Plasma Pool Research Articles

Measuring residual anti-Xa activity of direct factor Xa inhibitors after reversal with andexanet alfa.

IntroductionAndexanet alfa (AnXa) was developed for anticoagulant effect reversal of direct factor Xa inhibitors (DXaI) (apixaban, rivaroxaban, edoxaban) in emergency situations. Regular anti‐Xa assays are not suitable to evaluate anti‐Xa activity after AnXa administration because of the high sample dilution resulting in the AnXa‐DXaI dissociation which gives inaccurately high DXaI measured concentrations. This study aimed at developing dedicated STA‐Liquid anti‐Xa test set‐ups for accurately measuring DXaI after reversal with AnXa.MethodsModified anti‐Xa test set‐ups, with reduced sample dilution, were developed to overcome regular assays limitations and to improve measured accuracy with results comparable to Portola microplate reference method used in clinical studies. Both regular and optimized assays were used to measure DXaI concentration in AnXa‐containing samples. Quality controls, normal pooled plasma spiked with five DXaI and three AnXa concentrations, samples from DXaI‐treated patients spiked with AnXa and ex vivo healthy volunteers having received both DXaI and AnXa were used.ResultsThe lower limit of quantitation of optimized anti‐Xa assays was <10 ng/mL with CVs ≤10%. DXaI samples containing 300 ng/mL and 1 µmol/L AnXa resulted in DXaI residual concentrations of 29‐72 ng/mL depending on the DXaI (76%‐90% reversal), compared to 20‐28 ng/mL with reference method (92%‐94% reversal) and 135‐165 ng/mL with regular assays (about 50% reversal).ConclusionModified test set‐ups are automated alternative to reference method with improved precision and reproducibility. They can be run in all laboratories where regular anti‐Xa assays are performed using commercially available reagents.

Abstract #1002999: Difficulty Monitoring Thyroid Cancer Recurrence With Thyroglobulin Antibody In Patients Receiving Immunoglobulin Therapy

Measuring serum thyroglobulin (Tg) levels and anti-Tg antibody is an important modality to monitor patients for recurrence in the follow up of DTC. High anti-Tg antibody levels could make interpretation of Tg levels unreliable and a trend towards increasing anti-Tg antibody levels should prompt additional investigations and potentially additional therapies. It is estimated that up to 10% of the general population can have detectable anti-Tg antibodies. Immunoglobulin therapy such as Octagam®, are sterile preparations of highly purified immunoglobulin G (IgG) derived from large pools of human plasma which leads to passive transfer of antibodies including anti-Tg antibody. Here we present two cases of patients with PTC on IVIG injections with fluctuating anti-Tg antibody levels, making monitoring extremely challenging.

Recent Advances in the Treatment of Hemophilia: A Review.

Progress in hemophilia therapy has been remarkable in the first 20 years of the third millennium, but the innovation began with the description the fractionation of plasma in 1946. The first concentrates followed the discovery of FVIII in the cryoprecipitate of frozen plasma and FIX in the supernatant in the early 1960s, which led to the initial attempts at replacement therapy. Unfortunately, the lack of screening methods for viral pathogens resulted in people with hemophilia (PWH) receiving concentrates contaminated by hepatitis A virus, hepatitis C virus, and human immunodeficiency virus, as these concentrates were made from large industrial pools of plasma derived from thousands of donors. Fortunately, by 1985, viral screening methods and proper virucidal techniques were developed that made concentrates safe. Increasingly pure products followed the introduction of chromatography steps with monoclonal antibodies in the production process. The problem of immunogenicity of exogenously administered concentrates has not yet had a complete solution. The development of alloantibodies against FVIII in about 25–35% of PWH is the most serious adverse effect of replacement therapy. The next major advance followed the cloning of the F8 gene and later the F9 genes, which paved the way to produce concentrates of factors obtained by the recombinant DNA technology. The injected FVIII and FIX molecules had a relatively short circulating half-life in the plasma of people with hemophilia A and B, approximately 12 and 18 hours, respectively. The ability to prolong the plasma half-life and extend the interval between injections followed the application of methods to conjugate the factor molecule with the fragment crystallizable of IgG1 or albumin or by adding polyethylene glycol, which has led to an increase in the half-life of concentrates, especially for rFIX. The next frontier in hemophilia therapy is the application of durable and potentially curative therapies such as with gene addition therapy. Experiments in hemophilia B have demonstrated durable responses. Unfortunately, the results with gene therapy for hemophilia A have not been as remarkable and the durability must still be demonstrated. Nonetheless, the long-term safety, predictability, durability, and efficacy of gene therapy for hemophilia A and B remain an open question. At present, only healthy adult PWH have been enrolled in gene therapy clinical trials. The application of gene therapy to children and those with pre-existing antibodies against the delivery vector must also be studied before this therapy becomes widespread.

