Multiplex Analysis of 230 Medications and 30 Illicit Compounds in Dried Blood Spots and Urine

2020 ◽  
Author(s):  
Christian Tagwerker ◽  
Irfan Baig ◽  
Eric J Brunson ◽  
Davan Dutra-Smith ◽  
Mary-Jane Carias ◽  
...  
Keyword(s):  
Medication Reconciliation ◽  
Dried Blood Spots ◽  
Mass Spectrometry Analysis ◽  
Clinical Samples ◽  
Medication List ◽  
Predictive Values ◽  
Multiplex Analysis ◽  
Blood Spots ◽  
Positive Results ◽  
Urine Specimens

Abstract Drugs of abuse and medication reconciliation testing can benefit from analysis methods capable of detecting a broader range of drug classes and analytes. Mass spectrometry analysis of a wide variety of commonly prescribed medications and over-the-counter drugs per sample also allows for application of a drug–drug interaction (DDI) algorithm to detect adverse drug reactions. In order to prevent adulteration of commonly collected clinical samples such as urine, dried blood spots (DBS) present a reliable alternative. A novel method is described for qualitative and quantitative multiplex analysis of 230 parent drugs, 30 illicit drugs and 43 confirmatory metabolites by HPLC–MS-MS This method is applicable to DBS specimens collected by volumetric absorptive microsamplers and confirmable in urine specimens. A patient cohort (n = 67) providing simultaneous urine specimens and DBS resulted in 100% positive predictive values of medications or illicits confirmed by detection of a parent drug and/or its metabolite during routine medication adherence analysis. An additional 5,508 DBS specimens screened (n = 5,575) showed 5,428 (97%) with an inconsistent positive compared to the provided medication list (including caffeine, cotinine or ethanol metabolites), 29 (0.5%) with no medication list and no unexpected positive results (consistent negative) and 22 (0.4%) showed all positive results matching the provided medication list (consistent positive). A DDI algorithm applied to all positive results revealed 17% with serious and 56% with moderate DDI warnings. Comprehensive DBS analysis proves a reliable alternative to urine drug testing for extended medication reconciliation, with the added advantage of detecting DDIs.

scholarly journals Assessment of Plasmodium antigens and CRP in dried blood spots with multiplex malaria array

2021 ◽  
Author(s):  
Ihn Kyung Jang ◽  
Sara Aranda ◽  
Rebecca Barney ◽  
Andrew Rashid ◽  
Muhammad Helwany ◽  
...  
Keyword(s):  
Thermal Stability ◽  
Whole Blood ◽  
Dried Blood Spots ◽  
Careful Consideration ◽  
Clinical Samples ◽  
Sample Type ◽  
Sample Collection ◽  
Malaria Surveillance ◽  
Inflammatory Biomarker ◽  
Blood Spots

AbstractDried blood spots (DBS) typically prepared on filter papers are an ideal sample type for malaria surveillance by offering easy and cost-effective methods in terms of sample collection, storage, and transport. The objective of this study was to evaluate the applicability of DBS with a commercial multiplex malaria assay, developed to concurrently measure Plasmodium antigens, histidine-rich protein 2 (HRP2), Plasmodium lactate dehydrogenase (pLDH), and a host inflammatory biomarker, C-reactive protein (CRP), in whole blood. The assay conditions were optimized for DBS, and thermal stability for measurement of Plasmodium antigens and CRP in dried blood were determined. Performance of the multiplex assay on matched DBS and whole blood pellet samples was also evaluated using the clinical samples. The results indicate the acceptable performance in multiplex antigen detection using DBS samples. At cutoff levels for DBS, with a diagnostic specificity with a lower 95% confidence bound > 92%, diagnostic sensitivities against polymerase chain reaction (PCR)–confirmed malaria for HRP2, Pf LDH, Pv LDH, and Pan LDH were 93.5%, 80.4%, 21.3%, and 55.6%, respectively. The half-life of pLDH was significantly less than that of HRP2 in thermal stability studies. Results with DBS samples collected from Peru indicate that the uncontrolled storage conditions of DBS can result in inaccurate reporting for infection with P. falciparum parasites with hrp2/3 deletions. With careful consideration that minimizing the unfavorable DBS storage environment is essential for ensuring integrity of heat-labile Plasmodium antigens, DBS samples can be used as an alternative to liquid whole blood to detect P. falciparum with hrp2/3 deletions in malaria surveillance.

scholarly journals Second-Tier Test for Quantification of Alloisoleucine and Branched-Chain Amino Acids in Dried Blood Spots to Improve Newborn Screening for Maple Syrup Urine Disease (MSUD)

