, Wu CH, Barr AM, Beasley CL. Effects of haloperidol and clozapine administration on oxidative stress in rat brain, liver and serum. Neurosci Lett 2015; 591:36-40. [PMID: 25684243 DOI: 10.1016/j.neulet.2015.02.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 01/08/2015] [Accepted: 02/11/2015] [Indexed: 10/24/2022]
Abstract
Antipsychotics remain the standard of care for individuals with schizophrenia, despite their association with adverse effects including extrapyramidal symptoms, metabolic syndrome and agranulocytosis. While the biological mechanisms underlying these side effects remain unresolved, it has been proposed that oxidative stress may play a role in their development. The aim of this study was to evaluate markers of oxidative stress associated with first- and second-generation antipsychotics, focusing on protein and lipid oxidation and expression of the antioxidant proteins peroxiredoxin-2 and peroxiredoxin-6. Following 28-day administration of haloperidol, clozapine or saline to adult rats, brain grey matter, white matter, serum and liver samples were obtained and lipid peroxidation, protein oxidation, peroxiredoxin-2 and peroxiredoxin-6 levels quantified. In grey matter, peroxiredoxin-6 was significantly increased in the haloperidol-exposed animals, with a trend towards increased lipid peroxidation also observed in this group. In liver, lipid peroxidation was increased in the clozapine-exposed animals, with a similar trend noted in the haloperidol group. Antipsychotics did not produce significant changes in serum or white matter. Our results suggest that haloperidol and clozapine may induce oxidative stress in brain and liver, respectively, consistent with the documented adverse effects of these agents.
Collapse
Affiliation(s)
- Ana C Andreazza
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Vilte E Barakauskas
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Salar Fazeli
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Abigail Feresten
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Li Shao
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Vivien Wei
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Che Hsuan Wu
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M Barr
- Department of Anaesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Clare L Beasley
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
16
|
Estey MP, Capote KR, Barakauskas VE, Clarke G, Higgins T. Hemoglobin C in a patient with sickle cell anemia: transfusion-acquired SC disease. Clin Biochem 2015; 48:463-4. [PMID: 25661304 DOI: 10.1016/j.clinbiochem.2015.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Mathew P Estey
- DynaLIFE(Dx)¸ Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Canada.
| | - Karina Rodriguez Capote
- DynaLIFE(Dx)¸ Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Canada
| | - Vilte E Barakauskas
- DynaLIFE(Dx)¸ Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Canada
| | - Gwen Clarke
- Department of Laboratory Medicine and Pathology, University of Alberta, Canada; Canadian Blood Services, Edmonton, Canada
| | | |
Collapse
|
17
|
|
18
|
Abstract
Abstract
BACKGROUND
False-positive drug screen results for tetrahydrocannabinol (THC) have been observed. This study investigated the rate of unconfirmed positive screen results in infant and noninfant urine samples and evaluated possible reasons for differences.
METHODS
The rate of unconfirmed positive THC screen results for urine samples was determined retrospectively in 2 independent data sets (n = 14 859, reference laboratory; n = 21 807, hospital laboratory) by comparing positive immunoassay-based drug screen results with the associated results of confirmation tests. We then assessed the rate of positive THC screens for samples with varying likelihoods of cannabinoid presence to evaluate the contribution of infant-specific urine constituents to positive results. Finally, a method to detect a THC metabolite (11-hydroxy-Δ9-THC) that occurs in meconium was developed to determine its prevalence in infant urine.
RESULTS
Positive screen results failed to confirm more frequently in samples from infants (47%) than in noninfants (0.8%). The hospital laboratory observed a similar discrepancy with a different immunoassay. Infant samples with a high likelihood of containing cannabinoids despite negative confirmatory results had a similar rate of positive screening results (50%, n = 20), whereas all samples with a low likelihood of containing cannabinoids screened negative (n = 23). 11-Hydroxy-Δ9-THC was not detected in any infant urine sample tested (n = 16).