Abstract P-43: Effect of Glucocerebrosidase Dysfunction on the Pool of Plasma Exosomes of Patients with Gaucher Disease

Background: Extracellular vesicles (EVs) are small membrane vesicles released from different types of cells. EVs are found in many human biological fluids. Exosomes are a subtype of EVs that are released by the fusion of multivesicular bodies with the plasma membrane. This type of vesicles is characterized by specific exosomal markers. Exosomes extracted from peripheral body liquids could have specific properties associated with different physiological conditions as well as human disorders, including neurodegenerative diseases. Gaucher disease (GD) – is the most common form of lysosomal storage disorders caused by mutations in the glucocerebrosidase (GBA) gene. Lysosome functionality is critical for the regulation of extracellular vesicle secretion and content. In model animals, the inhibition of glucocerebrosidase has been shown to increase the secretion of extracellular vesicles in brain tissues. Amount evaluation of EVs and their size in the biological fluids of patients with GD has not been early performed; therefore, it is unknown whether lysosomal dysfunction found in GD patients influences the plasma pool of EVs. The aim of this study was to evaluate the amount of blood plasma EVs in patients with GD and their characterization for morphology and size. Methods: EVs were isolated from the blood plasma of 8 GD patients and 8 controls by ultracentrifugation, and were characterized using cryo-electron microscopy (cryo-EM), nanoparticle tracking analysis (NTA), and dynamic light scattering (DLS). Also, the presence of exosomal markers CD9, CD63, CD81, and HSP70 was analyzed by flow cytometry and western blot. Results: Here, it was first shown an increased proportion of exosome fraction in EVs from plasma of GD patients compared to controls by DLS and cryo-EM (p&lt;0.001) that was confirmed by mode size detected by NTA (p&lt;0.02). Moreover, an increased number of double and multilayer vesicles in plasma EVs from GD patients was demonstrated by cryo-EM. We also detected an increase in the expression of exosomal markers on the surface of vesicles from the blood plasma of patients with GD compared to controls. Conclusion: Here, we firstly report that the exosomes obtained from the blood plasma of GD patients have a larger size and altered morphology. Thus, we have shown that lysosomal dysfunction in GD patients leads to a striking alteration of blood plasma extracellular vesicle pool.

Screening for parvovirus B19 antigen through chemiluminescent enzyme immunoassay is equivalent to B19 nucleic acid amplification test-based screening of pooled plasma.

Human parvovirus B19 (B19) is a pathogen that threatens the quality of plasma products. Therefore, health authorities have mandated measures against B19 contamination of plasma pools. The US FDA has recommended a B19 genome level of 104 IU/ml or lower in pooled plasma lots. Therefore, the B19 nucleic acid amplification test (B19-NAT) has been introduced in many plasma fractionators. However, in the Japanese Red Cross, which is the only approved blood collector in Japan, the B19 antigen test has been introduced for screening donated blood in Japan. Therefore, to clarify whether the antigen test is robust enough to screen blood samples according to the FDA recommendation, we evaluated B19 genome levels in each pooled plasma lot from 2003 to 2020. Data of 5576 pooled plasma lots from factories A and B, which were derived from plasma bags and passed the B19 antigen-based tests, receptor-mediated hemagglutination assay (B19-RHA), or chemiluminescent enzyme immunoassay (B19-CLEIA), during 2003 to 2020, were evaluated. The amount of B19 genome in each lot was determined using quantitative or semiquantitative B19-NAT. The B19 genome levels in pooled plasma lots screened using B19-RHA did not meet the FDA recommendation, whereas the lots derived from B19-CLEIA fulfilled the FDA recommendation, even during the B19 epidemic in Japan. The results suggest that the B19-CLEIA donor screening for plasma pools is also useful in light of the US FDA recommendation.

