Blood Analysis System Research Articles

A-368 Feasibility of a Five-Minute Sample-to-Answer Basic Metabolic Panel for Point-of-Care Testing on the Fluxergy Analyzer

Abstract Background Adoption of point-of-care (POC) platforms has been limited by their high cost and limited menu (e.g., molecular only). Fluxergy has developed a cost-effective multimodal POC platform capable of performing the most common clinical chemistry, immunochemistry, hematology, molecular tests in CLIA-waived settings. This method comparison study describes the performance of the Fluxergy’s feasibility stage basic metabolic panel (BMP) with contrived samples compared to the Siemen’s epoc® Blood Analysis System. Methods Fluxergy Analyzer: The Fluxergy Analyzer is a rapid and cost-effective multimodality platform that can perform lab-quality PCR, clinical chemistry, immunochemistry, and cytometry in a single instrument and if required, in a single cartridge. Fluxergy BMP: Fluxergy BMP rapidly quantifies key electrolytes (K+, Na+, Ca2+, Cl-) and metabolites (glucose, creatinine, and BUN) from whole blood in under five minutes on the Fluxergy Analyzer, utilizing the Fluxergy test cards with screen-printed electrochemical sensor. Feasibility Study: A method comparison study was conducted to assess the performance of the feasibility stage Fluxergy BMP using contrived samples generated by spiking known concentrations of K+, Na+, Ca2+, Cl-, and glucose into buffer solutions. Samples were tested in triplicate with both the Fluxergy BMP and Siemen’s epoc® Blood Analysis System at three different concentrations across the reportable range of the epoc® Blood Analysis System. Results The feasibility stage Fluxergy BMP demonstrated strong correlation across the reportable range for K+, Na+, Ca2+, Cl-, and glucose versus the epoc® Blood Analysis System (Table 1). The error percentage for all samples tested except one glucose sample (9.5 mM) was less than 10%. The coefficient of variance for all samples tested except one Ca2+ sample (0.44 mM) was less than ten percent. Conclusions This feasibility data demonstrates the Fluxergy Analyzer is well-suited to perform rapid and accurate metabolic testing from whole blood samples at the POC.

A-367 Development of a Multimodal Point-of-Care Diagnostic Platform to Perform Rapid, Accurate, and Cost-Effective Molecular, Immunochemistry, Clinical Chemistry, and Cytometry Tests

Abstract Background Access to point-of-care (POC) testing can make a significant impact on the quality of care. However, because POC diagnostic platforms available today are expensive and only perform one type of test, clinicians are unable to implement all the POC tests they wish to perform. Fluxergy is developing a multimodal POC diagnostic platform that consolidates diverse diagnostic modalities into a single, compact platform to minimize the cost of POC testing and standardize testing workflow for the most common clinical chemistry, hematology, immunochemistry and molecular tests. This study describes feasibility studies performed to benchmark these assay modalities on the Fluxergy Analyzer. Methods Fluxergy Analyzer: The Fluxergy Analyzer integrates conventional detection systems—colorimetric, fluorometric, and electrochemical—into a singular POC platform. This unique design expands -omics testing capabilities, including molecular, immunochemistry, clinical chemistry, and hematology within a single instrument. Benchmarking Feasibility Studies: Molecular benchmarking was performed using a multiplex respiratory panel on contrived samples in UTM/VTM. Immunochemistry benchmarking was performed using a procalcitonin assay on spiked sodium citrate plasma samples. Cytometry benchmarking was performed using a white blood cell count (WBC) assay and testing contrived samples whole blood samples. Results For molecular testing, the Fluxergy Analyzer was able to accurately detect flu A, flu B, SARS-CoV-2, and RSV with agreements with the Luminex ARIES® Flu A/B & RSV Assay and Cepheid Xpert® SARS-CoV-2 test results. For immunochemistry testing, the Fluxergy Analyzer accurate quantified PCT levels at 0.3, 0.6, 1.25 and 2.5 ng/mL. For hematology testing, the Fluxergy Analyzer demonstrated a strong correlation across the reportable range against the standard of care HemoCue analyzer. For clinical chemistry testing, the Fluxergy Analyzer demonstrated a strong correlation against the Siemen’s epoc® Blood Analysis System. Conclusions The Fluxergy Analyzer is uniquely suited to offer a comprehensive menu of the most common POC tests on a single, cost-effective platform.