2008 ◽  
Vol 54 (3) ◽  
pp. 542-549 ◽  
Author(s):  
Devin Oglesbee ◽  
Karen A Sanders ◽  
Jean M Lacey ◽  
Mark J Magera ◽  
Bruno Casetta ◽  
...  
Keyword(s):  
Amino Acids ◽  
Newborn Screening ◽  
Dried Blood Spots ◽  
Branched Chain Amino Acids ◽  
Maple Syrup ◽  
Blood Spots ◽  
Urine Disease ◽  
Second Tier ◽  
Branched Chain ◽  
Positive Results

Abstract Background: Newborn screening for maple syrup urine disease (MSUD) relies on finding increased concentrations of the branched-chain amino acids (BCAAs) leucine, isoleucine, and valine by tandem mass spectrometry (MS/MS). d-Alloisoleucine (allo-Ile) is the only pathognomonic marker of MSUD, but it cannot be identified by existing screening methods because it is not differentiated from isobaric amino acids. Furthermore, newborns receiving total parenteral nutrition often have increased concentrations of BCAAs. To improve the specificity of newborn screening for MSUD and to reduce the number of diet-related false-positive results, we developed a LC-MS/MS method for quantifying allo-Ile. Methods: Allo-Ile and other BCAAs were extracted from a 3/16-inch dried blood spot punch with methanol/H2O, dried under nitrogen, and reconstituted into mobile phase. Quantitative LC-MS/MS analysis of allo-Ile, its isomers, and isotopically labeled internal standards was achieved within 15 min. To determine a reference interval for BCAAs including allo-Ile, we analyzed 541 dried blood spots. We also measured allo-Ile in blinded samples from 16 MSUD patients and 21 controls and compared results to an HPLC method. Results: Intra- and interassay imprecision (mean CVs) for allo-Ile, leucine, isoleucine, and valine ranged from 1.8% to 7.4%, and recovery ranged from 91% to 129%. All 16 MSUD patients were correctly identified. Conclusions: The LC-MS/MS method can reliably measure allo-Ile in dried blood spots for the diagnosis of MSUD. Applied to newborn screening as a second-tier test, it will reduce false-positive results, which produce family anxiety and increase follow-up costs. The assay also appears suitable for use in monitoring treatment of MSUD patients.

scholarly journals Use of Dried Blood Spots to Elucidate Full-Length Transmitted/Founder HIV-1 Genomes

2016 ◽  
Vol 1 (1) ◽  
pp. 129 ◽  
Author(s):  
Jesus F. Salazar-Gonzalez ◽  
Maria G. Salazar ◽  
Damien C. Tully ◽  
Colin B. Ogilvie ◽  
Gerald H. Learn ◽  
...  
Keyword(s):  
Dried Blood Spots ◽  
Full Length ◽  
Cold Chain ◽  
Clinical Samples ◽  
Envelope Gene ◽  
Acid Extraction ◽  
Resource Limited Settings ◽  
Blood Spots ◽  
Resource Limited ◽  
Hiv 1

Background: Identification of HIV-1 genomes responsible for establishing clinical infection in newly infected individuals is fundamental to prevention and pathogenesis research. Processing, storage, and transportation of the clinical samples required to perform these virologic assays in resource-limited settings requires challenging venipuncture and cold chain logistics. Here, we validate the use of dried-blood spots (DBS) as a simple and convenient alternative to collecting and storing frozen plasma.Methods: We performed parallel nucleic acid extraction, single genome amplification (SGA), next generation sequencing (NGS), and phylogenetic analyses on plasma and DBS.Results: We demonstrated the capacity to extract viral RNA from DBS and perform SGA to infer the complete nucleotide sequence of the transmitted/founder (TF) HIV-1 envelope gene and full-length genome in two acutely infected individuals. Using both SGA and NGS methodologies, we showed that sequences generated from DBS and plasma display comparable phylogenetic patterns in both acute and chronic infection. SGA was successful on samples with a range of plasma viremia, including samples as low as 1,700 copies/ml and an estimated ~50 viral copies per blood spot. Further, we demonstrated reproducible efficiency in gp160 env sequencing in DBS stored at ambient temperature for up to three weeks or at -20ºC for up to five months.Conclusions: These findings support the use of DBS as a practical and cost-effective alternative to frozen plasma for clinical trials and translational research conducted in resource-limited settings.

scholarly journals Validation of a combined ELISA to detect IgG, IgA and IgM antibody responses to SARS-CoV-2 in mild or moderate non-hospitalised patients

2020 ◽  
Author(s):  
A M Cook ◽  
S E Faustini ◽  
L J Williams ◽  
A F Cunningham ◽  
M T Drayson ◽  
...  
Keyword(s):  
Dried Blood Spots ◽  
Antibody Responses ◽  
Clinical Samples ◽  
Serum Samples ◽  
Blood Spots ◽  
Moderate Disease ◽  
Hospitalised Patients ◽  
Supplementary Material ◽  
Human Viruses ◽  
Targeted Detection