Detection of hepatitis C virus and parvovirus B19 in human plasma pools by nucleic-acid amplification techniques – Trends in results of EDQM proficiency testing studies from 2004 to 2018

The European Directorate for the Quality of Medicines & HealthCare (EDQM) has run proficiency testing schemes on the detection of viral contaminants in human plasma pools by nucleic-acid amplification techniques since 1999 for hepatitis C virus and since 2004 for parvovirus B19. A retrospective analysis was performed to assess their impact and identify trends and progress in the results obtained by participating laboratories over a 15-year span, from 2004 to 2018. The results demonstrate that overall performance improved over that time, especially among the regular participants. Participation in these proficiency testing schemes is therefore recommended for all interested control laboratories. This analysis also shows that hepatitis C virus detection now seems well established compared to that of parvovirus B19, which still appears more challenging.

Applying index of circulating anticoagulant to mixing tests with lupus anticoagulant screen and confirm reagents can distinguish with high specificity between lupus anticoagulants and direct factor Xa inhibitors.

Lupus anticoagulants (LA) are detected by prolongation of clotting times for dilute Russell's viper venom time (dRVVT) and activated partial thromboplastin time (APTT) screening tests. Direct oral anticoagulants (DOACs) can interfere with both screening and confirmatory tests. The present study aimed to investigate the influence of direct factor Xa inhibitors (DiXaIs) on screen, confirm and mixing tests and establish a method for differentiation from other sample types. A total of 257 samples including nonanticoagulated LA positive, LA positive with DiXaIs, factor deficiency, FVIII inhibitors, warfarin and non-APS DiXaIs were tested. APTT reagents Cephen LS/Cephen and dRVVT reagents LA1/LA2 were used, respectively, to screen/confirm the study group. Index of circulating anticoagulant (ICA) was calculated from clotting times based on the following formula as ICA screening and ICA confirmation. ICA= (1:1 Mix sample - Normal pooled plasma) / Screen patient x 100. An ICA matrix was established which suggested the presence of a DiXaI when both ICA screening and confirmation were above the cut-off. When only ICA screening is elevated, LA is suspected. Sensitivity and specificity of the ICA matrix were 52.2% and 92.8% for DiXaIs and 38.1% and 96.7% for LA in APTT, and 61.2% and 92.9% for DiXaIs and 22.2% and 88.4% for LA in dRVVT, respectively. The ICA matrix achieved high specificity with a lower apparent sensitivity for DiXaI samples comparatively to other devices but due only to less interferences: the matrix could contribute to differentiating DiXaIs from LA in samples where anticoagulation status is unknown.

Development and characterization of two equine formulations towards SARS-CoV-2 proteins for the potential treatment of COVID-19

In the current global emergency due to SARS-CoV-2 outbreak, passive immunotherapy emerges as a promising treatment for COVID-19. Among animal-derived products, equine formulations are still the cornerstone therapy for treating envenomations due to animal bites and stings. Therefore, drawing upon decades of experience in manufacturing snake antivenom, we developed and preclinically evaluated two anti-SARS-CoV-2 polyclonal equine formulations as potential alternative therapy for COVID-19. We immunized two groups of horses with either S1 (anti-S1) or a mixture of S1, N, and SEM mosaic (anti-Mix) viral recombinant proteins. Horses reached a maximum anti-viral antibody level at 7 weeks following priming, and showed no major adverse acute or chronic clinical alterations. Two whole-IgG formulations were prepared via hyperimmune plasma precipitation with caprylic acid and then formulated for parenteral use. Both preparations had similar physicochemical and microbiological quality and showed ELISA immunoreactivity towards S1 protein and the receptor binding domain (RBD). The anti-Mix formulation also presented immunoreactivity against N protein. Due to high anti-S1 and anti-RBD antibody content, final products exhibited high in vitro neutralizing capacity of SARS-CoV-2 infection, 80 times higher than a pool of human convalescent plasma. Pre-clinical quality profiles were similar among both products, but clinical efficacy and safety must be tested in clinical trials. The technological strategy we describe here can be adapted by other producers, particularly in low- and middle-income countries.

