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1E04-20
30-3968/R3
TRANSFERRIN
This package insert contains information to run the Transferrin 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
Reagent 1
Reagent 2
1
NAME REAGENT HANDLING AND STORAGE
TRANSFERRIN 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 Transferrin assay is used for the quantitation of transferrin in human storage temperature to allow the bubbles to dissipate. To minimize
serum or plasma. 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
Transferrin is a β-globulin, synthesized primarily in the liver, which which could impact results.
is the principal protein responsible for iron transport. Transferrin
transports ferric ions from the iron stores of intracellular or mucosal Reagent Storage
ferritin to bone marrow where erythrocyte precursors and other cells Unopened reagents are stable until the expiration date when stored
have transferrin surface receptors.1 Transferrin is responsible for 50% at 2 to 8°C.
to 70% of the iron binding capacity of serum. Since other proteins Reagent onboard stability is approximately 57 days if quality control
may bind iron, transferrin concentration correlates with, but is not results meet acceptance criteria. If quality control results do not meet
identical to, TIBC.2 acceptance criteria, refer to the QUALITY CONTROL section of this
Indications for transferrin quantitation include: screening for nutritional package insert.
status; differential diagnosis of anemia; and monitoring anemia
treatment. Iron deficiency and iron overload are best diagnosed using WARNINGS AND PRECAUTIONS
a combination of iron, transferrin, and ferritin determinations.3
Precautions for Users
Transferrin is considered to belong to a group of proteins, along with
albumin, prealbumin, and β-lipoprotein, referred to as negative acute 1. For in vitro diagnostic use.
phase reactants (APRs). Negative APRs are found in decreased levels 2. Do not use components beyond the expiration date.
in response to inflammation, necrosis, or malignancy. Decreased 3. Do not mix materials from different kit lot numbers.
levels of transferrin are also associated with conditions involving 4. Do not mix fresh reagent with in-use reagents.
chronic liver disease, malnutrition, nephrotic syndrome, protein-losing 5. This product contains sodium azide; for a specific listing, refer to the
enteropathies, iron overload due to multiple transfusion or hereditary REAGENTS section. Contact with acids liberates very toxic gas. This
hemochromatosis, and congenital atransferrinemia.4 Transferrin Index material and its container must be disposed of in a safe way.
(calculated as serum iron/transferrin) has been suggested as a better NOTE: Refer to Section 8 of the instrument-specific operations
screen for iron overload.2 manual for proper handling and disposal of reagents containing
Elevated levels of transferrin are associated with iron deficiency anemia sodium azide.
where elevated transferrin often precedes the appearance of anemia 6. CAUTION: This product requires the handling of human specimens.
by days to months. Transferrin levels are also elevated with increased It is recommended that all human sourced materials be considered
estrogen due to pregnancy, oral contraceptives, etc.3 potentially infectious and be handled in accordance with the OSHA
Standard on Bloodborne Pathogens.5 Biosafety Level 26 or other
PRINCIPLES OF PROCEDURE appropriate biosafety practices7,8 should be used for materials that
The Transferrin assay is an immunoturbidimetric procedure that contain or are suspected of containing infectious agents.
measures increasing sample turbidity caused by the formation of For product not classified as dangerous per European Directive
insoluble immune complexes when antibody to transferrin is added to 1999/45/EC as amended, safety data sheet available for professional
the sample. Sample containing transferrin is incubated with a buffer user on request.
( ) and a sample blank determination is performed prior to the
addition of transferrin antibody ( ). In the presence of an appropriate SPECIMEN COLLECTION AND HANDLING
antibody in excess, the transferrin concentration is measured as a
function of turbidity. Suitable Specimens
Methodology: Immunoturbidimetric Serum and plasma are acceptable specimens.
• Serum: Use serum collected by standard venipuncture techniques
REAGENTS into glass or plastic tubes with or without gel barriers. Ensure
complete clot formation has taken place prior to centrifugation.
Reagent Kit Separate serum from red blood cells or gel as soon after collection
1E04 Transferrin is supplied as a liquid, ready-to-use, two-reagent as possible.
kit which contains:
Some specimens, especially those from patients receiving
5 x 20 mL anticoagulant or thrombolytic therapy, may take longer to complete
5 x 9 mL their clotting processes. Fibrin clots may subsequently form in these
sera and the clots could cause erroneous test results.
Estimated tests per kit: 391 • Plasma: Use plasma collected by standard venipuncture techniques
Calculation is based on the minimum reagent fill volume per kit. into glass or plastic tubes. Acceptable anticoagulants are lithium
heparin (with or without gel barrier), sodium heparin, and EDTA.
