Home Cooperation experience in a multicentre study to define the upper limits in a normal population for the diagnostic assessment of the functional lupus anticoagulant assays
Article
Licensed
Unlicensed Requires Authentication

Cooperation experience in a multicentre study to define the upper limits in a normal population for the diagnostic assessment of the functional lupus anticoagulant assays

  • Paola Pradella EMAIL logo , Gabriella Azzarini , Liliana Santarossa , Livio Caberlotto , Cristina Bardin , Alessandra Poz , Federica D’Aurizio and Roberta Giacomello
Published/Copyright: September 22, 2012
Become an author with De Gruyter Brill
Submit Manuscript Author Information
Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 51 Issue 2

Abstract

Background: Phospholipid-dependent coagulation tests for lupus anticoagulant (LA) are considered an important step for the diagnosis of anti-phospholipid syndrome; however, LA laboratory detection is difficult because of many variables. Five hospital laboratories, located in a North-Italy area and using the same method for LA testing, cooperated to standardise sample treatment and analytical procedure in order to define the upper values for LA negativity.

Methods: In total, 200 normal subjects (40 for each centre) were studied for six LA functional assays, using the same procedure, reagent lot and analyser type. The first tests done were LA screen and LA confirm assays, based on diluted Russell’s Viper Venom Time, with low and high phospholipid content, respectively. The second tests performed were silica clotting time screen and confirm assays, based on activated partial thromboplastin time, with low and high phospholipid content, respectively. Finally, two mixing assays were executed for both screening assays, diluting patient sample with a pool prepared with plasma collected from the study population.

Results: Data analysis demonstrated a difference between centres for all assays when results were expressed in seconds; the difference disappeared when results are normalised with the local mean normal value of each centre and are expressed as a normalised ratio. The study population was normally distributed; so the value corresponding to 99th percentile was used as limit value for LA negativity. Values expressed as normalised ratio, for LA and silica clotting time screenings were 1.22 and 1.23, respectively.

Conclusions: The study allowed us to define a uniform approach to LA testing and evaluation for laboratories employing the same methods.

Keywords: acquired coagulation disorders; antiphospholipid antibodies; haemostasis; thrombosis
Corresponding author: Paola Pradella, Haemostasis Laboratory, Department of Transfusion Medicine, AOUTs “Ospedali riuniti”, University Hospital of Cattinara, Strada di Fiume 447, 34149 Trieste, Italy, Phone: +39 040 3994337, Fax: +39 040 3994893

A wholehearted acknowledgement to Dr. Massimo Gion, director of the Department of Clinical Pathology, AULLS 12, General Hospital “Dell’Angelo”, Venezia-Mestre, Italy, for his helpful feedback and suggestions. The authors would like to thank the Instrumentation Laboratory for providing reagent kits to perform the assays.

Conflict of interest statement

Authors’ conflict of interest disclosure: The authors stated that there are no conflicts of interest regarding the publication of this article.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

References

1. Hughes GR. The antiphospholipid syndrome: ten years on. Lancet 1993;342:341–4.10.1016/0140-6736(93)91477-4Search in Google Scholar

2. Ruiz-Irastorza G, Crowther M, Branch W, Khamashta MA. Antiphospholipid syndrome. Lancet 2010;376:1498–509.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000284248500033&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1016/S0140-6736(10)60709-XSearch in Google Scholar

3. Arnout J. Antiphospholipid syndrome: diagnostic aspects of lupus anticoagulants. Thromb Haemost 2001;86:83–91.10.1055/s-0037-1616204Search in Google Scholar PubMed

4. Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 2006;4:295–306.10.1111/j.1538-7836.2006.01753.xSearch in Google Scholar PubMed

5. Pierangeli SS, de Groot PG, Dlott J, Favaloro E, Harris EN, Lakos G, et al. ‘Criteria’ aPL tests: Report of a Task Force and preconference workshop at the 13th International Congress on Antiphospholipid Antibodies, Galveston, Texas, April 2010. Lupus 2011;20:182–90.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000287078600012&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1177/0961203310395055Search in Google Scholar PubMed