AbstractBackgroundFrequently SARS-CoV-2 results in mild or moderate disease with potentially lower concentrations of antibodies compared to those that are hospitalised. Here, we validated an ELISA using SARS-CoV-2 trimeric spike glycoprotein, with targeted detection of IgG, IgA and IgM (IgGAM) using serum and dried blood spots (DBS) from adults with mild or moderate disease.MethodsTargeting the SARS-CoV-2 trimeric spike, a combined anti-IgG, IgA and IgM serology ELISA assay was developed using 62 PCR-confirmed non-hospitalised, mild or moderate COVID-19 samples, ≥14 days post symptom onset and 624 COVID-19 negative samples. The assay was validated using 73 PCR-confirmed non-hospitalised COVID-19 and 359 COVID-19 negative serum samples with an additional 81 DBSs, and further validated in 226 PCR-confirmed non-hospitalised COVID-19 and 426 COVID-19 negative clinical samples.ResultsA sensitivity and specificity of 98.6% (95% CI, 92.6–100.0), 98.3% (95% CI, 96.4–99.4), respectively, was observed following validation of the SARS-CoV-2 ELISA. No cross-reactivities with endemic coronaviruses or other human viruses were observed, and no change in results were recorded for interfering substances. The assay was stable at temperature extremes and components were stable for 15 days once opened. A matrix comparison showed DBS to correlate with serum results. Clinical validation of the assay reported a sensitivity of 94.7% (95% CI, 90.9-97.2%) and a specificity of 98.4% (95% CI, 96.6-99.3%).ConclusionsThe human anti-IgGAM SARS-CoV-2 ELISA provides accurate and sensitive detection of SARS-CoV-2 antibodies in non-hospitalised adults with mild or moderate disease. The use of dried blood spots makes the assay accessible to the wider community.Supplementary MaterialNo

scholarly journals Performance of PURE-LAMP to Detect Declining Prevalence of Malaria in Haiti

2020 ◽  
Author(s):  
Jeanne Perpétue VINCENT ◽  
Alexandre Valcena Existe ◽  
Kanako Komaki-Yasuda ◽  
Jacques Boncy ◽  
Shigeyuki Kano
Keyword(s):  
Nested Pcr ◽  
Diagnostic Method ◽  
Dried Blood Spots ◽  
World Health ◽  
Lamp Method ◽  
Kappa Statistics ◽  
Predictive Values ◽  
Blood Spots ◽  
The World ◽  
Asymptomatic Subjects

Abstract Background Malaria continues to cause burden in various parts of the world. Endemic countries are developing schemes to end this nuisance in accordance with the World Health Organization’s Global Technical Strategy for Malaria 2016–2030. Haiti, a Caribbean country, is among those aiming to eliminate malaria within a few years. Two surveys were conducted in Haiti in the summers of 2017 and 2018, respectively, during which we aimed to evaluate the performance of the simple and rapid PURE-LAMP (procedure for ultra-rapid extraction–loop-mediated isothermal amplification) method with dried blood spots as an alternative diagnostic method for malaria in the context of low to very low rates of transmission.Methods Febrile and asymptomatic subjects were recruited from three administrative divisions within Haiti. Their blood samples were tested by microscopy, rapid diagnostic tests (RDT), PURE-LAMP and nested PCR to detect Plasmodium infection. The positive rates for the two study periods as determined by the different methods were compared. Sensitivity, specificity, positive and negative predictive values and kappa statistics were estimated with the nested PCR results as the gold standard.Results Among 1074 samples analyzed, a positive rate of 8.3% was calculated based on the nested PCR results. Among symptomatic subjects, the rates in 2017 and 2018 were 14.6% and 1.4%, respectively. Three positives were detected among 172 asymptomatic participants in 2018 by PURE-LAMP and nested PCR, and all three were from the same locality. No asymptomatic subjects were recruited in 2017. The PURE-LAMP, RDT and microscopy had respective sensitivities of 100%, 85.4% and 49.4%. All of the testing methods had specificities over 99%.Conclusion The prevalence of malaria was found to have substantially decreased in 2018 in Haiti. A specific focus of infection appeared to require intervention with a sensitive malaria diagnostic method and treatment. This study confirmed the high performance of the PURE-LAMP method with dried blood spots and recommends its use in targeted mass screening and treatment activities in low endemic areas of malaria.