A-328 Accuracy of the Glucose Test in the i-STAT® G Cartridge Using the i-STAT 1 System for Venous, Arterial and Capillary Whole Blood Specimens in Clinical Settings

Abstract Background Precise and accurate measurements of whole blood glucose levels are important for the diagnosis, monitoring and treatment of carbohydrate metabolism disorders, such as diabetes and hypoglycemia. This study demonstrates the accuracy of the glucose test in the i-STAT G cartridge with the i-STAT 1 System in arterial, venous, and capillary whole blood specimens in point of care or clinical laboratory settings. Methods The accuracy of the glucose test in the i-STAT G cartridge was assessed at external clinical sites in a method comparison study using whole blood specimens across the measurement range of 20 - 700 mg/dL. Specimens used in this study were venous, arterial, and capillary specimens prospectively collected under Institutional Review Board-approved informed consent or were leftover de-identified venous or arterial specimens. The study included venous whole blood samples from 164 adult subjects (≥ 18 years) and arterial whole blood samples from 173 adult subjects at 3 clinical sites, and capillary whole blood samples from 211 adult subject at 3 clinicals sites and 23 neonate subjects (birth to 28 days) at 2 clinical sites. For venous and arterial whole blood, samples were collected and tested in duplicate on the i-STAT G cartridge and on the i-STAT CHEM8+ cartridge (comparator). For capillary whole blood samples, adult fingerstick samples and neonate heel-stick samples were collected in capillary tubes and tested in singlicate on the i-STAT G cartridge and in singlicate on the epoc® Blood Analysis System (comparator). Passing-Bablok linear regression was performed for venous and arterial whole blood samples using the first replicate from the i-STAT G cartridge versus the mean result of the comparator, and for capillary whole blood samples (adult and neonate combined) using the singlicate result from the i-STAT G cartridge versus the singlicate result of the comparator. Results Passing-Bablok regression of i-STAT G cartridge results versus the comparator was used to calculate slope and correlation coefficient (r). Adult venous whole blood results had slope = 1.00 and r = 1.00, and adult arterial whole blood results had slope = 1.00 and r = 1.00. Adult and neonate capillary whole blood results had slope = 1.00 and r = 1.00. Conclusions These results demonstrate that the i-STAT 1 System delivers accurate glucose test results within ∼2 minutes using the i-STAT G cartridge for venous, arterial and capillary whole blood samples for adult and neonate subjects across a glucose range of 20-700 mg/dL when tested by end-users in a point of care or clinical laboratory setting. This study was funded by Abbott Laboratories.

#2359 Kinetic modifications in cardiac remodeling in a rat model of CKD

Abstract Background and Aims The bi-directional relationship between the kidneys and heart leads to different forms of cardiorenal syndrome (CRS) in which acute or chronic dysfunction in one organ affects the other. CRS type 4 is characterized by chronic kidney disease leading to the impairment of cardiac function through diastolic dysfunction and cardiac remodeling, such as fibrosis and hypertrophy. The progression of CRS type 4 occurs dynamically thus identifying key changes could prove beneficial for treatment and prediction of outcome for the patients. This present study assessed the impact on heart remodeling and function after 12 and 24 weeks of chronic kidney disease in rats undergoing subtotal nephrectomy. Method Twelve-week-old Sprague Dawley male rats either underwent 5/6 nephrectomy (SNX) or Sham operated and were sacrificed at 12 or 24 weeks after kidney infarction. Serum creatine levels were assessed using the epoc® Blood Analysis System. Before sacrifice, a catheter was inserted into the right carotid artery for systolic arterial pressure (SAP) measurement. Echocardiography (VisualSonics/Fujifilm) was performed under isoflurane anesthesia. To determine the diastolic function of the heart, mitral flow was assessed and recorded using a pulse-wave doppler. The peak early filling (E wave)-to-late diastolic filling (A wave) ratio (E/A) as well as E deceleration time was used to determine diastolic function. Left Ventricle posterior wall thickness (LVPW_S) was measured during end-systole and end-diastole. Image analyses were performed using VisualSonics Vevolab 3.1.0 software. Fibrosis of the kidney and left ventricle was determined through Sirius Red histology staining. The mRNA expression levels of FGF23 and GDF-15 were measured through qPCR. Unpaired T-test, Non-parametric, or One-way ANOVA were applied, and log transformation was performed when applicable. Statistical Analysis was performed using GraphPad Prism 8 software. Results The plasma creatinine dosage confirmed the renal insufficiency of the animals however, no changes were observed between 12 and 24 weeks of SNX (Table 1). Fibrosis in the kidney increased between 12 and 24 weeks of SNX as well as between their corresponding Sham (Table 1). Twenty-four weeks of SNX rats exhibited increased heart fibrosis in comparison to sham (Table 1). An increase in SAP was observed at 24 weeks of SNX in comparison to their Sham (Table 1). Cardiac remodeling between 12 and 24 weeks of SNX was observed through the increase in the left ventricle wall thickness (Table 1) (Fig. 1A). This was coupled with an increase in the expression of cardiac remodeling and protective-related genes FGF23 and GDF-15 (Fig. 1B,C). Diastolic function, as measured by E/A, remained unchanged in the model at both ages (Table 1). E deceleration time decreased at 24 weeks of SNX compared to their Sham (Table 1). Conclusion These preliminary results show a change in cardiac remodeling and function at 24 weeks of SNX compared to Sham. Between 12 and 24 weeks of SNX, changes in cardiac remodeling, namely hypertrophy of the posterior wall, can be observed. These changes were accompanied by an increase in FGF23 and GDF-15. As our model of cardio-renal syndrome has been characterized; we will turn our attention to the signaling involved in the establishment of cardiac fibrosis. This pre-clinical model will also make it possible to test new anti-fibrosis treatments.