CONCLUSIONS
Conventional confirmatory methods for THC may be inappropriate for urine samples from infants. Our results suggest that one or more currently unrecognized THC-associated compounds are responsible for positive THC screen results for infant urine, as opposed to an infant-associated interference.
Collapse
Affiliation(s)
- Vilte E Barakauskas
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT
| | - Rebecka Davis
- ARUP Institute for Clinical and Experimental Pathology, ARUP Laboratories Inc., Salt Lake City, UT
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Gwendolyn A McMillin
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT
- ARUP Institute for Clinical and Experimental Pathology, ARUP Laboratories Inc., Salt Lake City, UT
| |
Collapse
|
19
|
Affiliation(s)
- Shawn R Clinton
- University of Utah School of Medicine, Department of Pathology, Salt Lake City, UT, USA
| | | | | |
Collapse
|
20
|
Abstract
Motherhood differentially affects learning and memory performance and this effect depends on reproductive experience. In turn, evidence suggests that the effects of oestradiol on learning and memory are mediated through binding to oestrogen receptors in the hippocampus and that this is related to hippocampal neurogenesis. The present study investigated the effect of pregnancy and reproductive experience on ERalpha expression throughout the hippocampus, as well as cell proliferation, new cell survival and cell death (as measured by pyknotic cells) in the granule cell layer of the hippocampus. Three groups of female Sprague-Dawley rats were used: virgin, primigravid and multigravid. All rats were injected with 5-bromo-2-deoxyuridine (BrdU; 200 mg/kg) on the afternoon of impregnation and at matched time-points in virgins. Rats were perfused either during early pregnancy (gestation day 1) or late pregnancy (gestation day 21) after BrdU injection. The results obtained show that, during late pregnancy, females, whether first or second pregnancy, have fewer ERalpha-positive cells in the CA3 region of the dorsal hippocampus than virgin females. In addition during early pregnancy, females have significantly fewer pyknotic cells in the granule cell layer than virgin females. There were no other differences between groups in the number of ERalpha-positive, BrdU-positive or pyknotic cells. Future studies will aim to investigate the mechanisms and consequences of the alteration in ERalpha expression in the hippocampus during late pregnancy, as well as the possible changes in ERbeta expression at this time.
Collapse
Affiliation(s)
- J L Pawluski
- Program in Neuroscience, Department of Psychology and Brain Research Centre, University of British Columbia, Vancouver, BC, Canada
| | | | | |
Collapse
|
21
|
Barakauskas VE, Beasley CL, Barr AM, Ypsilanti AR, Li HY, Thornton AE, Wong H, Rosokilja G, Mann JJ, Mancevski B, Jakovski Z, Davceva N, Ilievski B, Dwork AJ, Falkai P, Honer WG. A novel mechanism and treatment target for presynaptic abnormalities in specific striatal regions in schizophrenia. Neuropsychopharmacology 2010; 35:1226-38. [PMID: 20072114 PMCID: PMC3055413 DOI: 10.1038/npp.2009.228] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 11/06/2009] [Accepted: 11/20/2009] [Indexed: 02/01/2023]
Abstract
Abnormalities of amount and function of presynaptic terminals may have an important role in the mechanism of illness in schizophrenia. The SNARE proteins (SNAP-25, syntaxin, and VAMP) are enriched in presynaptic terminals, where they interact to form a functional complex to facilitate vesicle fusion. SNARE protein amounts are altered in the cortical regions in schizophrenia, but studies of protein-protein interactions are limited. We extended these investigations to the striatal regions (such as the nucleus accumbens, ventromedial caudate (VMC), and dorsal caudate) relevant to disease symptoms. In addition to measuring SNARE protein levels, we studied SNARE protein-protein interactions using a novel ELISA method. The possible effect of antipsychotic treatment was investigated in parallel in the striatum of rodents that were administered haloperidol and clozapine. In schizophrenia samples, compared with controls, SNAP-25 was 32% lower (P=0.015) and syntaxin was 26% lower (P=0.006) in the VMC. In contrast, in the same region, SNARE protein-protein interactions were higher in schizophrenia (P=0.008). Confocal microscopy of schizophrenia and control VMC showed qualitatively similar SNARE protein immunostaining. Haloperidol treatment of rats increased levels of SNAP-25 (mean 24%, P=0.003), syntaxin (mean 18%, P=0.010), and VAMP (mean 16%, P=0.001), whereas clozapine increased only the VAMP level (mean 13%, P=0.004). Neither drug altered SNARE protein-protein interactions. These results indicate abnormalities of amount and interactions of proteins directly related to presynaptic function in the VMC in schizophrenia. SNARE proteins and their interactions may be a novel target for the development of therapeutics.