The Activity of von Willebrand Factor in Hospitalized Patients with COVID‐19

Infection with the SARS‐CoV‐2 virus, or COVID‐19, is associated with an increased risk of thrombosis at all levels of the vascular tree including the microvasculature, arteries and veins. However, the mechanisms involved in the heterogenic thrombotic presentations in COVID‐19 are poorly understood. One potential contributor to the prothrombotic state in COVID‐19 is von Willebrand Factor (vWF), a multimeric glycoprotein produced by endothelial cells and platelets that is unfolded and activated by shear stress or artificially with ristocetin. vWF has been implicated in pathogenesis of arterial clots including stroke, consistent with its activation by shear. vWF has also been implicated in thrombotic thrombocytopenic purpura, a subtype of microvascular thrombosis. Elevated vWF has even been associated with increased risk of venous thrombosis, a classically low shear environment. The purpose of this study was to determine whether vWF had a higher propensity to become activated in COVID‐19, suggestive of an altered configuration. We hypothesized that vWF from patients with COVID‐19 would be more active than healthy controls. Discarded whole blood samples were collected from hospitalized patients diagnosed with COVID‐19; blood from healthy donors was collected via venipuncture. Patient and control plasma were rapidly thawed at 37 ℃ then transferred to de‐identified containers to blind performing scientist. Samples were processed in a duplicate manner adding 30 μL of plasma to a solution containing 200 x103/μL lyophilized platelets. We measured vWF activation using two methods: the first involved agglutination with an intermediate concentration of ristocetin (between 0.6 ‐ 0.7 mg/mL) to achieve less than 40% of normal agglutination. The second method involved detection of A1‐12 antibody binding with ELISA. The A1‐12 antibody binds to the N‐terminus of the A1 subunit, a location that is typically obscured by the A2 domain and thus is only accessible with vWF is unfolded. All measured values were compared to normal pooled plasma (NPP) processed in the same experiment. Notably all measures of activation of vWF were significantly higher in COVID‐19 patients compared to healthy controls. The primary slope of the agglutination was the most significantly elevated when compared to controls (162 verses 106 % of NPP, p = 0.002). The absolute amount of vWF was also significantly increased in patients compared to controls (148 verses 100% of NPP, p < 0.001). These preliminary data are suggestive of increased activity of vWF in COVID‐19 infectionin addition to an increased absolute level. vWF may be a significant pathway that becomes dysregulated during the immune response to SARS‐CoV‐2. This study is limited by its use of discarded blood that has undergone one freeze‐thaw cycle. Further work is needed to correlate these results to clinical outcomes.

Organohalogens: A persisting burden in Slovenia?

Persistent organic pollutants (POPs) represent a concern for the environment and human health due to their persistence and toxicity. Exposure in Slovenia is geographically differentiated because the country, as part of former Yugoslavia, has a history of industry and regional contamination and is – at the same time – known for its clean nature. The PCB pollution of the Krupa River drew the public's attention to the chemical burden of Slovenians, and the demand for studies has been rising since. We assessed the exposure of men (n = 548) and primiparous women (n = 536) to POPs in 12 regions of Slovenia as well as exposure pathways via questionnaires. Most PCDD/Fs, PCBs, and PBDEs could be determined in pooled samples of maternal milk at low concentrations (1.57 pg/gTEQ, 1.47 pg/gTEQ, and 1076 pg/g fat, respectively), but a much lower number of compounds could be measured above the LOQ in pooled men's plasma samples (PCDD/Fs 0.08 pg/gTEQ, PCBs 0.007 pg/gTEQ, ΣPBDE 920 pg/g), and only HCB, p,p’-DDE, ΣDDT, and the non-dioxin-like PCB congeners 138, 153, and 180 could be determined in individual samples of milk (concentration range 5–60 ng/g fat). In individual samples of men's serum, only p,p’-DDE and ΣPCB were detected at concentrations of 0.25 ng/g and 0.3 ng/g, respectively. Nonetheless, we were able to differentiate between polluted and unpolluted areas on a national level, with higher exposure levels in the PCB polluted region of Bela Krajina, the industrial region Zasavje, and the capital, Ljubljana. Despite low concentrations, determinants of exposure, such as age, proximity to roads, old building materials, private water supplies, and consumption of alcohol, fish, meat, and eggs that have previously been observed only at higher levels could still be identified. Furthermore, levels of PCBs and PBDEs were highly correlated suggesting common exposure sources and pathways, whereas PCDD/Fs were correlated to a lesser extent. The calculated ratio between DDT and DDE in maternal milk samples was decreasing with the year of sampling, suggesting no ongoing exposure to DDT. The study findings suggest low exposure of men and lactating women to legacy pollutants in Slovenia, which gave rise to the hypothesis that Slovenia's geographical location might provide shelter from the long-range transport of POPs via Westerly winds. This hypothesis remains to be confirmed within future studies.