Reactive Ingredients Concentration Ensure centrifugation is adequate to remove platelets. Separate
TRIS 100 mmol/L plasma from red blood cells or gel as soon after collection as
possible.
Polyethylene Glycol 45 g/L Refer to the specimen collection tube manufacturer’s instructions for
Sodium Azide 0.1% processing and handling requirements.
Anti-human transferrin goat serum 40% For total sample volume requirements, refer to the instrument-specific
TRIS 100 mmol/L ASSAY PARAMETERS section of this package insert and Section 5 of
the instrument-specific operations manual.
Sodium Azide 0.1%
2
SPECIMEN COLLECTION AND HANDLING (Continued) CALIBRATION
Specimen Storage The linear high field of the assay parameters must be edited to the
concentration of the highest calibrator specified in the value sheet.
Serum and plasma: Analyze fresh specimens if possible. Repeated
freeze/thaw cycles should be avoided to minimize potential protein Calibration is stable for approximately 57 days (1,368 hours) and is
degradation. required with each change in reagent lot number. Verify calibration with
at least three levels of controls according to the established quality
Temperature Maximum Bibliographic control requirements for your laboratory. If control results fall outside
Storage Reference acceptable ranges, recalibration may be necessary.
A multi-point calibration (Spline) curve is generated using Specific
2 to 8°C 3 days 3, 9 Proteins Multiconstituent Calibrator.
-20°C 6 months 3 For a detailed description of how to calibrate an assay, refer to
Section 6 of the instrument-specific operations manual.
Teitz3 suggests storage of frozen specimens at -20°C for no longer
than the time interval cited above. However, limitations of laboratory For information on calibrator standardization, refer to the Specific
equipment make it necessary in practice for clinical laboratories to Proteins Multiconstituent Calibrator package insert.
establish a range around -20°C for specimen storage. This temperature
range may be established from either the freezer manufacturer’s QUALITY CONTROL
specifications or your laboratory standard operating procedure(s) for The following is the recommendation of Abbott Laboratories for quality
specimen storage. control. As appropriate, refer to your laboratory standard operating
NOTE: Stored specimens must be inspected for particulates. If present, procedure(s) and/or quality assurance plan for additional quality control
mix and centrifuge the specimen to remove particulates prior to testing. requirements and potential corrective actions.
• Three levels of quality control are to be run every 24 hours.
PROCEDURE • If more frequent control monitoring is required, follow the established
Materials Provided quality control procedures for your laboratory.
• If quality control results do not meet the acceptance criteria
1E04 Transferrin Reagent Kit
defined by your laboratory, patient values may be suspect. Follow
Materials Required but not Provided the established quality control procedures for your laboratory.
• 1E78 Specific Proteins Multiconstituent Calibrator Recalibration may be necessary.
1 x 1 mL • Review quality control results and acceptance criteria following a
change of reagent or calibrator lot.
• Control Material
• Saline (0.85% to 0.90% NaCl) for specimens that require dilution RESULTS
Assay Procedure Refer to the instrument-specific operations manual for information on
For a detailed description of how to run an assay, refer to Section 5 of results calculations.
the instrument-specific operations manual. • ARCHITECT System Operations Manual—Appendix C
Specimen Dilution Procedures • AEROSET System Operations Manual—Appendix A
The ARCHITECT c Systems and the AEROSET System have automatic Representative performance data are given in the EXPECTED VALUES
dilution features; refer to Section 2 of the instrument-specific operations and SPECIFIC PERFORMANCE CHARACTERISTICS sections of this
manual for additional information. package insert. Results obtained in individual laboratories may vary.
Serum and plasma: Specimens with transferrin values exceeding the LIMITATIONS OF THE PROCEDURE
highest calibrator are flagged and may be diluted using the Automated
Dilution Protocol or the Manual Dilution Procedure. Refer to the SPECIMEN COLLECTION AND HANDLING and SPECIFIC
PERFORMANCE CHARACTERISTICS sections of this package insert.
Automated Dilution Protocol The performance characteristics of Transferrin on an analyzer other
If using the Automated Dilution Protocol, the system performs a than the ARCHITECT c Systems or the AEROSET System must be
1:2 dilution of the specimen and automatically corrects the concentration validated and verified.
by multiplying the result by the appropriate dilution factor. Samples containing paraproteins (abnormal monoclonal antibodies)
Manual Dilution Procedure may interfere with test results. Samples with elevated total
protein concentrations or samples from patients with suspected
Manual dilutions should be performed as follows: paraproteinemia can be screened using other laboratory methods such
• Use saline (0.85% to 0.90% NaCl) to dilute the sample. as protein electrophoresis.10
• The operator must enter the dilution factor in the patient or control Turbidity and particles in the samples can interfere with the assay.
order screen. The system uses this dilution factor to automatically Therefore, particulate matter should be removed by centrifugation prior
correct the concentration by multiplying the result by the entered to running the assay.
factor.