Collapse
Affiliation(s)
- Vilte E Barakauskas
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Clare L Beasley
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Athena R Ypsilanti
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Hong-Ying Li
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Hubert Wong
- Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC, Canada
| | - Gorazd Rosokilja
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Surgeons of Columbia University, New York, NY, USA
- Macedonian Academy of Sciences and Arts, University ‘SS. Cyril and Methodius' Skopje, Macedonia
| | - J John Mann
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Surgeons of Columbia University, New York, NY, USA
| | - Branislav Mancevski
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Surgeons of Columbia University, New York, NY, USA
| | - Zlatko Jakovski
- Institute for Forensic Medicine, University ‘SS. Cyril and Methodius,' Skopje, Macedonia
| | - Natasha Davceva
- Institute for Forensic Medicine, University ‘SS. Cyril and Methodius,' Skopje, Macedonia
| | - Boro Ilievski
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
- Institute for Pathology, University ‘SS. Cyril and Methodius,', Skopje, Macedonia
| | - Andrew J Dwork
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Surgeons of Columbia University, New York, NY, USA
- Department of Pathology and Cell Biology, College of Physicians, Surgeons of Columbia University, New York, NY, USA
| | - Peter Falkai
- Department of Psychiatry, Göttingen University, Göttingen, Germany
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
22
|
Van Raamsdonk JM, Pearson J, Rogers DA, Lu G, Barakauskas VE, Barr AM, Honer WG, Hayden MR, Leavitt BR. Ethyl-EPA treatment improves motor dysfunction, but not neurodegeneration in the YAC128 mouse model of Huntington disease. Exp Neurol 2005; 196:266-72. [PMID: 16129433 DOI: 10.1016/j.expneurol.2005.07.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [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: 04/30/2005] [Revised: 07/09/2005] [Accepted: 07/28/2005] [Indexed: 10/25/2022]
Abstract
Huntington disease (HD) is an adult-onset neurodegenerative disorder that is characterized by selective degeneration in the striatum. There are currently no treatments that can prevent the progressive decline of motor and cognitive function in HD. In parallel with a human clinical trial, we examined the efficacy of ethyl-EPA treatment in the YAC128 mouse model of HD. Oral delivery of ethyl-EPA to symptomatic YAC128 mice beginning at 7 months of age increased membrane EPA levels 3-fold (P < 0.001) and resulted in a modest but significant improvement in motor dysfunction by 12 months of age as measured by open-field activity (P = 0.01) and performance on the rotarod (P = 0.05). At this age, ethyl-EPA-treated YAC128 mice showed no improvement in striatal volume, striatal neuron counts, striatal neuronal cross-sectional area, or striatal DARPP-32 expression compared to untreated YAC128 mice, thereby indicating no reduction of striatal neuropathology. This result is congruent with modest motor benefits observed in HD patients treated with ethyl-EPA. Overall, this work demonstrates the feasibility of experimental therapeutics in the YAC128 mouse model and suggests that experiments in these mice may be predictive for future human clinical trials.
Collapse
Affiliation(s)
- Jeremy M Van Raamsdonk
- Department of Medical Genetics and Centre for Molecular Medicine and Therapeutics, British Columbia Research Institute for Children's and Women's Health, University of British Columbia, 980 West 28th Avenue, Vancouver, BC, Canada V5Z 4H4
| | | | | | | | | | | | | | | | | |
Collapse
|