Measuring the Level of Agreement for Lactate Measurements in Hispaniolan Amazon Parrots (Amazona ventralis) Among 2 Point-of-Care Analyzers and a Benchtop Analyzer.

Lactate is an important biochemistry analyte used in human and veterinary medicine to assess tissue perfusion and can be used as a prognostic indicator for certain disease conditions. Whereas lactate is commonly measured using "patient-side" handheld meters, these meters have not been validated for companion avian species. The purpose of this study was to measure the level of agreement between 2 commercially available point-of-care lactate meters and a laboratory benchtop blood analyzer in Hispaniolan Amazon parrots (Amazona ventralis). Blood samples were collected from 20 adult parrots at Louisiana State University by drawing 1.5 mL of blood from the right jugular vein. One drop of whole blood was used for the Lactate Plus analyzer and the remainder of the sample transferred into a lithium heparin microtainer. From the blood in the microtainer, 0.2 mL whole blood was analyzed using the epoc Blood Analysis System, and the remaining sample was centrifuged to obtain plasma that was immediately frozen at -80°C (-112°F) and submitted to the Texas A&M University Clinical Pathology Laboratory for analysis on the VITROS 4500 benchtop analyzer. Bland-Altman agreement plots and Passing-Bablok regression were used to measure the level of agreement between the methods. There was poor agreement between all 3 methods with mean percentage differences in lactate concentrations ≥22% (epoc and Lactate Plus: 33.6% [95% CI: 27-40]; epoc and VITROS 4500: 55% [95% CI:52-58]; VITROS 4500 and Lactate Plus: 22% [95% CI:16-28]). Based on these results, the point-of-care meters tested in this study are not interchangeable, and separate reference intervals were calculated for each method. Blood lactate concentrations may have more utility in tracing lactate trends over time in an individual rather than being able to utilize this information at 1 time point for disease diagnosis and prognosis.

Analysis of blood composition by porcine breeding cycle.

Pigs for biomedical research are administered commercial fluids made for human consumption when they receive intravenous (IV) fluid therapy. Although pigs and humans have slightly different bodily fluid compositions, the composition shift happens at the same rate as their rapid growth. The study aimed to analyse the composition of porcine blood according to breeding cycle using a portable blood analyser and provides data for developing customized IV fluids for pigs. Pigs were sorted 25, 50, 100 and 120 days after birth, and sows were classified into candidate, pregnant and farrowing groups. A blood sample was collected from the external jugular vein and analysed using the EPOC blood analysis system using haematological, biochemical and gas parameters. There was no difference among pig groups by age, but hematocrit and haemoglobin amounts decreased in sows after farrowing, but their concentrations were higher as compared to pigs. Glucose gradually reduced as age increased in pigs and during pregnancy in sows. This study provided a comprehensive analysis of porcine blood composition by breeding cycle and highlighted the importance of glucose supplementation for IV fluid therapy in pigs.

Viscoelastic blood coagulation testing system enabled by a non‐contact triboelectric angle sensor

AbstractThromboelastography (TEG) remains a convenient and effective viscoelastic blood coagulation testing device for guiding blood component transfusion and assessing the risk of thrombosis. Here, a TEG enabled by a non‐contact triboelectric angle sensor (NTAS) with a small size (∼7 cm3) is developed for assessing the blood coagulation system. With the assistance of a superelastic torsion wire structure, the NTAS‐TEG realizes the detection of blood viscoelasticity. Benefiting from a grating and convex design, the NTAS holds a collection of compelling features, including accurate detection of rotation angles from −2.5° to 2.5°, high linearity (R2 = 0.999), and a resolution of 0.01°. Besides, the NTAS exhibits merits of low cost and simplified fabrication. Based on the NTAS‐TEG, a viscoelastic blood coagulation detection and analysis system is successfully constructed, which can provide a graph and parameters associated with clot initiation, formation, and stability for clinicians by using 0.36 mL of whole blood. The system not only validates the feasibility of the triboelectric coagulation testing sensor, but also further expands the application of triboelectric sensors in healthcare.