Incurred sample reanalysis comparison of dried blood spots and plasma samples on the measurement of lopinavir in clinical samples

Bioanalysis ◽  
2012 ◽  
Vol 4 (3) ◽  
pp. 237-240 ◽  
Author(s):  
Roland JW Meesters ◽  
Gero P Hooff ◽  
Rob Gruters ◽  
Jeroen JA van Kampen ◽  
Theo M Luider
Keyword(s):  
Dried Blood Spots ◽  
Clinical Samples ◽  
Plasma Samples ◽  
Blood Spots ◽  
Incurred Sample Reanalysis

scholarly journals EDTA in Dried Blood Spots Leads to False Results in Neonatal Endocrinologic Screening

2008 ◽  
Vol 54 (3) ◽  
pp. 602-605 ◽  
Author(s):  
Ute Holtkamp ◽  
Jeanette Klein ◽  
Johannes Sander ◽  
Michael Peter ◽  
Nils Janzen ◽  
...  
Keyword(s):  
Newborn Screening ◽  
False Positive ◽  
Neonatal Screening ◽  
False Negative ◽  
Dried Blood Spots ◽  
Screening Tests ◽  
Blood Collection ◽  
Blood Spots ◽  
Sampling Procedures ◽  
Positive Results

Abstract Background: Blood samples for neonatal screening for inborn errors of metabolism are collected and shipped on standardized filter paper cards. Occasionally these samples are contaminated with EDTA, which is often used for anticoagulation. EDTA may interfere with newborn screening tests based on lanthanide fluorescence and thus lead to false-negative or false-positive results. Methods: We used tandem mass spectrometry (MS/MS) to detect EDTA in dried blood spots by use of an extra experiment that was integrated into the standard MS/MS neonatal screening and did not require an additional sample spot, nor extra time or work. We analyzed the influence of different blood sampling procedures on lanthanide fluorescence tests for thyroid-stimulating hormone (TSH) and 17-hydroxyprogesterone (17-OHP). Results: EDTA was increased in 138 of 190 000 newborn screening samples, 27 of which caused false- positive results in the immunoassay for 17-OHP. No false-negative TSH results were found. False-positive results in the 17-OHP test occurred when EDTA concentrations were >2.0 g/L; the TSH test, however, produced false negatives only when EDTA concentrations were >3.0 g/L. Using EDTA-containing devices the procedure of blood collection significantly influenced the concentration of the anticoagulant. Conclusion: Addition of EDTA quantification into standard MS/MS tests is a simple and useful method to avoid false-positive or false-negative neonatal screening results in lanthanide fluorescence–based tests.

scholarly journals Tandem Mass Spectrometric Analysis for Amino, Organic, and Fatty Acid Disorders in Newborn Dried Blood Spots

2001 ◽  
Vol 47 (11) ◽  
pp. 1945-1955 ◽  
Author(s):  
Thomas H Zytkovicz ◽  
Eileen F Fitzgerald ◽  
Deborah Marsden ◽  
Cecilia A Larson ◽  
Vivian E Shih ◽  
...  
Keyword(s):  
Amino Acid ◽  
Multiple Reaction Monitoring ◽  
Dried Blood Spots ◽  
Spectrometric Analysis ◽  
Tandem Mass ◽  
Predictive Values ◽  
Screening Programs ◽  
Blood Spots ◽  
Chain Acyl ◽  
Tandem Mass Spectrometric

Abstract Background: Tandem mass spectrometry (MS/MS) is rapidly being adopted by newborn screening programs to screen dried blood spots for >20 markers of disease in a single assay. Limited information is available for setting the marker cutoffs and for the resulting positive predictive values. Methods: We screened >160 000 newborns by MS/MS. The markers were extracted from blood spots into a methanol solution with deuterium-labeled internal standards and then were derivatized before analysis by MS/MS. Multiple reaction monitoring of each sample for the markers of interest was accomplished in ∼1.9 min. Cutoffs for each marker were set at 6–13 SD above the population mean. Results: We identified 22 babies with amino acid disorders (7 phenylketonuria, 11 hyperphenylalaninemia, 1 maple syrup urine disease, 1 hypermethioninemia, 1 arginosuccinate lyase deficiency, and 1 argininemia) and 20 infants with fatty and organic acid disorders (10 medium-chain acyl-CoA dehydrogenase deficiencies, 5 presumptive short-chain acyl-CoA dehydrogenase deficiencies, 2 propionic acidemias, 1 carnitine palmitoyltransferase II deficiency, 1 methylcrotonyl-CoA carboxylase deficiency, and 1 presumptive very-long chain acyl-CoA dehydrogenase deficiency). Approximately 0.3% of all newborns screened were flagged for either amino acid or acylcarnitine markers; approximately one-half of all the flagged infants were from the 5% of newborns who required neonatal intensive care or had birth weights <1500 g. Conclusions: In screening for 23 metabolic disorders by MS/MS, an mean positive predictive value of 8% can be achieved when using cutoffs for individual markers determined empirically on newborns.

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