Effects of sample storage conditions on glycated hemoglobin measurement: evaluation of five different high performance liquid chromatography methods.

BACKGROUND: Glycated hemoglobin, reported as hemoglobin A1c (HbA1c), is widely used as a measure of long-term glycemic control in patients with diabetes. The accuracy of measurements depends in part on proper storage of the sample prior to analysis. METHODS: Three whole blood (WB) samples at three HbA1c levels were collected and stored at -70 degrees C, -20 degrees C, 4 degrees C, room temperature (17-23 degrees C), and 37 degrees C. One aliquot from each temperature was analyzed by each method on days 1, 2, 3, 6, 7, 10, 14, 21, 28, and 57. RESULTS: The Primus CLC (385 and 330) (Primus Corp., Kansas City, MO) showed stability of WB at -20 degrees C and 4 degrees C for 57 days, room temperature for 14 days, and 37 degrees C for 1 day. The Tosoh 2.2 Plus (Tosoh Bioscience, Inc., South San Francisco, CA) showed stability at -20 degrees C for 3 days, 4 degrees C for 14 days, room temperature for 3 days, and 37 degrees C for less than 24 h. With the Tosoh G7, results were acceptable at -20 degrees C for 10 days, 4 degrees C for 57 days, room temperature for 7 days, and 37 degrees C for less than 24 h. The Bio-Rad Variant (Bio-Rad Laboratories, Hercules, CA) showed stability at -20 degrees C for 6 days, 4 degrees C for 14 days, room temperature for 3 days, and 37 degrees C for less than 24 h. The Bio-Rad Variant II showed stability at -20 degrees C for 28 days, 4 degrees C for 57 days, room temperature for 7 days, and 37 degrees C for less than 24 h. CONCLUSIONS: All methods either met or exceeded manufacturers' claims for stability. The CLC 385/330, Tosoh G7, and Bio-Rad Variant II high performance liquid chromatography methods showed better stability than the Tosoh 2.2 Plus and Bio-Rad Variant.

Measurement of Hba(1C) in patients with chronic renal failure.

BACKGROUND: Carbamylated hemoglobin (carbHb) is reported to interfere with measurement and interpretation of HbA(1c) in diabetic patients with chronic renal failure (CRF). There is also concern that HbA1c may give low results in these patients due to shortened erythrocyte survival. METHODS: We evaluated the effect of carbHb on HbA(1c) measurements and compared HbA(1c) with glycated albumin (GA) in patients with and without renal disease to test if CRF causes clinically significant bias in HbA(1c) results by using 11 assay methods. Subjects included those with and without renal failure and diabetes. Each subject's estimated glomerular filtration rate (eGFR) was used to determine the presence and degree of the renal disease. A multiple regression model was used to determine if the relationship between HbA(1c) results obtained from each test method and the comparative method was significantly (p<0.05) affected by eGFR. These methods were further evaluated for clinical significance by using the difference between the eGRF quartiles of >7% at 6 or 9% HbA(1c). The relationship between HbA(1c) and glycated albumin (GA) in patients with and without renal failure was also compared. RESULTS: Some methods showed small but statistically significant effects of eGFR; none of these differences were clinically significant. If GA is assumed to better reflect glycemic control, then HbA(1c) was approximately 1.5% HbA(1c) lower in patients with renal failure. CONCLUSIONS: Although most methods can measure HbA(1c) accurately in patients with renal failure, healthcare providers must interpret these test results cautiously in these patients due to the propensity for shortened erythrocyte survival in renal failure.

Effects of whole blood storage on hemoglobin a1c measurements with five current assay methods.

BACKGROUND: Hemoglobin A1c (HbA1c) is an important index of average glycemia in patients with diabetes mellitus that is widely used in clinical trials and large-scale epidemiological studies. Previous studies have shown that adverse sample storage conditions can cause erroneous HbA1c results. We examined the effect of storage at different temperatures with five current HbA1c methods: Tosoh G7 and G8 (Tosoh Bioscience, Inc., South San Francisco, CA) and Bio-Rad Variant™ II (Bio-Rad Laboratories, Hercules, CA) (all ion-exchange high-performance liquid chromatography); Siemens DCA 2000+ (Siemens Healthcare Diagnostics, Deerfield, IL) (immunoassay); and Trinity Biotech (Kansas City, MO) ultra(2) (boronate-affinity high-performance liquid chromatography). METHODS: Five whole blood specimens with different HbA1c levels were analyzed by each assay method on Day 0 and then divided into aliquots that were stored at six different temperatures (-70°C, -20°C, 4°C, room temperature, 30°C, and 37°C) for analyses on subsequent days out to Day 84. Acceptance limits were defined as within ±3 SD of all -70°C results or ±0.2% HbA1c, whichever was wider, for each sample. Stability was considered acceptable for a given temperature only if results for all five specimens were acceptable on that day. RESULTS: The DCA 2000+ demonstrated the best stability at -20°C and room temperature, whereas the ultra(2) showed the best stability with specimens stored at 4°C. No methods demonstrated stability at 30°C or 37°C for more than 3 days. CONCLUSIONS: Exposure of specimens to high temperatures should be avoided regardless of assay methodology. For the ion-exchange methods tested 4°C storage is preferable to -20°C (stability 14-21 days vs. 4-10 days). For studies where long-term stability is required, samples should be stored at -70°C or colder.

Standardization of C-peptide measurements.

BACKGROUND: C-peptide is a marker of insulin secretion in diabetic patients. We assessed within- and between-laboratory imprecision of C-peptide assays and determined whether serum calibrators with values assigned by mass spectrometry could be used to harmonize C-peptide results. METHODS: We sent 40 different serum samples to 15 laboratories, which used 9 different routine C-peptide assay methods. We also sent matched plasma samples to another laboratory for C-peptide analysis with a reference mass spectrometry method. Each laboratory analyzed 8 of these samples in duplicate on each of 4 days to evaluate within- and between-day imprecision. The same 8 samples were also used to normalize the results for the remaining samples to the mass spectrometry reference method. RESULTS: Within- and between-run CVs ranged from <2% to >10% and from <2% to >18%, respectively. Normalizing the results with serum samples significantly improved the comparability among laboratories and methods. After normalization, the differences among laboratories in mean response were no longer statistically significant (P = 0.24), with least-squares means of 0.93-1.02. CONCLUSIONS: C-peptide results generated by different methods and laboratories do not always agree, especially at higher C-peptide concentrations. Within-laboratory imprecision also varied, with some methods giving much more consistent results than others. These data show that calibrating C-peptide measurement to a reference method can increase comparability between laboratories.