6. Žigon P, Ambrožič A, Čučnik S, Kveder T, Rozman B, Božič B. Modified phosphatidylserine-dependent antithrombin ELISA enables identification of patients negative for other antiphospholipid antibodies and also detects low avidity antibodies. Clin Chem Lab Med 2011;49:1011–8.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000291429500012&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1515/CCLM.2011.162Search in Google Scholar PubMed

7. Wong RC, Gillis D, Adelstein S, Baumgart K, Favaloro EJ, Hendle MJ, et al. Consensus guidelines on anti-cardiolipin antibody testing and reporting. Pathology 2004;36:63–8.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000252338900011&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Search in Google Scholar

8. Pierangeli SS, Harris EN. A protocol for determination of anticardiolipin antibodies by ELISA. Nat Protoc 2008;3: 840–8.10.1038/nprot.2008.48http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000258423600009&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Search in Google Scholar PubMed

9. Wong RC, Favaloro EJ, Adelstein S, Baumgart K, Bird R, Brighton TA, et al. Consensus Guidelines on anti-beta 2 glycoprotein I testing and Reporting. Pathology 2008;40:58–63.10.1080/00313020701717720http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000252338900011&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Search in Google Scholar PubMed

10. Greaves M, Cohen H, Machin SJ, Mackie I. Guidelines on the investigation and management of antiphospholipid syndrome. Br J Haematol 2000;109:704–15.10.1046/j.1365-2141.2000.02069.xSearch in Google Scholar PubMed

11. Galli M. Clinical utility of laboratory tests used to identify antiphospholipid antibodies and to diagnose the antiphospholipid syndrome. Semin Thromb Hemost 2008;34:329–34.10.1055/s-0028-1085474http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000259790200005&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Search in Google Scholar PubMed

12. Galli M, Luciani D, Bertolini G, Barbui T. Lupus anticoagulants are stronger risk factors for thrombosis than anticardiolipin antibodies in the antiphospholipid syndrome: a systematic review of the literature. Blood 2003;101:1827–32.10.1182/blood-2002-02-0441Search in Google Scholar PubMed

13. Finazzi G. The epidemiology of the antiphospholipid syndrome: who is at risk? Curr Rheumatol Rep 2001;3:271–6.10.1007/s11926-001-0030-5Search in Google Scholar PubMed

14. Pengo V. Antiphospholipid syndrome: interpretation of laboratory data. J Thromb Haemost 2011;9:402–3.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000286626800020&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1111/j.1538-7836.2010.04151.xSearch in Google Scholar PubMed

15. Pengo V, Banzato A, Bison E, Bracco A, Denas G, Ruffatti A. What have we learned about antiphospholipid syndrome from patients and antiphospholipid carrier cohorts? Semin Thromb Hemost 2012;38:322–7.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000304352600003&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1055/s-0032-1304719Search in Google Scholar PubMed

16. Tripodi A. Laboratory testing for lupus anticoagulants: a review of issues affecting results. Clin Chem 2007;53:1629–35.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000249193100011&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1373/clinchem.2007.089524Search in Google Scholar PubMed

17. Favaloro EJ, Wong RC. Laboratory testing for the antiphospholipid syndrome: making sense of antiphospholipid assays. Clin Chem Lab Med 2011;49:447–61.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000288238500013&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Search in Google Scholar PubMed

18. Froom P, Barak M. Lupus anticoagulant testing: analyzing fresh samples after a single centrifugation and after a 6–8 h delay. Clin Chem Lab Med 2012;50:367–70.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000301991300024&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1515/cclm.2011.768Search in Google Scholar

19. Exner T, Triplett DA, Taberner D, Machin SJ. Guidelines for testing and revised criteria for lupus anticoagulants. SSC Subcommittee for the Standardization of Lupus Anticoagulants. Thromb Haemost 1991;65:320–2.10.1055/s-0038-1648143Search in Google Scholar PubMed

20. Brandt JT, Triplett DA, Alving B, Scharrer I. Criteria for the diagnosis of lupus anticoagulants: an update. On behalf of the subcommittee on Lupus Anticoagulant/Antiphospholipid Antibody of the Scientific and Standardization Committee of the ISTH. Thromb Haemost 1995;74:1185–90.10.1055/s-0038-1649901Search in Google Scholar

21. Pengo V, Tripodi A, Reber G, Rand JH, Ortel TL, Galli M, et al. Update of the guidelines for lupus anticoagulant detection. J Thromb Haemost 2009;7:1737–40.10.1111/j.1538-7836.2009.03555.xhttp://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000270129200019&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Search in Google Scholar PubMed