A-357 Performance of Blood Urea Nitrogen on the epoc Analyzer

Abstract Background The epoc Blood Analysis System (Siemens, Tarrytown, NY) performs blood gases, electrolytes, and metabolites using a Blood Gas Electrolyte and Metabolite (BGEM) Test Card panel on 92 uL of whole blood. The BGEM Test Card uses potentiometric sensors to measure sodium, potassium, chloride, ionized calcium, pH, pCO2; amperometric sensors to measure pO2, glucose, creatinine, and lactate; and a conductometric sensor to measure hematocrit. Results are available in 3–10 minutes, depending upon the time of sample injection. TJUH implemented the epoc in its ICUs in 2012 to provide rapid, whole blood Point of Care (POC) results, then expanded to other locations (Emergency Department, Outpatient Radiology, Cardiothoracic Surgery). Siemens recently added a potentiometric sensor for measurement of Blood Urea Nitrogen (BUN) to its BGEM card. We evaluated this card for possible future use. Methods Precision and method comparison studies were performed at our Center City location. Inter- and intra-precision studies were performed on two levels of controls (Eurotrol, Elizabethtown, KY). Remnant whole blood was collected from 30 patients. Comparison studies were performed on the Piccolo Xpress (Abbott, Princeton, NJ), which provides a whole blood BUN measurement using a coupled-enzyme reaction. Results Intra-assay precision for epoc BUN (n = 20, 2 devices) was 2.8%CV and 6.5%CV for Levels 1 and 3, respectively. Inter-assay precision for epoc BUN (n = 20, 2 devices over 10 days) was 2.4%CV and 7.1%CV for Levels 1 and 3, respectively. Method comparison for BUN (n = 30) was: mean = 42, median = 29, r2 = 0.9889, y = 0.8840x-3.6416. Conclusion The epoc BUN studies showed comparable results when compared to the Piccolo Xpress. Previous studies showed good correlation between whole blood on the Piccolo Xpress and plasma on the Roche Cobas c702 which is also a coupled-enzyme reaction; therefore the test is considered acceptable for implementation at our Center City sites where epoc is currently in use.

A-359 Performance of Measured TCO2 on the epoc Analyzer

Abstract Background The epoc Blood Analysis System (Siemens, Tarrytown, NY) performs blood gases, electrolytes, and metabolites using a Blood Gas, Electrolyte and Metabolite (BGEM) Test Card on 92 uL of whole blood. The BGEM Test Card uses potentiometric sensors to measure sodium, potassium, chloride, ionized calcium, pH, pCO2; amperometric sensors to measure pO2, glucose, creatinine, and lactate; and a conductometric sensor to measure hematocrit. Results are available in 3–10 minutes, depending upon the time of sample injection. TJUH implemented epoc in its ICUs in 2012 to provide rapid, whole blood Point of Care (POC) results and has expanded to other locations (Emergency Department, Outpatient Radiology, Cardiothoracic Surgery). While previous epoc cards provided calculated TCO2 (cTCO2), Siemens recently added measured TCO2 (mTCO2; combination of potentiometric sensors and calculation) to its BGEM card. We evaluated this card for future use. Methods Precision and method comparison studies were performed at our Center City location. Inter- and intra-precision studies were performed on two levels of controls (Eurotrol, Elizabethtown, KY). Whole blood was collected in heparinized syringes from 20 patients. Comparison studies were performed on the ABL800 (Radiometer, Brea, CA). We simultaneously compared epoc mTCO2 against epoc cTCO2 and against the cTCO2 on the ABL800. Results Intra-assay precision for epoc mTCO2 (n = 20, 2 devices) was 0.8%CV and 2.3%CV for Levels 1 and 3, respectively. Inter-assay precision for epoc mTCO2 (n = 20, 2 devices over 10 days) was 1.1%CV and 3.3%CV for Levels 1 and 3, respectively. Method comparison for epoc mTCO2 (n = 20) was: mean = 22.9, median = 22.1, r2 = 0.9174, y = 0.9751x + 1.2925. In comparison, method comparison for epoc cTCO2 (n = 20) was: mean = 24.7, median = 23.9, r2 = 0.9165 y = 0.9855x + 2.8559. Conclusion The epoc measured TCO2 studies show better correlation to the Radiometer ABL800 than the epoc calculated cTCO2, and it is considered acceptable for implementation at our Center City sites where epoc is currently in use.