• If the operator does not enter the dilution factor, the result must be
multiplied by the appropriate dilution factor before reporting the result.
NOTE: If a diluted sample result is flagged indicating it is less than the
linear low limit, do not report the result. Rerun using an appropriate
dilution.
For detailed information on ordering dilutions, refer to Section 5 of the
instrument-specific operations manual.
The patient result flag “>” (ARCHITECT c Systems) and the EXT and
LH result error codes (AEROSET) may indicate antigen excess. Dilute
sample and rerun. Samples were tested for antigen excess up to
2,851.5 mg/dL (28.515 g/L).
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EXPECTED VALUES SPECIFIC PERFORMANCE CHARACTERISTICS
Reference Range (Continued)
Serum/Plasma11 Interfering Substances
Interference studies were conducted using CLSI protocol NCCLS
Range* (mg/dL) Range* (g/L) EP7-P.13 Interference effects were assessed by Dose Response and
1 to 14 years Paired Difference methods, at two medical decision levels of the
analyte.
Male 186 to 388 1.86 to 3.88
Female 180 to 391 1.80 to 3.91 Medical Decision Level 1
> 14 to 60 years Interfering Interferent Concentration N Target Observed
Male 174 to 364 1.74 to 3.64 Substance (mg/dL) (% of Target)
Female 180 to 382 1.80 to 3.82 30 mg/dL (513 μmol/L) 4 256.3 98.1
Bilirubin
> 60 to 80 years 60 mg/dL (1,026 μmol/L) 4 256.3 94.3
Male 163 to 344 1.63 to 3.44 1,000 mg/dL (10.0 g/L) 4 213.3 102.7
Hemoglobin
Female 173 to 360 1.73 to 3.60 2,000 mg/dL (20.0 g/L) 4 213.3 101.4
* Reference ranges are based on a 95% confidence interval for a large Human 750 mg/dL (8.5 mmol/L) 4 275.7 101.7
North American caucasian population. triglyceride 1,000 mg/dL (11.3 mmol/L) 4 275.7 101.1
To convert results from mg/dL to g/L, multiply mg/dL by 0.01. 1,000 mg/dL (10.0 g/L) 4 231.1 100.3
Intralipid
A study was conducted using 121 serum samples from volunteers. 2,000 mg/dL (20.0 g/L) 4 231.1 99.4
Data were analyzed as described by Clinical and Laboratory Standards
Institute (CLSI) protocol NCCLS C28-A.12 From this study, 95% of all
specimens fell within 181.28 to 330.66 mg/dL (1.81 to 3.31 g/L), with Medical Decision Level 2
samples ranging from 170.35 to 401.23 mg/dL (1.7 to 4.01 g/L).
Interfering Interferent Concentration N Target Observed
It is recommended that each laboratory determine its own reference Substance
range based upon its particular locale and population characteristics. (mg/dL) (% of Target)
30 mg/dL (513 μmol/L) 4 341.7 100.3
SPECIFIC PERFORMANCE CHARACTERISTICS Bilirubin
60 mg/dL (1,026 μmol/L) 4 341.7 98.1
Reportable Range (Accuracy by Recovery) 1,000 mg/dL (10.0 g/L) 4 278.6 100.3
The Transferrin assay reportable range is from 19 mg/dL (0.19 g/L) to Hemoglobin
the highest calibrator concentration. Human serum containing a known 2,000 mg/dL (20.0 g/L) 4 278.6 101.2
concentration of transferrin was diluted with saline and the resulting Human 750 mg/dL (8.5 mmol/L) 4 373.6 98.7
samples were analyzed. Observed mean results across the reportable triglyceride
range were within 9 mg/dL (0.09 g/L) or 10%, whichever is greater, of 1,000 mg/dL (11.3 mmol/L) 4 373.6 97.3
the target concentrations. Representative data are summarized below. 1,000 mg/dL (10.0 g/L) 4 294.6 99.4
Intralipid
%Recovery = (Observed Mean / Target Concentration) × 100 2,000 mg/dL (20.0 g/L) 4 294.6 101.4
Target Concentration Observed Mean Delta* Percent (%) Bilirubin solutions at the above concentrations were prepared by
(mg/dL) (mg/dL) (mg/dL) Recovery* addition of a bilirubin stock to human serum pools. Hemoglobin
7.0 0.3 -6.6 5.0 solutions at the above concentrations were prepared by addition
of hemolysate to human serum pools. Human triglyceride solutions
16.0 9.2 -6.9 57.1 at the above concentrations were prepared by mixing an elevated
26.7 22.6 -4.2 84.4 triglyceride human serum pool with a normal triglyceride human serum
pool. Intralipid solutions at the above concentrations were prepared by
53.5 50.1 -3.4 93.7 addition of Intralipid to human serum pools.