22. Chang SH, Tillema V, Scherr D. A “percent correction” formula for evaluation of mixing studies. Am J Clin Pathol 2002;117:62–73.10.1309/RREK-8L6M-D2KC-HWLHSearch in Google Scholar PubMed

23. Devreese KM. Interpretation of normal plasma mixing studies in the laboratory diagnosis of lupus anticoagulants. Thromb Res 2007;119:369–76.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000243707200015&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1016/j.thromres.2006.03.012Search in Google Scholar PubMed

24. Pengo V, Biasiolo A, Rampazzo P, Brocco T. DRVVT is more sensitive than KCT or TTI for detecting lupus anticoagulant activity of anti-beta2-glycoprotein I autoantibodies. Thromb Haemost 1999;81:256–8.10.1055/s-0037-1614453Search in Google Scholar PubMed

25. Tripodi A, Mannucci PM. Laboratory investigation of thrombophilia. Clin Chem 2001;47:1597–606.10.1093/clinchem/47.9.1597Search in Google Scholar PubMed

26. Chantarangkul V, Tripodi A, Arbini A, Mannucci PM. Silica Clotting Time (SCT) as a screening and confirmatory test for detection of the Lupus Anticoagulants. Thromb Res 1992;67:355–65.10.1016/0049-3848(92)90266-DSearch in Google Scholar PubMed

27. Montaruli B, Vaccarino A, Foli C, Rus C, Agnes C, Saitta M, et al. Lupus anticoagulant: performance of a new, fully automated commercial screening and confirmation assay. Clin Chem 2005;51:1031–3.10.1373/clinchem.2004.042028Search in Google Scholar PubMed

28. Grypiotis P, Ruffatti A, Pengo V, Tonello M, Biasiolo A, Zamboni D, et al. Use of a new silica clotting time for diagnosing lupus anticoagulant in patients who meet the clinical criteria for antiphospholipid syndrome. J Clin Lab Anal 2006;20:15–8.10.1002/jcla.20093Search in Google Scholar PubMed PubMed Central

29. Rosner E, Pauzner R, Lusky A, Modan M, Many A. Detection and quantitative evaluation of lupus circulating anticoagulant activity. Thromb Haemost 1987;57:144–7.10.1055/s-0038-1651083Search in Google Scholar PubMed

30. Mameli M, Barcellona D, Vannini ML, Marongiu F. High frequency of inadequate test requests for antiphospholipid antibodies in daily clinical practice. Clin Chem Lab Med 2011;49:695–8.http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000289464200018&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1515/CCLM.2011.111Search in Google Scholar PubMed

31. Jennings I, Greaves M, Mackie IJ, Kitchen S, Woods TA, Preston FE. On behalf of the UK National External Quality Assessment Scheme for Blood Coagulation. Lupus anticoagulant testing: improvements in performance in a UK NEQAS proficiency testing exercise after dissemination of national guidelines on laboratory methods. Br J Haematol 2002;119:364–9.10.1046/j.1365-2141.2002.03821.xSearch in Google Scholar PubMed

32. Tincani A, Filippini M, Scarsi M, Galli M, Meroni PL. European attempts for the standardization of the antiphospholipid antibodies. Lupus 2009;18:913–9.10.1177/0961203309106919http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=000268841200010&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3Search in Google Scholar PubMed

33. Pengo V, Biasiolo A, Gresele P, Marongiu F, Erba N, Veschi F, et al. On behalf of participating centres of Italian Federation of Thrombosis Centres (FCSA). Survey of lupus anticoagulant diagnosis by central evaluation of positive plasma samples. J Thromb Haemost 2007;5:925–30.10.1111/j.1538-7836.2007.02454.xSearch in Google Scholar PubMed

Received: 2012-06-14
Accepted: 2012-08-20
Published Online: 2012-09-22
Published in Print: 2013-02-01