Optimization of hemolysis, icterus and lipemia interference thresholds for 35 clinical chemistry assays

ObjectivesInterference of chemistry assays by hemolysis, icterus and lipemia (HIL) was investigated on the Abbott Alinity c system. We sought to empirically establish optimized HIL index thresholds for the purposes of reporting HIL interference in a hospital laboratory and advising clinicians on the interpretation of laboratory results in the presence of hemolysis, icterus or lipemia. MethodsHIL index values measured by spectrophotometry were compared with concentrations of hemoglobin, bilirubin and Intralipid. HIL interference of 35 Abbott Alinity chemistry assays was subsequently investigated by pairwise comparison of test results in pooled serum or plasma with those in test preparations spiked with hemolysate, bilirubin or Intralipid. Data generated from the interference experiments were critically assessed according to assay-specific acceptance criteria adapted from multiple sources, and optimized thresholds for HIL indices were established. ResultsCorrelations between HIL index values and their corresponding concentrations of hemoglobin, bilirubin and Intralipid were, in general, very good within the ranges of interferent concentrations tested. Hemolysis significantly affected 12 of 35 assays, whereas bilirubin and Intralipid interfered with four and three assays, respectively. Both the direction and magnitude of Intralipid interference with the direct bilirubin assay were dependent on the concentrations of the analyte. ConclusionsHIL interference of the Abbott Alinity clinical chemistry assays investigated in this study was not uncommon. At present, there are no universally accepted criteria for defining significant assay interference for clinical practice. In establishing acceptance criteria for defining assay interference, each assay should be assessed according to both analytical criteria and clinical relevance.

127 Plasma from Patients with Burn Injury Increases Endothelial Permeability In-Vitro

Abstract Introduction The contribution of endothelial injury to the pathogenesis of burn shock is not well characterized. Human umbilical endothelial cells (HUVECs) have been used to study endotheliopathy in myriad shock states. This work investigates the impact of burn patient plasma on the vascular endothelium and its barrier function. Methods HUVECs were seeded into the apical chambers of transwell plates and cultured over 5–7 days to a confluent monolayer which was confirmed by a transendothelial electrical resistance (TEER) of ≥30Ω. After IRB approval, plasma was collected from burn-injured patients 4 hours after admission. Demographic and injury characteristics were collected from the medical record. Plasma Syndecan-1 (SDC-1) was quantified by ELISA. HUVEC monolayers were exposed to 10% multi-donor pooled healthy human plasma (HHP) or burn patient plasma. Monolayers were subsequently incubated with FIT-C Dextran (40,000 kD). FIT-C diffusion through monolayers was measured in basal chamber supernatants. Monolayer permeability was measured with indices calculated by normalizing values to blank (transwell inserts) and HHP-treated monolayer FIT-C diffusion. HUVECs were also cultured on glass slides and exposed to HHP or burn patient plasma. Cells were fixed with 4% Paraformaldehyde and F-Actin was stained with Texas Red-Phalloidin. Intercellular gap area was calculated using imaging software. Differences between treatment conditions were analyzed with Welch’s t-test and one-way ANOVA, simple linear regression was used to characterize the relationship between plasma SDC-1 and permeability indices, significance was set at p &amp;lt; 0.05. Results Eight burn patient plasma samples were tested. Patients were mostly male (75%) with a mean age of 50±20 years and mean %TBSA burn of 37±34%. Five burn plasma samples significantly increased monolayer permeability. There were no significant differences between patient samples that increased permeability in age, TBSA, gender, or in-hospital mortality. Monolayer permeability indices increased between 7–15% (p&amp;lt; 0.05) among burn plasma treatment conditions (n=6) that increased permeability. There was a strong relationship between monolayer permeability index (%) and plasma SDC-1 (µg/mL) (p=0.03, R2=0.93). Morphological F-actin rearrangement was apparent on microscopy and intercellular gap area was increased in burn plasma treatment conditions (12% vs. 49%, p≤0.0007, n=6). Conclusions Plasma from burn patients induces endothelial damage that increases endothelial cell monolayer permeability. The endothelial biomarker SDC-1 is a reliable indicator of endothelial damage. F-actin rearrangement and an increase in intercellular gap area likely contributes to burn endotheliopathy.

Selenium Kinetics in Humans Change Following 2 Years of Supplementation With Selenomethionine.

