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9D91-20
30-3966/R4
HAPTOGLOBIN
This package insert contains information to run the Haptoglobin 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
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NAME REAGENT HANDLING AND STORAGE
HAPTOGLOBIN 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 Haptoglobin assay is used for the quantitation of haptoglobin in storage temperature to allow the bubbles to dissipate. To minimize
human 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
Haptoglobin is a protein synthesized in the liver that binds with the which could impact results.
globin α-chains of hemoglobin A, F, S, or C. Haptoglobin does not
bind methemoglobin, heme, or unusual forms of hemoglobin in which Reagent Storage
the α-chain is missing. The haptoglobin-hemoglobin complex is rapidly Unopened reagents are stable until the expiration date when stored
removed from circulation by the reticuloendothelial system to prevent/ at 2 to 8°C.
minimize hemoglobin loss and to conserve iron.1 Reagent onboard stability is approximately 57 days if quality control
Indications for haptoglobin quantitation include: anemia or other results meet acceptance criteria. If quality control results do not meet
indicators of possible hemolysis; pregnancy-induced hypertension; acceptance criteria, refer to the QUALITY CONTROL section of this
transfusion reactions (assay of pre- and post-transfusion samples); package insert.
assessment of acute phase response; and evaluation of changes in the
α2-region of serum protein electrophoresis.2 WARNINGS AND PRECAUTIONS
Decreased levels of haptoglobin are most frequently associated with Precautions for Users
conditions of increased intravascular hemolysis or hemoglobin turnover,
such as hemolytic anemias, intravascular hemolytic transfusion 1. For in vitro diagnostic use.
reactions, and malaria. Extravascular hemolysis does not usually affect 2. Do not use components beyond the expiration date.
haptoglobin concentrations. Other conditions associated with decreased 3. Do not mix materials from different kit lot numbers.
haptoglobin levels are congenital anhaptoglobinemia (ahaptoglobinemia) 4. Do not mix fresh reagent with in-use reagents.
and severe liver diseases where protein synthesis is affected.1 5. This product contains sodium azide; for a specific listing, refer to the
Mechanical heart valves or vigorous athletic activity where repetitive REAGENTS section. Contact with acids liberates very toxic gas. This
erythrocytic mechanical trauma may occur can cause sustained lower material and its container must be disposed of in a safe way.
haptoglobin levels.1,2 NOTE: Refer to Section 8 of the instrument-specific operations
Elevated levels of haptoglobin are most frequently associated with manual for proper handling and disposal of reagents containing
acute phase reactions (i.e., involving tissue infection, surgery, trauma, sodium azide.
or necrosis).3 Other conditions associated with elevated haptoglobin 6. CAUTION: This product requires the handling of human specimens.
levels are corticosteroid therapy and biliary obstruction.2 It is recommended that all human sourced materials be considered
potentially infectious and be handled in accordance with the OSHA
PRINCIPLES OF PROCEDURE Standard on Bloodborne Pathogens.4 Biosafety Level 25 or other
The Haptoglobin assay is an immunoturbidimetric procedure that appropriate biosafety practices6,7 should be used for materials that
measures increasing sample turbidity caused by the formation of contain or are suspected of containing infectious agents.
insoluble immune complexes when antibody to haptoglobin is added to
the sample. Sample containing haptoglobin is incubated with a buffer For product not classified as dangerous per European Directive
(Reagent 1) and a sample blank determination is performed prior to 1999/45/EC as amended, safety data sheet available for professional
the addition of haptoglobin antibody (Reagent 2). In the presence of user on request.
an appropriate antibody in excess, the haptoglobin concentration is
measured as a function of turbidity. SPECIMEN COLLECTION AND HANDLING
Methodology: Immunoturbidimetric Suitable Specimens
Serum and plasma are acceptable specimens.
REAGENTS • Serum: Use serum collected by standard venipuncture techniques
Reagent Kit into glass or plastic tubes with or without gel barriers. Ensure
9D91 Haptoglobin is supplied as a liquid, ready-to-use, two-reagent complete clot formation has taken place prior to centrifugation.
kit which contains: Separate serum from red blood cells or gel as soon after collection
as possible.