©2013 by Walter de Gruyter Berlin Boston

Articles in the same Issue

  1. Letters to the Editor
  2. Performance evaluation of three different immunoassays for detection of antibodies to hepatitis B core
  3. Serum homocysteine concentrations in Chinese children with autism
  4. Interchangeability of venous and capillary HbA1c results is affected by oxidative stress
  5. Interference of hemoglobin (Hb) N-Baltimore on measurement of HbA1c using the HA-8160 HPLC method
  6. First human isolate of Mycobacterium madagascariense in the sputum of a patient with tracheobronchitis
  7. Protein S and protein C measurements should not be undertaken during vitamin K antagonist therapy
  8. α2-HS glycoprotein is an essential component of cryoglobulin associated with chronic hepatitis C
  9. An unusual interference in CK MB assay caused by a macro enzyme creatine phosphokinase (CK) type 2 in HIV-infected patients
  10. An automated technique for the measurement of the plasma glutathione reductase activity and determination of reference limits for a healthy population
  11. Is osteopontin stable in plasma and serum?
  12. Evidence-based approach to reducing perceived wasteful practices in laboratory medicine
  13. Masthead
  14. Masthead
  15. Editorials
  16. Testing volume is not synonymous of cost, value and efficacy in laboratory diagnostics
  17. Lessons from controversy: biomarkers evaluation
  18. Commercial immunoassays in biomarkers studies: researchers beware!1)
  19. Trials and tribulations in lupus anticoagulant testing
  20. Reviews
  21. Mass spectrometry: a revolution in clinical microbiology?
  22. Chronic Chagas disease: from basics to laboratory medicine
  23. General Clinical Chemistry and Laboratory Medicine
  24. Shop for quality or quantity? Volumes and costs in clinical laboratories
  25. Minor improvement of venous blood specimen collection practices in primary health care after a large-scale educational intervention
  26. Evaluation of high resolution gel β2-transferrin for detection of cerebrospinal fluid leak
  27. Serum kallikrein-8 correlates with skin activity, but not psoriatic arthritis, in patients with psoriatic disease
  28. Soluble urokinase plasminogen activator receptor (suPAR) in the assessment of inflammatory activity of rheumatoid arthritis patients in remission
  29. Bone mass density selectively correlates with serum markers of oxidative damage in post-menopausal women
  30. Validation of a fast and reliable liquid chromatography-tandem mass spectrometry (LC-MS/MS) with atmospheric pressure chemical ionization method for simultaneous quantitation of voriconazole, itraconazole and its active metabolite hydroxyitraconazole in human plasma
  31. Performance of different screening methods for the determination of urinary glycosaminoclycans
  32. Intestinal permeability and fecal eosinophil-derived neurotoxin are the best diagnosis tools for digestive non-IgE-mediated cow’s milk allergy in toddlers
  33. An internal validation approach and quality control on hematopoietic chimerism testing after allogeneic hematopoietic cell transplantation
  34. Serum levels of IgG antibodies against oxidized LDL and atherogenic indices in HIV-1-infected patients treated with protease inhibitors
  35. Cooperation experience in a multicentre study to define the upper limits in a normal population for the diagnostic assessment of the functional lupus anticoagulant assays
  36. Contribution of procoagulant phospholipids, thrombomodulin activity and thrombin generation assays as prognostic factors in intensive care patients with septic and non-septic organ failure
  37. Suitability of POC lactate methods for fetal and perinatal lactate testing: considerations for accuracy, specificity and decision making criteria
  38. Point-of-care testing on admission to the intensive care unit: lactate and glucose independently predict mortality
  39. Reference Values and Biological Variations
  40. CA125 reference values change in male and postmenopausal female subjects
  41. Distributions and ranges of values of blood and urinary biomarker of inflammation and oxidative stress in the workers engaged in office machine manufactures: evaluation of reference values
  42. Cancer Diagnostics
  43. Association of acute phase protein-haptoglobin, and epithelial-mesenchymal transition in buccal cancer: a preliminary report
  44. Comparison of diagnostic and prognostic performance of two assays measuring thymidine kinase 1 activity in serum of breast cancer patients
  45. Evaluation of the BRAHMS Kryptor® Thyroglobulin Minirecovery Test in patients with differentiated thyroid carcinoma
https://doi.org/10.1515/cclm-2012-0382
Keywords for this article
acquired coagulation disorders; antiphospholipid antibodies; haemostasis; thrombosis

