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PreAlbumin ARC CHEM
PreAlbumin ARC CHEM
1E02-21
304381/R1
PREALBUMIN
This package insert contains information to run the Prealbumin assay on the ARCHITECT c Systems and the
AEROSET System.
NOTE: This package insert must be read carefully prior to product use. Package insert instructions must be
followed accordingly. Reliability of assay results cannot be guaranteed if there are any deviations from the
instructions in this package insert.
Customer Support
United States: 1-877-4ABBOTT
Canada: 1-800-387-8378 (English speaking customers)
1-800-465-2675 (French speaking customers)
International: Call your local Abbott representative
Concentration Reagent 2
October 2009
©2009 Abbott Laboratories
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NAME REAGENT HANDLING AND STORAGE
PREALBUMIN Reagent Handling
Remove air bubbles, if present in the reagent cartridge, with a new
INTENDED USE applicator stick. Alternatively, allow the reagent to sit at the appropriate
The Prealbumin assay is used for the quantitation of prealbumin in storage temperature to allow the bubbles to dissipate. To minimize
human serum. volume depletion, do not use a transfer pipette to remove the bubbles.
CAUTION: Reagent bubbles may interfere with proper detection of
SUMMARY AND EXPLANATION OF TEST reagent level in the cartridge, causing insufficient reagent aspiration
Prealbumin (transthyretin or thyroxin-binding prealbumin) is synthesized which could impact results.
in the liver and is involved in triiodothyronine (T3), thyroxine (T4), and
vitamin A transport. Prealbumin is capable of binding two separate Reagent Storage
ligands at unique binding sites. Each tetrameric prealbumin molecule Unopened reagents are stable until the expiration date when stored
binds one molecule of retinol-binding protein (which complexes with at 2 to 8°C.
vitamin A) at one site and up to two molecules of T3 or T4 at another Reagent onboard stability is approximately 57 days if quality control
site. Prealbumin is secondary to thyroxine-binding globulin in the results meet acceptance criteria. If quality control results do not meet
transport of T3 and T4.1 acceptance criteria, refer to the QUALITY CONTROL section of this
Because prealbumin has an extremely short half-life, quantitation package insert.
of prealbumin serum levels can provide a more timely and sensitive
assessment of protein malnutrition or liver dysfunction than transferrin WARNINGS AND PRECAUTIONS
or albumin.2
Precautions for Users
Prealbumin is a very sensitive negative acute phase protein (or acute
phase reactant); decreased levels are associated with inflammation, 1. For in vitro diagnostic use.
malignancy, liver cirrhosis, and protein diseases of the gut or kidneys. 2. Do not use components beyond the expiration date.
Prealbumin levels also fall during periods of calorie/protein malnutrition; 3. Do not mix materials from different kit lot numbers.
therefore, during inflammatory processes with concomitant malnutrition, 4. Do not mix fresh reagent with in-use reagents.
levels fall rapidly and markedly. Decreased prealbumin levels are also 5. CAUTION: This product requires the handling of human specimens.
associated with cystic fibrosis, chronic illness, and some forms of It is recommended that all human sourced materials be considered
hereditary amyloidosis.1 potentially infectious and be handled in accordance with the OSHA
Although the presence of acute or chronic inflammation may limit Standard on Bloodborne Pathogens.5 Biosafety Level 26 or other
its specificity, prealbumin can be a useful marker for assessing appropriate biosafety practices7,8 should be used for materials that
protein‑energy nutritional status of maintenance dialysis patients. contain or are suspected of containing infectious agents.