3 x 17 mL
Some specimens, especially those from patients receiving
3 x 7 mL anticoagulant or thrombolytic therapy, may take longer to complete
Estimated tests per kit: 230 their clotting processes. Fibrin clots may subsequently form in these
sera and the clots could cause erroneous test results.
Calculation is based on the minimum reagent fill volume per kit.
• Plasma: Use plasma collected by standard venipuncture techniques
Reactive Ingredients Concentration into glass or plastic tubes. Acceptable anticoagulants are lithium
heparin (with or without gel barrier), sodium heparin, and EDTA.
TRIS 100 mmol/L Ensure centrifugation is adequate to remove platelets. Separate
plasma from red blood cells or gel as soon after collection as
Polyethylene Glycol 30 g/L
possible.
Sodium Azide 0.1%
Refer to the specimen collection tube manufacturer’s instructions for
Anti-human haptoglobin goat serum 50% processing and handling requirements.
TRIS 100 mmol/L For total sample volume requirements, refer to the instrument-specific
Sodium Azide 0.1% ASSAY PARAMETERS section of this package insert and Section 5 of
the instrument-specific operations manual.
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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 1 week 8, 9 Proteins Multiconstituent Calibrator.
-20°C 2 weeks 2 For a detailed description of how to calibrate an assay, refer to
Section 6 of the instrument-specific operations manual.
Teitz2 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.
9D91 Haptoglobin Reagent Kit • If quality control results do not meet the acceptance criteria
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
• Control Material change of reagent or calibrator lot.
• 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 haptoglobin values exceeding the
highest calibrator are flagged and may be diluted using the Automated LIMITATIONS OF THE PROCEDURE
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 Haptoglobin on an analyzer other
If using the Automated Dilution Protocol, the system performs a 1:2 or than the ARCHITECT c Systems or the AEROSET System must be
1:4 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
Manual dilutions should be performed as follows: protein concentrations or samples from patients with suspected
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
1,433 mg/dL (14.33 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
0 to 1 year Paired Difference methods, at the medical decision level of the analyte.
Male 0 to 300 0.00 to 3.00 Interfering Interferent Concentration N Target Observed
Female 0 to 235 0.00 to 2.35 Substance (mg/dL) (% of Target)
> 1 to 12 years 30 mg/dL (513 μmol/L) 4 171.3 96.6
Bilirubin
Male 3 to 270 0.03 to 2.70 60 mg/dL (1,026 μmol/L) 4 171.3 93.2
Female 11 to 220 0.11 to 2.20 1,000 mg/dL (10.0 g/L) 4 138.9 90.1
Hemoglobin
> 12 to 60 years 2,000 mg/dL (20.0 g/L) 4 138.9 89.8
Male 14 to 258 0.14 to 2.58 Human 750 mg/dL (8.5 mmol/L) 4 175.7 103.2
Female 35 to 250 0.35 to 2.50 triglyceride 1,000 mg/dL (11.3 mmol/L) 4 175.7 102.6
> 60 years 1,000 mg/dL (10.0 g/L) 4 133.1 99.8
Intralipid
Male 40 to 268 0.40 to 2.68 2,000 mg/dL (20.0 g/L) 4 133.1 97.1
Female 63 to 273 0.63 to 2.73 Bilirubin solutions at the above concentrations were prepared by
addition of a bilirubin stock to human serum pools. Hemoglobin
* Reference ranges are based on a 90% confidence interval.
solutions at the above concentrations were prepared by addition
To convert results from mg/dL to g/L, multiply mg/dL by 0.01. of hemolysate to human serum pools. Human triglyceride solutions
at the above concentrations were prepared by mixing an elevated
NOTE: The reportable range may not be suitable for the reference triglyceride human serum pool with a normal triglyceride human serum
range of certain populations. An alternate method should be used for pool. Intralipid solutions at the above concentrations were prepared by
samples with results below the reportable range. addition of Intralipid to human serum pools.
A study was conducted using 121 serum samples from volunteers.