Articles in the same Issue

  1. Letters to the Editor
  2. Performance evaluation of three different immunoassays for detection of antibodies to hepatitis B core
  3. Serum homocysteine concentrations in Chinese children with autism
  4. Interchangeability of venous and capillary HbA1c results is affected by oxidative stress
  5. Interference of hemoglobin (Hb) N-Baltimore on measurement of HbA1c using the HA-8160 HPLC method
  6. First human isolate of Mycobacterium madagascariense in the sputum of a patient with tracheobronchitis
  7. Protein S and protein C measurements should not be undertaken during vitamin K antagonist therapy
  8. α2-HS glycoprotein is an essential component of cryoglobulin associated with chronic hepatitis C
  9. An unusual interference in CK MB assay caused by a macro enzyme creatine phosphokinase (CK) type 2 in HIV-infected patients
  10. An automated technique for the measurement of the plasma glutathione reductase activity and determination of reference limits for a healthy population
  11. Is osteopontin stable in plasma and serum?
  12. Evidence-based approach to reducing perceived wasteful practices in laboratory medicine
  13. Masthead
  14. Masthead
  15. Editorials
  16. Testing volume is not synonymous of cost, value and efficacy in laboratory diagnostics
  17. Lessons from controversy: biomarkers evaluation
  18. Commercial immunoassays in biomarkers studies: researchers beware!1)
  19. Trials and tribulations in lupus anticoagulant testing
  20. Reviews
  21. Mass spectrometry: a revolution in clinical microbiology?
  22. Chronic Chagas disease: from basics to laboratory medicine
  23. General Clinical Chemistry and Laboratory Medicine
  24. Shop for quality or quantity? Volumes and costs in clinical laboratories
  25. Minor improvement of venous blood specimen collection practices in primary health care after a large-scale educational intervention
  26. Evaluation of high resolution gel β2-transferrin for detection of cerebrospinal fluid leak
  27. Serum kallikrein-8 correlates with skin activity, but not psoriatic arthritis, in patients with psoriatic disease
  28. Soluble urokinase plasminogen activator receptor (suPAR) in the assessment of inflammatory activity of rheumatoid arthritis patients in remission
  29. Bone mass density selectively correlates with serum markers of oxidative damage in post-menopausal women
  30. Validation of a fast and reliable liquid chromatography-tandem mass spectrometry (LC-MS/MS) with atmospheric pressure chemical ionization method for simultaneous quantitation of voriconazole, itraconazole and its active metabolite hydroxyitraconazole in human plasma
  31. Performance of different screening methods for the determination of urinary glycosaminoclycans
  32. Intestinal permeability and fecal eosinophil-derived neurotoxin are the best diagnosis tools for digestive non-IgE-mediated cow’s milk allergy in toddlers
  33. An internal validation approach and quality control on hematopoietic chimerism testing after allogeneic hematopoietic cell transplantation
  34. Serum levels of IgG antibodies against oxidized LDL and atherogenic indices in HIV-1-infected patients treated with protease inhibitors
  35. Cooperation experience in a multicentre study to define the upper limits in a normal population for the diagnostic assessment of the functional lupus anticoagulant assays
  36. Contribution of procoagulant phospholipids, thrombomodulin activity and thrombin generation assays as prognostic factors in intensive care patients with septic and non-septic organ failure
  37. Suitability of POC lactate methods for fetal and perinatal lactate testing: considerations for accuracy, specificity and decision making criteria
  38. Point-of-care testing on admission to the intensive care unit: lactate and glucose independently predict mortality
  39. Reference Values and Biological Variations
  40. CA125 reference values change in male and postmenopausal female subjects
  41. Distributions and ranges of values of blood and urinary biomarker of inflammation and oxidative stress in the workers engaged in office machine manufactures: evaluation of reference values
  42. Cancer Diagnostics
  43. Association of acute phase protein-haptoglobin, and epithelial-mesenchymal transition in buccal cancer: a preliminary report
  44. Comparison of diagnostic and prognostic performance of two assays measuring thymidine kinase 1 activity in serum of breast cancer patients
  45. Evaluation of the BRAHMS Kryptor® Thyroglobulin Minirecovery Test in patients with differentiated thyroid carcinoma
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 16.11.2025 from https://www.degruyterbrill.com/document/doi/10.1515/cclm-2012-0382/html
Scroll to top button