#5228 ASSESSING ACCURACY OF POINT-OF-CARE CREATININE AND POTASSIUM TESTING IN A MULTI-ETHNIC SOUTH LONDON POPULATION

Abstract Background and Aims Point-of-care (POC) testing allows rapid analysis of blood samples without delay of laboratory testing. For patients with chronic kidney disease (CKD), this allows for instant identification of changes in kidney function, such as acute kidney injury or hyperkalaemia, and assists in timely decision-making in outpatient or community settings (e.g. commencing or up-titrating medications dependent on renal function). It also provides an opportunity for early recognition of CKD in high-risk populations by providing screening in more convenient and trusted settings. To achieve these aims, it essential to confirm that POC systems can produce accurate results in real world settings with diverse patient populations. This pilot validation study assessed accuracy of the Siemens Epoc Blood Analysis System venous creatinine and potassium compared with laboratory assays in a diverse UK renal patient population. Method Venous blood samples from 57 patients, aged ≥ 18 years old and receiving care at a London teaching hospital, were analysed using the Siemens Epoc Blood Analysis System. POC-Creatinine (POC-Cr) and Potassium (POC-K) measurements were compared with laboratory (IDMS-traceable Siemens enzymatic and Roche) assays. Demographics (age, ethnicity and sex) were recorded for each patient. Passing-Bablock regression analysis were used to compare the results using both methods. Comparison between testing methods was assessed using a Bland-Altman plot. Limits of agreement were compared with CLIA criteria for acceptable performance for creatinine and potassium. Results The mean age was 55.6 ± 15.3 years old and 64.9% were male (n = 37). The majority of patients were of White (N = 23; 40.4%), Black (N = 21; 36.8%) or South Asian (N = 9; 15.8%) ethnicity respectively. Median POC-Cr was 216 μmol/L (interquartile range (IQR) 111, 396 μmol/L) versus median venous creatinine 212 μmol/L (IQR 114, 380 μmol/L). The median bias for creatinine was +1.0 (IQR -3.0, +8.0). Limits of agreement on Bland-Altman plot were +36.5μmol/L and – 34.4μmol/L (Figure 1). Overall, there remained a strong positive correlation between POC-Cr and IDMS-traceable enzymatic creatinine assays (R = 0.997; P<0.0001) (Figure 2). Median POC-K was 4.3 mmol/L, IQR 4.0, 4.8 mmol/L versus median venous potassium 5.0, IQR 4.3, 5.3 mmol/L. The median bias for potassium was +0.4 (IQR +0.2, +0.5). Limits of agreement on Bland-Altman plot were +0.16mmol/L and – 0.91mmol/L (Figure 3). A strong positive correlation between POC-K and laboratory potassium assays was also confimed (R = 0.937; P<0.0001) (Figure 4). Conclusion There was strong positive correlation between POC and laboratory analysis of venous creatinine, comparable to product literature (R = 0.997 vs 0.998). Limits of agreement were outside the CLIA criteria for acceptable performance (+/- 27μmol/L). POC and laboratory potassium levels were also strongly correlated and comparable to product literature (R = 0.937 vs 0.997). Limits of agreement were outside the CLIA criteria for acceptable performance (+/- 0.5mmol/L). This discrepancy is likely due to haemolysis in some blood samples and small sample size. Overall, this pilot study demonstrated a strong correlation between POC and laboratory testing. Larger scale evaluation is still required in a multi-ethnic population, prior to assessing feasibility in community-led protocolized pathways.

Identifying Hypocalcemia in Dairy Cattle by Combining 3D Printing and Paper Diagnostics

This paper describes the design, fabrication, and validation of a paper-based diagnostic device for the rapid diagnosis of hypocalcemia in dairy cattle at the point-of-care (POC). The device incorporates a 3D printed calcium ion-selective membrane (ISM) as the sensing element for free—unbound—calcium in real bovine whole blood samples. With a linear response range of 100 mM to 97.7 μM, the sensor covers the clinically relevant concentrations of Ca2+ associated with both healthy cattle as well as those suffering from hypocalcemia. The components of the Ca2+ ion-selective electrodes were successfully translated to a paper-based device to provide a sensing platform that is simple to use, disposable, and low-cost, and is therefore well-situated for applications at the POC. The paper-based calcium sensor showed a Nernstian response between 10 mM and 100 μM and required only 12 μl of sample to perform a measurement, which can be accomplished in less than two minutes without the need for time-consuming separation steps. The performance of the paper-based Ca2+ sensor was validated using the commercially available epoc® Blood Analysis System, which provided results within 5% of the data obtained with 3D printed Ca2+-ISM integrated paper-based device.