In 2000, the Kidney Disease Outcomes Quality Initiative (K/DOQI) 6. This product contains sodium azide. For a specific listing, refer to
recommended a prealbumin goal of ≥ 30 mg/dL, stating, “An individual the REAGENTS section of this package insert. Contact with acids
with predialysis or stabilized serum prealbumin of less than 30 mg/dL liberates very toxic gas. This material and its container must be
should be evaluated for protein-energy malnutrition”.3 It has been disposed of in a safe way.
reported that serum prealbumin is higher in peritoneal dialysis patients NOTE: Refer to Section 8 of the instrument-specific operations
than in hemodialysis patients.4 manual for proper handling and disposal of reagents containing
Elevated prealbumin levels are associated with high doses of sodium azide.
corticosteroids, high levels of endogenous steroids secondary to
adrenal hyperactivity, high doses of nonsteroidal anti-inflammatory SPECIMEN COLLECTION AND HANDLING
medication, and Hodgkin’s disease.1
Suitable Specimens
PRINCIPLES OF PROCEDURE Serum is the acceptable specimen.
The Prealbumin assay is an immunoturbidimetric procedure that Serum: Use serum collected by standard venipuncture techniques into
measures increasing sample turbidity caused by the formation of glass or plastic tubes with or without gel barriers. Ensure complete clot
insoluble immune complexes when antibody to prealbumin is added to formation has taken place prior to centrifugation. When processing
the sample. Sample containing prealbumin is incubated with a buffer, samples, separate serum from blood cells or gel according to the
, and a sample blank determination is performed prior to the addition specimen collection tube manufacturer’s instructions.
of prealbumin antibody, . In the presence of an appropriate antibody Some specimens, especially those from patients receiving anticoagulant
in excess, the prealbumin concentration is measured as a function of or thrombolytic therapy, may take longer to complete their clotting
turbidity. processes. Fibrin clots may subsequently form in these sera and the
Methodology: Immunoturbidimetric clots could cause erroneous test results.
For total sample volume requirements, refer to the instrument-specific
REAGENTS ASSAY PARAMETERS section of this package insert and Section 5 of
the instrument‑specific operations manual.
Reagent Kit
1E02 Prealbumin is supplied as a liquid, ready-to-use, two-reagent Specimen Storage
kit which contains: Serum: Analyze fresh specimens if possible. Repeated freeze/thaw
3 x 18 mL cycles should be avoided to minimize potential protein degradation.
3 x 6 mL Temperature Maximum Bibliographic
Estimated tests per kit: 242 Storage Reference
Calculation is based on the minimum reagent fill volume per kit. 2 to 8°C 3 days 1, 9
Reactive Ingredients Concentration -20°C 6 months 1
TRIS 100 mmol/L Teitz1 suggests storage of frozen specimens at -20°C for no longer
than the time interval cited above. However, limitations of laboratory
Polyethylene Glycol 50 g/L equipment make it necessary in practice for clinical laboratories to
Anti-human prealbumin goat serum 30% establish a range around -20°C for specimen storage. This temperature
range may be established from either the freezer manufacturer’s
TRIS 100 mmol/L
specifications or your laboratory standard operating procedure(s) for
Inactive Ingredients: and contain sodium azide (0.1%) as a specimen storage.
preservative. NOTE: Stored specimens must be inspected for particulates. If present,
mix and centrifuge the specimen to remove particulates prior to testing.
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PROCEDURE RESULTS
Materials Provided Refer to the instrument-specific operations manual for information on
results calculations.
1E02 Prealbumin Reagent Kit
• ARCHITECT System Operations Manual—Appendix C
Materials Required but not Provided • AEROSET System Operations Manual—Appendix A
• 6E57 Prealbumin Calibrator, 1 x 1 mL Representative performance data are given in the EXPECTED VALUES
• Control Material and SPECIFIC PERFORMANCE CHARACTERISTICS sections of this
package insert. Results obtained in individual laboratories may vary.
• Saline (0.85% to 0.90% NaCl) for specimens that require dilution
Assay Procedure LIMITATIONS OF THE PROCEDURE
For a detailed description of how to run an assay, refer to Section 5 of Refer to the SPECIMEN COLLECTION AND HANDLING and SPECIFIC
the instrument-specific operations manual. PERFORMANCE CHARACTERISTICS sections of this package insert.
