Detection results of blood donors with HBsAg reactivity to single reagent: a retrospective analysis / 中国输血杂志

【Objective】 To retrospectively analyze the detection results of blood donors with HBsAg reactivity to single reagent detected by enzyme-linked immunosorbent assay (ELISA) in our center, so as to provide basis for further consolidating the blood donor team. 【Methods】 Samples of blood donors who had been deferred for at least 6 months due to HBsAg reactivity to sole ELISA assay were collected, and HBsAg ELISA and NAT were further performed. Meanwhile, HBsAg/HBsAb/HBeAg/HBeAb/HBcAb were detected by Roche electrochemiluminescence immunoassay, and the results were statistically analyzed. 【Results】 Among these 51 selected samples, 45 were negative to two assays, 6 were reactive to sole assay, with reactivity-yield rate at 11.76% (6/51). The results of NAT/ECLIA were all negative. For five indicators of hepatitis B virus infection, 23 samples were all negative and 28 were partially positive, mainly anti-HBs, anti-HBc and anti-HBe. 【Conclusion】 The follow-up detection of HBsAg ELISA sole-reagent reactive samples, supplemented with the detection of HBV serological markers, can reduce the number of deferred blood donors, increase the willingness to donate blood again, and protect the rights and interests of blood donors.

Study on Reentry Evaluation Mode for Blood Donors Used to be HBV Reactive in Jiangsu Province / 中国实验血液学杂志

OBJECTIVE@#To evaluate the risk of reentry in HBV reactive blood donors and feasibility of HBV reentry strategy.@*METHODS@#HBsAg+ or HBV DNA+ donors who had been quarantined for more than 6 months in Jiangsu Province could propose for reentry application. Blood samples were routinely screened by dual-ELISA for HBsAg, anti-HCV, HIV Ab/Ag, and anti- Treponema pallidum and those non-reactive ones were tested by minipool nucleic acid testing (NAT) for three times. To identify occult HBV donors, samples of NAT non-reactive were further tested by electrochemiluminescence immunoassay (ECLIA) for HBV seromarkers (including HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb). Donors of only 4 ECLIA patterns were accepted to reentry, including all 5 HBV seromarkers negative, anti-HBs only but having history of hepatitis B vaccine injection, HBcAb only, HBsAb+ / HBcAb+ with HBsAb more than 200 IU/L. Additionally, the detection rate of HBV infection was compared between routine screening mode and ECLIA, as well as the reentry qualified rate of HBsAg+ and HBV DNA+ blood donors.@*RESULTS@#From Oct. 2016 to Aug. 2019, a total of 737 HBV reactive donors had applied for reentry, including 667 HBsAg+ reactive and 70 HBV DNA+ reactive donors. Among 3 screening methods, the highest HBV detection rate (43.15%, 318/737) was observed on ECLIA, while only 4.75% (35/737) on ELISA and 3.12% (23/737) on NAT, respectively. Among 4 qualified patterns of HBV serological markers, the highest proportion was found in the all negative group (22.90%, 155/677), followed by the group with HBsAb+ only and history of hepatitis B vaccine injection (19.35%, 131/677), and the median concentration of HBsAb was 237.7 IU/L. The unqualified rate of HBV DNA+ donors was 82.86%, which was significantly higher than 47.98% of HBsAg+ donors.@*CONCLUSION@#Routine screening tests merely based on ELISA and NAT could miss occult HBV donors and may not be sufficient for blood safety. HBsAb concentration and vaccine injection history should be included in the evaluation of HBV reactive donors who intend to apply for reentry. There is a relatively larger residual risk of occult HBV infection in blood donors quarantined for HBV DNA reactive.