Expert consensus on the application of blood analysis system in primary medical laboratories

Blood analysis and detection plays an important role in diagnosis, monitor of curative effect and prevention of disease. Blood analysis and detection system has been widely used in the laboratories of centers of disease control and prevention and hospitals, and standardized application is an important prerequisite to ensure the quality of blood analysis. Based on the core content of blood analysis and detection system application in laboratories, especially in primary medical laboratories, and referring to relevant documents such as national laws and regulations, national standards, industry standards, guidelines and specifications, the Grassroots Inspection Technology Standardization Branch of China Health Care International Exchange Promotion Association formulates this consensus. And the consensus focus on the personnel management, equipment, reagents and consumables management and use, the whole process of test, quality control, result report and other related elements involved in the application of blood analysis system, so as to guide the primary medical laboratories to improve the quality management system, standardize the application of blood analysis and testing system, and improve the quality of blood analysis and testing.

The Importance of Renal NBCe1‐B During Metabolic Acidosis

Background The kidney responds to acidosis by increasing ammonium (NH4+) excretion via the metabolic process ammoniagenesis. The electrogenic Na+/HCO3- co-transporter (NBCe1) has an essential role in maintaining overall acid-base balance, and specifically, has been implicated in the regulation of renal ammoniagenesis. Two isoforms of NBCe1 exist in the kidney: NBCe1-A and NBCe1-B. Historically, NBCe1-A was considered the only renal NBCe1 variant and it was further demonstrated that NBCe1-A deletion in mice impairs ammoniagenesis. Recently, NBCe1-B renal expression was demonstrated; however, the physiologic role of NBCe1-B in the kidney remains unknown. Therefore, the goal of this study is to determine the contribution of NBCe1-B to renal ammoniagenesis. We hypothesize that NBCe1-B is essential for the ammoniagenic response to metabolic acidosis. Methods An NBCe1-B/C knockout (KO) mouse model was generated by our laboratory using Crispr/Cas9 gene editing. Since NBCe1-C mRNA is not expressed in the mouse kidney, we refer to this model as the NBCe1-B KO mouse. To determine if NBCe1-B loss alters the renal response to an exogenous acid load, WT and KO mice were housed in metabolic cages for 24-hours and allowed to spontaneously drink a 0.28M NH4Cl solution prepared with 0.5% sucrose for palatability. Control groups of WT and KO mice drank only 0.5% sucrose solution during the same 24-hour period. After the 24-hour experimental period, mice were anaesthetized with isoflurane, sacrificed via cardiac puncture, and blood gases were immediately assessed using the Siemens epoc blood analysis system. The volumes of individual 24-hour urine samples were measured, and urine NH4+ concentrations were determined using the Sigma-Aldrich Ammonia Assay Kit, which together were used to calculate daily NH4+ excretion rates. Results Acid-base characteristics in control and acid-loaded WT and NBCe1-B KO mice are summarized in Table 1. We observed no significant differences between WT and KO mice under control conditions. After 24-hour acid loading, WT and KO mice had significantly lower blood pH and bicarbonate concentrations than control groups, characteristic of metabolic acidosis. As expected, in response to acid-loading, WT mice exhibited a large increase in NH4+ excretion. On the other hand, while acid-loading also induced a significant increase in ammonium excretion in KO mice, it was significantly less than the response observed in WT mice. Conclusion The results of this study demonstrate that the ammoniagenic response is impaired in NBCe1-B KO mice during metabolic acidosis.

Performance evaluation of all analytes on the epoc® Blood Analysis System for use in hospital surgical and intensive care units

ObjectiveTo evaluate the performance of the epoc hand-held analyzer against the RAPIDPoint 500 blood gas analyzer and laboratory analyzers where applicable. MethodsVenous or arterial whole blood samples collected in balanced heparinized syringes were obtained from 69 patients (35 females, 34 males) predominantly (77%) from the surgical unit and intensive care unit (ICU). Method comparison was performed for all analytes on the epoc System against the RAPIDPoint 500 Blood gas analyzer or laboratory analyzers where applicable. Results: Mean bias was <5% for blood gases, electrolytes, lactate and glucose. Hematocrit showed a bias of -6.76% (95% CI ​= ​-8.91, - 4.61) compared to the HemataSTAT-II method, whereas calculated total hemoglobin showed a bias of 1.51% (95% CI ​= ​-1.04, 4.06) against the Sysmex XN-10 hematology analyzer. Creatinine showed the largest bias relative to laboratory analyzers, Abbott Architect c8000 Jaffe method (13.54%, 95% CI ​= ​5.43, 21.65) and Roche Cobas c702 enzymatic method (30.01%, 95% CI ​= ​12.64, 47.38). Conclusions: The epoc system is fit for use in the surgical and ICU setting for the measurement of all analytes except for creatinine.