Specimen Dilution Procedures The performance characteristics of Prealbumin on an analyzer other
than the ARCHITECT c Systems or the AEROSET System must be
The ARCHITECT c Systems and the AEROSET System have automatic validated and verified.
dilution features; refer to Section 2 of the instrument-specific operations Samples containing paraproteins (abnormal monoclonal antibodies)
manual for additional information. may interfere with test results. Samples with elevated total
Serum: Specimens with prealbumin values exceeding the highest protein concentrations or samples from patients with suspected
calibrator are flagged and may be diluted using the Automated Dilution paraproteinemia can be screened using other laboratory methods such
Protocol or the Manual Dilution Procedure. as protein electrophoresis.10
Turbidity and particles in the samples can interfere with the assay.
Automated Dilution Protocol Therefore, particulate matter should be removed by centrifugation prior
If using the Automated Dilution Protocol, the system performs a 1:4 to running the assay.
dilution of the specimen and automatically corrects the concentration by
multiplying the result by the appropriate dilution factor. EXPECTED VALUES
Manual Dilution Procedure Reference Range
Manual dilutions should be performed as follows:
• Use saline (0.85% to 0.90% NaCl) to dilute the sample. Serum11 Range* (mg/dL) Range* (g/L)
• The operator must enter the dilution factor in the patient or control 0 to 1 year
order screen. The system uses this dilution factor to automatically Male 7 to 25 0.07 to 0.25
correct the concentration by multiplying the result by the entered Female 8 to 25 0.08 to 0.25
factor.
> 1 to 12 years
• If the operator does not enter the dilution factor, the result must be
multiplied by the appropriate dilution factor before reporting the result. Male 11 to 34 0.11 to 0.34
NOTE: If a diluted sample result is flagged indicating it is less than the Female 12 to 30 0.12 to 0.30
linear low limit, do not report the result. Rerun using an appropriate > 12 to 60 years
dilution. Male 18 to 45 0.18 to 0.45
For detailed information on ordering dilutions, refer to Section 5 of the Female 16 to 38 0.16 to 0.38
instrument-specific operations manual.
> 60 years
The patient result flag “>” (ARCHITECT c Systems) and the EXT and
LH result error codes (AEROSET) may indicate antigen excess. Dilute Male 16 to 42 0.16 to 0.42
sample and rerun. Samples were tested for antigen excess up to Female 14 to 37 0.14 to 0.37
254.6 mg/dL (2.546 g/L). * Reference ranges are based on a 90% confidence interval.
CALIBRATION To convert results from mg/dL to g/L, multiply mg/dL by 0.01.
The linear high field of the assay parameters must be edited to the A study was conducted using 143 serum samples from volunteers.
concentration of the highest calibrator specified in the value sheet. Data were analyzed as described by Clinical and Laboratory Standards
Calibration is stable for approximately 57 days (1,368 hours) and is Institute (CLSI) protocol NCCLS C28-A.12 From this study, 95% of all
specimens fell within 17.77 to 36.35 mg/dL (0.18 to 0.36 g/L), with
required with each change in reagent lot number. Verify calibration with samples ranging from 14.47 to 40.07 mg/dL (0.14 to 0.40 g/L).
at least three levels of controls according to the established quality
control requirements for your laboratory. If control results fall outside It is recommended that each laboratory determine its own reference
acceptable ranges, recalibration may be necessary. range based upon its particular locale and population characteristics.
A multi-point (Linear) calibration curve is generated using Prealbumin
Calibrator.
For a detailed description of how to calibrate an assay, refer to
Section 6 of the instrument-specific operations manual.
For information on calibrator standardization, refer to the Prealbumin
Calibrator package insert.
QUALITY CONTROL
The following is the recommendation of Abbott Laboratories for quality
control. As appropriate, refer to your laboratory standard operating
procedure(s) and/or quality assurance plan for additional quality control
requirements and potential corrective actions.
• Three levels of quality control are to be run every 24 hours.
• Run three levels of quality control with cartridge change.
• If more frequent control monitoring is required, follow the established
quality control procedures for your laboratory.
• If quality control results do not meet the acceptance criteria
defined by your laboratory, patient values may be suspect. Follow
the established quality control procedures for your laboratory.