Detection and analysis of hepatitis B virus serum markers in children treated in Wuhan Children's Hospital / 公共卫生与预防医学

Objective To investigate the status of hepatitis B virus (HBV) infection in children in Wuhan, and to analyze the expression pattern and distribution of serum markers. Methods Five serum markers of HbsA, HbsAb, HbeAg, HbeAb and HBcAb were detected by electrochemiluminescence immunoassay in 67 027 children aged 0-18 years including inpatients, outpatients, and physical examinees in Wuhan Children's Hospital. SPSS24.0 statistical software was used to analyze the results by age and gender. Results The “all negative” detection rate of all 67,027 children was 18.98%. There was a significant difference in the positive rate of HBcAb between male and female. The positive rate of HBcAb was higher in 0~28 days and 1~12 months group and decreased significantly after 1 year old. The positive rate of HBcAb was 5.02% in 1-14 years old but increased slightly in 15-18 years old. Among HBsAb positive children, the positive rate of HBsAb reached the peak of 95.65% in 1~2 years old group and the lowest of 68.90% in 6~14 years old group, and gradually decreased before 15 years old. Among the children with HBsAb concentration ≥100 IU/L, the proportion of 1~2 years old group was the highest (76.99%), and the proportion of 6~14 years old group was the lowest (40.99%). A total of 20 HBsAb serum marker expression patterns were detected, and the detection rates of “single HBsAb+”, “all negative”, “HBsAb+/HBcAb+”, and “HBsAb+/HBeAb+/HBcAb+” were 71.40%, 18.98%, 4.80% and 4.20%, respectively. Among them, 11 kinds of uncommon expression patterns were detected, and 9 kinds of uncommon expression patterns were detected in neonates, with a detection rate of 1.21%, which was higher than that in other age groups. Among all serological patterns, only the detection rate of “single HBcAb+” showed a statistical difference between male and female. Conclusion The HBV infection rate in all ages of 0~18 years old children in Wuhan is low. “Single HBsAb+” is the main serological pattern, and the concentration distribution of HBsAb is mostly in the range of 100-999 IU /L. There is a high “all negative” detection rate. School-age children should be inoculated with hepatitis B vaccine, which may be beneficial to reduce the risk of infection.

Establish deferral criterion for HIV serological testing in blood donors / 中国输血杂志

【Objective】 To establish deferral criterion of HIV ELISA (enzyme-linked immunosorbent assay) and electrochemiluminescence immunoassay(ECLIA) by using receiver operating characteristic curve(ROC) method to screen HIV reactive blood donors suitable for entering the re-entry process and improve the management efficiency of reactive blood donors. 【Methods】 The test results of 92 001 blood donors from February to September 2019 were analyzed, and 177 reactive samples were screened by conventional screening mode (twice ELISA and once nucleic acid), supplemented with electrochemiluminescence immunoassay assay (ECLIA), and confirmed by Western blotting (WB). Screening reactive samples were divided into three groups: group A was both serological and nucleic acid reactivity, group B was only serological reactive, and group C was only nucleic acid reactivity. Its efficacy in blood donor classification was assessed by drawing ROC curves with 99% specific corresponding S/CO low values as the deferral criterion of the corresponding serological method. 【Results】 1) A total of 177 HIV reactive samples were detected in conventional mode, including 34 in group A, 142 in Group B and 1 in Group C. The positive predictive value (PPV) was 100%, 0.75% and 100%, respectively. ECLIA detection mode (once ECLIA and once NAT), a total of 67 HIV reactive samples including 34 in group A, 32 in group B and 1 in group C, with positive predictive values of 100%, 3.7% and 100%, respectively.2) The HIV test results showed diversity, with 36 true positive samples including 1 HIV elite controller and 3 early HIV infections (1 HIV ELISA antigen/antibody window and 2 ELISA HIV antibody window), and 32 serological and NAT cases were reactive infections.3) The deferral limit of ELISA 1 and ELISA 2 in conventional screening mode were 20.25 and 9.85, respectively, can screen 97.14% (34/35) of all true positive samples in group A and B, except for one ELISA HIV antibody window (ELISA 2 reactivity). The positive predictive values were 93.94% and 92.85%, respectively. The ECLIA deferral limit of 7.83 can screens all true positive samples in Groups A and B (35/35)in ECLIA mode. The positive predictive value was 94.59%. 【Conclusion】 The establishment of deferral limits in this study can effectively screen HIV-positive blood donors, and the number of screened blood donors is greatly reduced, which is helpful to fine and scientific management of HIV-reactive blood donors. The deferral limit values of different testing reagents are quite different, so each laboratory should choose appropriate testing methods to establish the deferral limit values suitable for the laboratory according to its own testing ability, so as to provide technical support for optimizing the process of returning blood donors to the team.