Critical Obstetric Patients During the Coronavirus Disease 2019 Pandemic: Operationalizing an Obstetric Intensive Care Unit.

Critical Obstetric Patients During the Coronavirus Disease 2019 Pandemic: Operationalizing an Obstetric Intensive Care Unit.

Impact of safety protocol in an ambulatory surgical setting vs a hospital setting for laparoscopic-assisted myomectomy (LAM)

Ambulatory surgery center (ASC) for major gynecological surgery improves efficiency and decreases cost compared to a hospital setting. Protocols to ensure safety when performing major gynecologic surgeries are critical in the ASC setting. The objective of this study is to assess whether protocols do ensure safety when performing major gynecological surgeries such as laparoscopic-assisted myomectomy (LAM) in a high-volume ASC and compare it with protocols and outcomes in a hospital setting. This is a descriptive / retrospective study. This paper descriptively outlines the similarities and differences of a surgical safety protocol in an ambulatory surgical center compared to a hospital setting. Furthermore there is retrospective analysis of LAM outcomes that are commonly considered as safety standards in both settings including intraoperative and postoperative complications. The protocols were similar with regards to preoperative patient selection and checklist, surgical precautions including prevention of retained surgical items, DVT prophylaxis, infection control, surgical wound classification, vaginal and genital antisepsis for the surgical patient, postoperative care in PACU and discharge criteria for surgical management. The major preoperative differences from hospital protocol were transfusion criteria preoperatively. In the ASC, a cut-off of 9.0 g/dl was used, and a cut-off of < 7.5 g/dl was used in the hospital setting. LAM cases are only scheduled as morning cases. 23 hour observation is available at ASC. Additionally myomectomy patients at the ASC have ISTAT (blood analysis system to check Hemoglobin/Hematocrit) prior to procedure and at 1 and 2 hours after the procedure in the PACU to detect any signs of bleeding. Any patients that did require blood transfusion postoperatively were transferred to the local hospital from the ASC. There were 588 patients that underwent LAM at the ASC compared to 228 patients at the hospital. There was no significant difference in case complexity factors between settings including BMI, number of previous abdominal and pelvic surgeries or other comorbidities. Intraoperative complication rate was 3.4% (95% CI 1.8-5.0) at the ASC compared to 4.9% (95% CI 1.7-8.1) , p = 0.4430. There were no significant differences in postoperative complications between the ASC and the hospital setting including infections and thromboembolic events. Blood transfusion was required in 1.7% of the cases at ASC compared to 8.8% at the hospital setting. The estimated blood loss and average fibroid weight were not statistically different between the two groups. The LAM safety protocol at a free-standing ASC allows for patient complication outcomes that are comparable to an in-hospital setting without apparent limitations in patient complexity.

Design and Implementation of Physiology Lab Management Blood Analysis System

The objective of this work is to build a database that provides a records of blood disease and accurate statistics as an important source of medical information and to provide assistance to the laboratory worker by conducting electronic blood tests, serial and fast steps and printing the results of the analysis electronically to facilitate the work and make communication between the official of the laboratory and the patient easier and faster and more accurate by using electronic blood analysis system. Where this system to conduct basic screening tests for determining certain blood disorders (anemia's, abnormal bleeding and clotting, inflammation, infection and inherited disorders of red blood cells, white blood cells, platelets, hemoglobin (HBC), and cell production (hematopoiesis)). In this work we propose a system which can manage the user for each action performed and justifying the authorization used to create a secure and easy log in. The Physiology lab Management System is tested through verification and validation (V&V) that was one of testing elements to uncover errors that were made inadvertently as it was designed and constructed.

Validation of capillary blood analysis and capillary testing mode on the epoc Point of Care system