Recalibration may be necessary.
• Review quality control results and acceptance criteria following a
change of reagent or calibrator lot.
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SPECIFIC PERFORMANCE CHARACTERISTICS SPECIFIC PERFORMANCE CHARACTERISTICS
Reportable Range (Accuracy by Recovery) (Continued)
The Prealbumin assay reportable range is from 3 mg/dL (0.03 g/L) to Precision
the highest calibrator concentration. Human serum containing a known The imprecision of the Prealbumin assay is ≤ 5.5% Total CV.
concentration of prealbumin was diluted with saline and the resulting Representative data from studies using CLSI protocols NCCLS
samples were analyzed. Observed mean results across the reportable EP5‑T214 and EP5-A15 are summarized below.
range were within 1 mg/dL (0.01 g/L) or 10%, whichever is greater, of
the target concentrations. Representative data are summarized below. Control Level 1 Level 2 Level 3
%Recovery = (Observed Mean / Target Concentration) × 100
N 80 80 80
Target Concentration Observed Mean Delta* Percent (%)
Mean (mg/dL) 13.4 21.2 31.2
(mg/dL) (mg/dL) (mg/dL) Recovery*
0.8 1.1 0.3 139.4 SD 0.12 0.18 0.80
Within Run
1.7 2.1 0.3 117.5 %CV 0.9 0.9 2.6
2.9 3.3 0.4 113.4 SD 0.11 0.15 0.48
5.8 5.6 -0.2 96.4 Between Run
%CV 0.8 0.7 1.6
11.6 11.3 -0.3 97.1
SD 0.35 0.14 0.51
23.3 23.3 0.0 100.0 Between Day
34.9 35.3 0.4 101.2 %CV 2.6 0.6 1.6
46.6 46.5 -0.1 99.8 SD 0.38 0.28 1.07
58.2 57.1 -1.1 98.2 Total
%CV 2.9 1.3 3.4
* Delta and %Recovery were calculated prior to rounding Target
Concentration and Observed Mean values. Method Comparison
Limit of Quantitation (LOQ) Correlation studies were performed using CLSI protocol NCCLS
EP9‑A.16
The LOQ for Prealbumin is ≤ 1 mg/dL (0.01 g/L). The LOQ is the
analyte concentration at which the CV = 20%. Performance studies Serum results from the Prealbumin assay on the AEROSET
produced an LOQ of 0.2 mg/dL (0.002 g/L). System were compared with those from a commercially available
immunoturbidimetric methodology.
Interfering Substances Serum results from the Prealbumin assay on an ARCHITECT c System
Interference studies were conducted using CLSI protocol NCCLS were compared with those from the Prealbumin assay on the AEROSET
EP7‑P.13 Interference effects were assessed by Dose Response and System.
Paired Difference methods, at the concentrations listed below.
AEROSET vs. ARCHITECT
Interfering Interferent Concentration N Target Observed Comparative Method vs. AEROSET
Substance (mg/dL) (% of Target)
N 80 95
30 mg/dL (513 µmol/L) 4 14.7 96.4
Bilirubin Y - Intercept 0.09 -0.45
60 mg/dL (1,026 µmol/L) 4 14.7 92.3
Correlation Coefficient 0.996 0.998
500 mg/dL (5.0 g/L) 4 13.6 91.2
Hemoglobin Slope 1.05 1.01
750 mg/dL (7.5 g/L) 4 13.6 88.6
Mean %Bias 5.7 -0.6
Human 750 mg/dL (8.5 mmol/L) 4 18.6 97.4
Range (mg/dL) 4.3 to 44.1 3.2 to 56.2
triglyceride 1,000 mg/dL (11.3 mmol/L) 4 18.6 98.6
1,000 mg/dL (10.0 g/L) 4 13.0 95.7
Intralipid
2,000 mg/dL (20.0 g/L) 4 13.0 64.0
Bilirubin solutions at the above concentrations were prepared by
addition of a bilirubin stock to human serum pools. Hemoglobin
solutions at the above concentrations were prepared by addition
of hemolysate to human serum pools. Human triglyceride solutions
at the above concentrations were prepared by mixing an elevated
triglyceride human serum pool with a normal triglyceride human serum
pool. Intralipid solutions at the above concentrations were prepared by
addition of Intralipid to human serum pools.