107.0 100.8 -6.2 94.3 Precision
213.9 217.6 3.7 101.7 The imprecision of the Transferrin assay is ≤ 5.0% Total CV.
Representative data from studies using CLSI protocols NCCLS
320.9 327.9 7.0 102.2 EP5-T214 and EP5-A15 are summarized below.
427.9 444.7 16.8 103.9 Control Level 1 Level 2 Level 3
534.9 552.8 17.9 103.4 N 80 80 80
* Delta and %Recovery were calculated prior to rounding Target Mean (mg/dL) 143.7 220.2 325.7
Concentration and Observed Mean values.
SD 2.46 2.51 5.22
Limit of Quantitation (LOQ) Within Run
%CV 1.7 1.1 1.6
The LOQ for Transferrin is ≤ 9 mg/dL (0.09 g/L). The LOQ is the
analyte concentration at which the CV = 20%. Performance studies SD 4.36 2.46 6.04
produced an LOQ of 1.0 mg/dL (0.010 g/L). Between Run
%CV 3.0 1.1 1.9
SD 4.27 1.21 7.33
Between Day
%CV 3.0 0.6 2.3
SD 6.58 3.72 10.83
Total
%CV 4.6 1.7 3.3
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SPECIFIC PERFORMANCE CHARACTERISTICS BIBLIOGRAPHY
(Continued) 1. Henry JB. Clinical Diagnosis and Management by Laboratory
Methods, 18th ed. Philadelphia, PA: WB Saunders; 1991:223.
Method Comparison
2. Jacobs DS, DeMott WR, Grady HJ, et al. Laboratory Test Handbook,
Correlation studies were performed using CLSI protocol
4th ed. Hudson, OH: Lexi-Comp; 1996:209.
NCCLS EP9-A.16
3. Tietz NW, editor. Clinical Guide to Laboratory Tests, 3rd ed.
Serum results from the Transferrin assay on an AEROSET System were
Philadelphia, PA: WB Saunders; 1995:604–7.
compared with those from a commercially available immunoturbidimetric
methodology. 4. Burtis CA, Ashwood ER, editors. Tietz Textbook of Clinical
Chemistry, 2nd ed. Philadelphia, PA: WB Saunders; 1994:712–3.
Serum results from the Transferrin assay on an ARCHITECT c System
were compared with the Transferrin assay on an AEROSET System. 5. US Department of Labor, Occupational Safety and Health
Administration. 29 CFR Part 1910.1030. Occupational Exposure to
AEROSET vs. ARCHITECT Bloodborne Pathogens.
Comparative vs. AEROSET 6. US Department of Health and Human Services. Biosafety in
Method Microbiological and Biomedical Laboratories. 5th ed. Washington,
DC: US Government Printing Office; January 2007.
N 80 114
7. World Health Organization. Laboratory Biosafety Manual. Geneva:
Y - Intercept -1.48 -0.38 World Health Organization, 2004.
Correlation Coefficient 0.995 0.988 8. Sewell DL, Bove KE, Callihan DR, et al. Protection of Laboratory
Workers from Occupationally Acquired Infections; Approved
Slope 1.04 0.97
Guideline—Third Edition (M29-A3). Wayne, PA: Clinical and
Mean %Bias 3.0 -3.5 Laboratory Standards Institute, 2005.
Range (mg/dL) 32.1 to 418.9 21.7 to 541.7 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, Palomaki GE, Neveux LM, et al. Reference distributions
for the negative acute-phase serum proteins, albumin, transferrin
and transthyretin: a practical, simple and clinically relevant
approach in a large cohort. J Clin Lab Anal 1999;13:273–9.
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
AEROSET and ARCHITECT are registered trademarks of Abbott
Laboratories.
c System is a trademark of Abbott Laboratories.
All other trademarks, brands, product names, and trade names are the
property of their respective companies.
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ARCHITECT c SYSTEMS ASSAY PARAMETERS
6
AEROSET SYSTEM ASSAY PARAMETERS
Refer to Assay Configuration in Section 2 of the AEROSET System Operations Manual for information regarding assay parameters.
* User defined or instrument defined.
** Reference range is from > 14 years to 60 years of age.
‡‡ Edit to highest calibrator concentration specified in the calibrator value sheet.
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