BackgroundSelenium (Se) is a nutritionally essential trace element and health may be improved by increased Se intake. Previous kinetic studies have shown differences in metabolism of organic vs. inorganic forms of Se [e.g., higher absorption of selenomethionine (SeMet) than selenite (Sel), and more recycling of Se from SeMet than Sel]. However, the effects on Se metabolism after prolonged Se supplementation are not known.ObjectiveTo determine how the metabolism and transport of Se changes in the whole-body in response to Se-supplementation by measuring Se kinetics before and after 2 years of Se supplementation with SeMet.MethodsWe compared Se kinetics in humans [n = 31, aged 40 ± 3 y (mean ± SEM)] studied twice after oral tracer administration; initially (PK1), then after supplementation for 2 y with 200 µg/d of Se as selenomethionine (SeMet) (PK2). On each occasion, we administered two stable isotope tracers of Se orally: SeMet, the predominant food form, and selenite (Na2 76SeO3, or Sel), an inorganic form. Plasma and RBC were sampled for 4 mo; urine and feces were collected for the initial 12 d of each period. Samples were analyzed for tracers and total Se by isotope dilution GC-MS. Data were analyzed using a compartmental model, we published previously, to estimate fractional transfer between pools and pool masses in PK2.ResultsWe report that fractional absorption of SeMet or Sel do not change with SeMet supplementation and the amount of Se absorbed increased. The amount of Se excreted in urine increases but does not account for all the Se absorbed. As a result, there is a net incorporation of SeMet into various body pools. Nine of the 11 plasma pools doubled in PK2; two did not change. Differences in metabolism were observed for SeMet and Sel; RBC uptake increased 247% for SeMet, urinary excretion increased from two plasma pools for Sel and from two different pools for SeMet, and recycling to liver/tissues increased from one plasma pool for Sel and from two others for SeMet. One plasma pool increased more in males than females in PK2.ConclusionsOf 11 Se pools identified kinetically in human plasma, two did not increase in size after SeMet supplementation. These pools may be regulated and important during low Se intake.

Independent and combined effects of biotin and hemolysis on high-sensitivity cardiac troponin assays.

This study compared the independent and combined effects of hemolysis and biotin on cardiac troponin measurements across nine high-sensitivity cardiac troponin (hs-cTn) assays. Parallel cTn measurements were made in pooled lithium heparin plasma spiked with hemolysate and/or biotin using nine hs-cTn assays: Abbott Alinity, Abbott ARCHITECT i2000, Beckman Access 2, Ortho VITROS XT 7600, Siemens Atellica, Siemens Centaur, Siemens Dimension EXL cTnI, and two Roche Cobas e 411 Elecsys Troponin T-hs cTnT assays (outside US versions, with and without increased biotin tolerance). Absolute and percent cTn recovery relative to two baseline concentrations were determined in spiked samples and compared to manufacturer's claims. All assays except the Ortho VITROS XT 7600 showed hemolysis and biotin interference thresholds equivalent to or greater than manufacturer's claims. While imprecision confounded analysis of Ortho VITROS XT 7600 data, evidence of biotin interference was lacking. Increasing biotin concentration led to decreasing cTn recovery in three assays, specifically both Roche Cobas e 411 Elecsys Troponin T-hs assays and the Siemens Dimension EXL. While one of the Roche assays was the most susceptible to biotin among the nine studied, a new version showed reduced biotin interference by approximately 100-fold compared to its predecessor. Increasing hemolysis also generally led to decreasing cTn recovery for susceptible assays, specifically the Beckman Access 2, Ortho VITROS XT 7600, and both Roche Cobas e 411 Elecsys assays. Equivalent biotin and hemolysis interference thresholds were observed at the two cTn concentrations considered for all but two assays (Beckman Access 2 and Ortho VITROS XT 7600). When biotin and hemolysis were present in combination, biotin interference thresholds decreased with increasing hemolysis for two susceptible assays (Roche Cobas e 411 Elecsys and Siemens Dimension EXL). Both Roche Cobas e 411 Elecsys as well as Ortho VITROS XT assays were susceptible to interference from in vitro hemolysis at levels routinely encountered in clinical laboratory samples (0-3g/L free hemoglobin), leading to falsely low cTn recovery up to 3ng/L or 13%. While most assays are not susceptible to biotin at levels expected with over-the-counter supplementation, severely reduced cTn recovery is possible at biotin levels of 10-2000ng/mL (41-8,180nmol/L) for some assays. Due to potential additive effects, analytical interferences should not be considered in isolation.