4
BIBLIOGRAPHY
1. Tietz NW, editor. Clinical Guide to Laboratory Tests, 3rd ed.
Philadelphia, PA: WB Saunders; 1995:608–9.
2. Burtis CA, Ashwood ER, editors. Tietz Textbook of Clinical
Chemistry, 2nd ed. Philadelphia, PA: WB Saunders; 1994:700.
3. K/DOQI clinical practice guidelines for nutrition in chronic renal
failure. Am J Kidney Dis 2000;35(Suppl 2):S20–2.
4. Goldwasser P, Feldman JG, Barth RH. Serum prealbumin is higher
in peritoneal dialysis than in hemodialysis: A meta-analysis. Kidney
Int 2002;62:276–81.
5. US Department of Labor, Occupational Safety and Health
Administration. 29 CFR Part 1910.1030. Bloodborne Pathogens.
6. US Department of Health and Human Services. Biosafety in
Microbiological and Biomedical Laboratories, 5th ed. Washington,
DC: US Government Printing Office, January 2007.
7. World Health Organization. Laboratory Biosafety Manual, 3rd ed.
Geneva: World Health Organization, 2004.
8. Sewell DL, Bove KE, Callihan DR, et al. Protection of Laboratory
Workers from Occupationally Acquired Infections; Approved Guideline
– Third Edition (M29-A3). Wayne, PA: Clinical and Laboratory
Standards Institute, 2005.
9. US Pharmacopeial Convention, Inc. General notices. In: US
Pharmacopeia National Formulary, 1995 ed (USP 23/NF 18).
Rockville, MD: The US Pharmacopeial Convention, Inc; 1994:11.
10. Ledue TB, Collins MF, Ritchie RF. Development of
immunoturbidimetric assays for fourteen human serum proteins on
the Hitachi 912. Clin Chem Lab Med 2002;40(5):520–8.
11. Ritchie RF, editor. Serum Proteins in Clinical Medicine, Vol 1. AACC,
1996:9.01-6.
12. Sasse EA, Aziz KJ, Harris EK, et al. How to Define and Determine
Reference Intervals in the Clinical Laboratory; Approved Guideline
(C28‑A). Villanova, PA: The National Committee for Clinical
Laboratory Standards, 1995.
13. Powers DM, Boyd JC, Glick MR, et al. Interference Testing in
Clinical Chemistry; Proposed Guideline (EP7-P). Villanova, PA: The
National Committee for Clinical Laboratory Standards, 1986.
14. Kennedy JW, Carey RN, Coolen RB, et al. Evaluation of Precision
Performance of Clinical Chemistry Devices—Second Edition;
Tentative Guideline (EP5-T2). Villanova, PA: The National
Committee for Clinical Laboratory Standards, 1992.
15. Kennedy JW, Carey RN, Coolen RB, et al. Evaluation of Precision
Performance of Clinical Chemistry Devices; Approved Guideline
(EP5-A). Wayne, PA: The National Committee for Clinical
Laboratory Standards, 1999.
16. Kennedy JW, Carey RN, Coolen RB, et al. Method Comparison and
Bias Estimation Using Patient Samples; Approved Guideline (EP9‑A).
Wayne, PA: The National Committee for Clinical Laboratory
Standards, 1995.
TRADEMARKS
The ARCHITECT c System family of instruments consists of c 4000,
c 8000, and c 16000 instruments.
AEROSET, ARCHITECT, c 4000, c 8000, c 16000, c System, and
SmartWash are trademarks of Abbott Laboratories in various
jurisdictions.
All other trademarks are property of their respective owners.
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ARCHITECT c SYSTEMS ASSAY PARAMETERS
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AEROSET SYSTEM ASSAY PARAMETERS