Data were analyzed as described by Clinical and Laboratory Standards Precision
Institute (CLSI) protocol NCCLS C28-A.12 From this study, 95% of all The imprecision of the Haptoglobin assay is ≤ 6.0% Total CV.
specimens fell within 31.62 to 213.16 mg/dL (0.32 to 2.13 g/L), with Representative data from studies using CLSI protocols NCCLS
samples ranging from 16.24 to 241.31 mg/dL (0.16 to 2.41 g/L). EP5-T214 and EP5-A15 are summarized below.
It is recommended that each laboratory determine its own reference
range based upon its particular locale and population characteristics. Control Level 1 Level 2 Level 3
N 80 80 80
SPECIFIC PERFORMANCE CHARACTERISTICS
Mean (mg/dL) 59.4 122.7 182.3
Reportable Range (Accuracy by Recovery)
The Haptoglobin assay reportable range is from 8 mg/dL (0.08 g/L) to SD 0.75 1.87 1.79
Within Run
the highest calibrator concentration. Human serum containing a known %CV 1.3 1.5 1.0
concentration of haptoglobin was diluted with saline and the resulting
samples were analyzed. Observed mean results across the reportable SD 0.72 1.13 2.84
range were within 4 mg/dL (0.04 g/L) or 10%, whichever is greater, of Between Run
%CV 1.2 0.9 1.6
the target concentrations. Representative data are summarized below.
%Recovery = (Observed Mean / Target Concentration) × 100 SD 3.19 1.41 2.97
Between Day
Target Concentration Observed Mean Delta* Percent (%) %CV 5.4 1.2 1.6
(mg/dL) (mg/dL) (mg/dL) Recovery* SD 3.35 2.60 4.49
Total
3.4 3.8 0.4 110.8 %CV 5.6 2.1 2.5
7.9 7.6 -0.3 96.0
Method Comparison
13.2 13.3 0.1 100.7
Correlation studies were performed using CLSI protocol NCCLS EP9-A.16
26.3 25.5 -0.8 97.0 Serum results from the Haptoglobin assay on an AEROSET
52.6 49.8 -2.8 94.7 System were compared with those from a commercially available
immunoturbidimetric methodology.
105.3 107.6 2.3 102.2 Serum results from the Haptoglobin assay on an ARCHITECT c System
157.9 163.8 5.9 103.7 were compared with the Haptoglobin assay on an AEROSET System.
210.6 225.2 14.6 107.0 AEROSET vs. ARCHITECT vs.
263.2 275.7 12.5 104.7 Comparative AEROSET
Method
* Delta and %Recovery were calculated prior to rounding Target
Concentration and Observed Mean values. N 47 91
Limit of Quantitation (LOQ) Y - Intercept 0.25 -0.88
The LOQ for Haptoglobin is ≤ 4 mg/dL (0.04 g/L). The LOQ is the Correlation Coefficient 0.998 0.999
analyte concentration at which the CV = 20%. Performance studies
Slope 1.03 0.98
produced an LOQ of 2.6 mg/dL (0.026 g/L).
Mean %Bias 5.0 -4.1
Range (mg/dL) 1.8 to 276.8 13.4 to 279.0
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BIBLIOGRAPHY
1. Burtis CA, Ashwood ER, editors. Tietz Textbook of Clinical
Chemistry, 2nd ed. Philadelphia, PA: WB Saunders; 1994:707–8.
2. Tietz NW, editor. Clinical Guide to Laboratory Tests, 3rd ed.
Philadelphia, PA: WB Saunders; 1995:306–9.
3. Henry JB. Clinical Diagnosis and Management by Laboratory
Methods, 18th ed. Philadelphia, PA: WB Saunders; 1991:225–7.
4. US Department of Labor, Occupational Safety and Health
Administration. 29 CFR Part 1910.1030. Occupational Exposure to
Bloodborne Pathogens.
5. US Department of Health and Human Services. Biosafety in
Microbiological and Biomedical Laboratories. 5th ed. Washington,
DC: US Government Printing Office; January 2007.
6. World Health Organization. Laboratory Biosafety Manual. Geneva:
World Health Organization, 2004.
7. 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.
8. Young DS. Effects of Preanalytical Variables on Clinical Laboratory
Tests, 2nd ed. Washington, DC: AACC Press; 1997:4-497.
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,
1996:7.04-5.
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 > 12 years to 60 years of age.
*** Edit to highest calibrator concentration specified in the calibrator value sheet.
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