BackgroundLaboratory test in transport is a critical component of patient care, and capillary blood is a preferred sample type particularly in children. This study evaluated the performance of capillary blood testing on the epoc Point of Care Blood Analysis System (Alere Inc). MethodsTen fresh venous blood samples was tested on the epoc system under the capillary mode. Correlation with GEM 4000 (Instrumentation Laboratory) was examined for Na+, K+, Cl-, Ca2+, glucose, lactate, hematocrit, hemoglobin, pO2, pCO2, and pH, and correlation with serum tested on Vitros 5600 (Ortho Clinical Diagnostics) was examined for creatinine. Eight paired capillary and venous blood was tested on epoc and ABL800 (Radiometer) for the correlation of Na+, K+, Cl-, Ca2+, glucose, lactate, hematocrit, hemoglobin, pCO2, and pH. Capillary blood from 23 apparently healthy volunteers was tested on the epoc system to assess the concordance to reference ranges used locally. ResultsDeming regression correlation coefficients for all the comparisons were above 0.65 except for ionized Ca2+. Accordance of greater than 85% to the local reference ranges were found in all assays with the exception of pO2 and Cl-. ConclusionData from this study indicates that capillary blood tests on the epoc system provide comparable results to reference method for these assays, Na+, K+, glucose, lactate, hematocrit, hemoglobin, pCO2, and pH. Further validation in critically ill patients is needed to implement the epoc system in patient transport. Impact of the studyThis study demonstrated that capillary blood tests on the epoc Point of Care Blood Analysis System give comparable results to other chemistry analyzers for major blood gas and critical tests. The results are informative to institutions where pre-hospital and inter-hospital laboratory testing on capillary blood is a critical component of patient point of care testing.

Evaluation of a new handheld point-of-care blood gas analyser using 100 equine blood samples

ObjectivesTo determine whether the Enterprise point-of-care blood analysis system (EPOC) produces results in agreement with two other blood gas analysers in regular clinical use (i-STAT and Radiometer ABL77) and to investigate the precision of the new machine when used with equine whole blood. Study designProspective, randomized, non-blinded, comparative laboratory analyser study. AnimalsHorses admitted to a university teaching hospital requiring arterial or venous blood gas analysis as part of their routine clinical management. MethodsOne hundred equine blood samples were run immediately, consecutively and in randomized order on three blood gas analysers. Results of variables common to all three analysers were tested for agreement and compared with guidelines used in human medicine. These require 80% of results from the test analyser to fall within a defined range or percentage of results from the comparator devices to achieve acceptability. Additionally, 21 samples were run twice in quick succession on the EPOC analyser to investigate precision. ResultsAgreement targets were not met for haematocrit, haemoglobin and base excess for either i-STAT or ABL77 analysers. EPOC precision targets were not met for partial pressure of carbon dioxide, ionized calcium, haematocrit and haemoglobin. Overall comparative performance of the EPOC was good to excellent for pH, oxygen tension, potassium, bicarbonate and oxygen saturation of haemoglobin, but marginal to poor for other parameters. Conclusions and clinical relevanceThe EPOC may be useful in performing analysis of equine whole blood, but trend analysis of carbon dioxide tension, ionized calcium, haematocrit and haemoglobin should be interpreted with caution. The EPOC should not be used interchangeably with other blood gas analysers.

Quantitative analysis of microcirculation blood perfusion in patients with hepatocellular carcinoma before and after transcatheter arterial chemoembolisation using contrast-enhanced ultrasound

To conduct a quantitative analysis of microcirculation blood perfusion in patients with hepatocellular carcinoma (HCC) before and after transcatheter arterial chemoembolisation (TACE) using contrast-enhanced ultrasound (CEUS). From 2013 June to 2105 October, a total of 106 HCC patients undergoing TACE were recruited. CEUS was performed before and after TACE to determine time–intensity curve (TIC) and perfusion quantitative parameters of the HCC lesions and surrounding liver parenchyma. Quantitative perfusion parameters were obtained using the region of interest method. The microcirculation blood perfusion was measured with a blood analysis system and microcirculation microscope. Tumour microvessel density (MVD) was detected by CD34 immunohistochemistry. Compared with surrounding liver parenchyma, the HCC lesions had earlier arrive time (AT), time to initial peak (TTP) and acceleration time, and faster slope of rise time (a3), but no differences were observed in mean transit time (MTT), slope of decrease to half of peak (a2), peak intensity (PI), increased signal intensity (ISI), area under the curve (AUC) and blood flow (BF). There were significant differences in PI, a3, ISI, AUC and BF in HCC lesions between before and after TACE. The high blood viscosity, low blood viscosity, plasma viscosity and integral viscosity in HCC lesions increased after TACE, but the velocity of nailfold microcirculation decreased after TACE. The MVD of well-differentiated HCC lesions was higher than that of poor-differentiated HCC lesions under a light microscope at 50× magnification. However, no significant differences were found in MVD between well-differentiated and poor-differentiated HCC lesions under a light microscope at 100× and 200× magnifications. The PI, ISI, AUC and BF of poor-differentiated HCC lesions were significant lower than those of well-differentiated HCC lesions, but there were no differences in AT, TTP, ACU, MTT, a2 and a3. In conclusion, these results indicate that quantitative CEUS perfusion parameters could be useful tools for assessing the efficacy of TACE for HCC.