Identification of human parvovirus 4 genotypes 1 and 2 in Chinese source plasma pools.

Human parvovirus B19 (B19V) and human parvovirus 4 (PARV4) are known to infect humans and transmit through contaminated blood and blood products. Globally, three genotypes of B19V, as well as PARV4, have been identified, respectively. The existence of different B19V genotypes in Chinese plasma donors has been investigated, however, the data regarding PARV4 were not available. The main objective of this study is to identify the genotypes of PARV4 circulating in Chinese plasma donors. By using a duplex quantitative polymerase chain reaction assay adapted for all genotypes of B19V and PARV4, 78 source plasma pools for fractionation were screened and quantified. Results showed that positive rates of B19V and PARV4 DNA in plasma pool samples were 25.64% and 14.10%, respectively. PARV4 sequences in two positive samples were next genotyped, and these two sequences belonged to PARV4 genotypes 1 and 2, respectively. In conclusion, the data present demonstrate the existence of PARV4 genotypes 1 and 2 in Chinese plasma donors for the first time and also show the relatively lower prevalence and level of PARV4 DNA in Chinese plasma donors in comparison with that of B19V DNA.

Insight into the hypercoagulable state of high‐risk thrombotic APS patients: Contribution of aβ2GPI and aPS/PT antibodies

ObjectiveMost high‐risk thrombotic antiphospholipid syndrome (APS) patients test positive for anti‐β2‐glycoprotein I (aβ2GPI) and anti‐phosphatidylserine/prothrombin (aPS/PT) antibodies. Information on the influence of these antibodies on thrombin generation and activated protein C resistance (aPCr) is still sparse and contradictory. MethodsPlasma of 16 patients poured into a β2GPI affinity column allowed the perfect separation of aβ2GPI and aPS/PT antibodies. aPS/PT antibodies were further purified through a prothrombin affinity column. Obtained material was spiked into normal pooled plasma (NPP) and tested in the thrombin generation assay in the absence or presence of aPC. ResultsaPS/PT antibodies showed a marked anticoagulant effect. Affinity purified aPS/PT and aβ2GPI antibodies from five patients were compared. aPS/PT antibodies showed significantly prolonged lag time and time to peak (5.0 minutes [interquartile range (IQR)3.5–6.1] versus 2.7 minutes [IQR2.2–3.5], P = .03 and 8.7 minutes [IQR6.7–10.3] versus 5.7 minutes [IQR4.5–6.2], P = .05, respectively) and significantly lower peak and velocity index (143 nmol/L [IQR131–163] versus 171 nmol/L [IQR157–182], P = .03 and 35 nmol/L/min [IQR32–59] versus 72 nmol/L/min [IQR54–77], P = .03, respectively). When aPC was added to the system, aPCr was significantly increased compared to controls for both aβ2GPI and aPS/PT antibodies. However, it was significantly stronger using aPS/PT antibodies. Median inhibition of endogenous thrombin potential was 22% (IQR16–33) with aPS/PT compared to 52% (IQR46–56) with aβ2GPI antibodies (P = .002). ConclusionsAβ2GPI antibodies show a mild anticoagulant and moderate procoagulant effect in thrombin generation and moderate aPC resistance. Conversely, aPS/PT antibodies show a strong anticoagulant effect and a strong aPCr.

Comparison of Different Sample Preparation Techniques for Untargeted Metabolomics Utilizing Q-TOF LC/MS and MetaboAnalyst 4.0

Background: Profiling the whole metabolome with a single injection is not an easy process because the chemical and physical properties of metabolites are totally different with each other and the analytical methodologies and data mining procedures need lots of effort to make such an approach in real. This reality leads researchers to select an already applied methodology for metabolite profiling and analyze the samples through identical techniques. Objective: In this study, it was focused on answer the question the sample preparation techniques on human blood samples prior to Q-TOF LC/MS analysis affect the number of detectable peaks and analyze the matched metabolites for these peaks. The results were compared with each other. Methods: Precipitation of proteins with methanol, ultrafiltration (Amicon® Ultra 3 kDa 0.5 mL Centrifugal Filters), liquid-phase extraction (EXtrelut® NT 3 cartridges) and solid-phase extraction (Supelco HybridSPE®-Phospholipid Cartridge) were used for sample preparation on commercial pooled plasma samples. C18 column (Agilent Zorbax 1.8 μM, 50 x 2.1 mm) was used as the chromatography column. Q-TOF LC/MS analysis was performed on positive ionization mode. XCMS and MetaboAnalyst 4.0 - MS Peaks to Pathways utility were used to evaluate the raw data. Results: Although the number of detected peaks through precipitation of proteins with methanol was the highest one (624 peaks), the detected peaks observed through ultrafiltration- based sample preparation technique matched with the highest number of metabolite peaks (151 metabolites). The number of the matched peaks with metabolites on liquid phase extraction (81 metabolites) was higher than the ones for solid phase extraction (29 metabolites). Conclusion: The results in this study may provide a novel perspective for analytical chemists working with clinicians to select their sample preparation technique prior to Q-TOF LC/MS based untargeted metabolomic approaches.

Monitoring molten pool temperature, grain size and molten pool plasma with integrated area of the spectrum during laser additive manufacturing

A new approach is presented in this paper to link the integrated area of the spectral curve with the molten pool temperature, the grain size and molten pool plasma during laser additive manufacturing. A fiber laser was used to deposit the CoCrMo powder on the Q235 steel substrate. The spectra generated during the additive manufacturing process were collected with an optical spectrometer attached to the laser head. According to the thermal radiation theory and the rapid solidification theory, spectral information was applied to calculate the molten pool temperature and the grain size. The relationship between the molten pool temperature and the integrated area of the spectral curve, as well as the relationship between the grain size and the integrated area of the spectral curve was established, respectively. Meanwhile, the electron temperature and electron density of the molten pool plasma were calculated from two different Cr I spectral lines at 403.292 and 434.429 nm wavelength. The results show that the molten pool temperature and the grain size are closely related to the integrated area of the spectral curve. Furthermore, the electron temperature and electron density also increase with the integrated area of the spectral curve.

Pre-analytical variables in haemostasis: Findings from the United Kingdom National External Quality Assessment scheme for Blood Coagulation (UK NEQAS BC) haemolysis exercise.

Haemolysis is considered one of the major contributors of nonconformities and sample rejection in coagulation testing. Two lyophilized plasmas were distributed to 800 centres registered for prothrombin time (PT), activated partial thromboplastin time (APTT) and either Clauss fibrinogen or thrombin time (TT) in the UK NEQAS BC programme. The same pool of normal plasma was used to prepare both samples, to one of which red blood cell haemolysate was added to mimic haemolysis at 3g/L haemoglobin concentration. Participants were asked to complete a questionnaire about their laboratory approach to dealing with haemolysed samples, including strategies used to deal with different levels of haemolysis. Results for tests performed did not show great differences between the two samples. It should be noted that artificially constructed haemolysed samples may not behave in the same way as patient samples (ie, may not be commutable). However, the possibility of carrying out a large multicentre study for detection of haemolysis was demonstrated. Inconsistency in practice was observed with 226/551 (41%) of centres indicated they reject haemolysed samples solely on visual checks, and 163 (30%) using initial visual checks with further sample rejection evaluation by analyser flags. Furthermore, 333 (72%) of centres indicated that the level of haemolysis affects sample rejection decisions, while 132 (28%) stated it did not. Variability of responses for dealing with haemolysed samples reflects a lack of clear consistency in the pre-analytical area of sample processing.

Dynamic behavior of plasma and molten pool of pure titanium during hyperbaric laser welding

In this study, the influence of increasing the ambient pressure on the penetration of pure titanium during fiber spot laser welding was studied. Theresultsindicatedthat the penetration of pure titanium decreased significantly with an increase in ambient pressure. Under the experimental conditions in this study, when the ambient pressure increased from 0.1 to 1.8 MPa, the penetration changed from 3.6 to 1.2 mm, decreasing by approximately 67%. A high-speed camera and spectrometer were used to analyze the mechanism of the sharp decline in penetration. First, the rate of plasma expansion and the cross-section area of pure titanium under different ambient pressures were observed using a high-speed camera. Subsequently, a spectrometer was used to detect the plasma intensity of pure titanium during laser welding under different ambient pressures. Finally, the influence of changes in environmental pressure on the dynamic behavior of a pure titanium molten pool was studied by using high-speed photography and “glass-metal composite samples”. The results of this research could help in enriching the theory regarding laser processing under hyperbaric conditions and develop laser manufacturing technology for offshore engineering structures.