ECLIA and confirmation results of HIV reactive samples in blood screening / 中国输血杂志

【Objective】 To perform electrochemiluminescence immunoassay (ECLIA) and Western blotting (WB) confirmation tests for HIV reactive samples in blood screening, and analyze the correlation between ELISA (enzyme-linked immunosorbent assay), ECLIA results and confirmed infection, so as to provide data support for the application of ECLIA in blood screening. 【Methods】 177 HIV reactive samples in blood screening testing detected by our laboratory from February to October 2019 were collected, of which 137 were reactiv to isolated ELISA reagent e, 39 to dual ELISA reagent, and 1 in window period. Ten maker-negative samples were randomly selected to undergo ECLIA with the above 177 samples. HIV reactive samples were sent to Centers for Disease Control and Prevention (CDC) for confirmation tests, and the results were analyzed and compared. 【Results】 Among the 177 HIV reactive samples, 66 were ECLIA reactive, 111 negative, and the 10 maker-negative samples remained negative. The sensitivity, specificity, positive predictive value, negative predictive value and total concordance rate of ECLIA were 97.1%, 81.1%, 55%, 99.1% and 84.2%, respectively, showing better performance than that of two ELISA reagents(P0.05). The positive predictive value and specificity were tested by chi-square test, and the difference between ECLIA and reagent 2 was statistically significant (P<0.05). The ECLIA results showed significant correlation with the confirmation results with good consistency(examed by Kappa test). Among the three reagents, ECLIA presented highest accuracy and largest Youden index. 【Conclusion】 ECLIA presents high detection sensitivity, which can improve the detection ability of early HIV infection and shorten the window period of HIV detection, therefore should be popularized in blood screening.

Analysis of NAT non-reactive results implicated in HBsAg ELISA reactive blood donors by multi-assays / 中国输血杂志

【Objective】 To investigate NAT non-reactive results implicated in HBsAg ELISA reactive voluntary blood donors in Shenzhen. 【Methods】 HBsAg ELISA+ but NAT-blood samples were collected, and HBsAg was further retested by TRFIA, Roche ECLIA and neutralization test. HBV DNA of individual donation was detected by commercial Roche MPX and Uultrio Elite, and virus nucleic acid was extracted via 2.5 mL. Molecular characterizations of HBsAg+ /NAT-samples were determined by quantitative polymerase chain reaction(qPCR) and nested PCR amplifification of the precore and core promoter regions and HBsAg(S) region. HBV serological markers were detected, and the samples with suspicious results were followed up and detected by multi-assay. 【Results】 Among 67 602 samples, 73(0.11%) HBsAg ELISA+ and NAT-blood samples were enrolled in the study. 15(20.5%, 15/73) were confirmed HBsAg+ by TRFIA, ECLI and five alternative DNA assays, and the other 2(2.7%, 2/73) were further identified as HBsAg+ by follow-up study. In 17 confirmed HBsAg+ samples, the viral loads ranged undetectable to 378 IU/mL, with the median of 10.1 IU/mL. Weak correlation was found between HBsAg and HBV DNA load(R2=0.394 4). 【Conclusion】 Some Hepatitis B virus infected blood samples may miss even with different HBsAg assays. Multi-assays with high sensitivity should be combined for blood screening to ensure blood safety..The inconsistent results should be followed up and further tested for hepatitis B serological markers to assist the confirmation.

A comparative study of two methods for detecting procalcitonin / 国际检验医学杂志

Objective To use cyclic amplified fluorescence immunoassay method and electrochemiluminescence immunoassay method for quantitative detection of procalcitonin (PCT),and to evaluate the consistency of the test results.Methods With the method of electrochemiluminescence used as the contrast method and the cyclic enhanced fluorescence immunoassay method used as experimental method,samples of 219 hospitalized patients were measured in two ways.The results were divided into three groups:the serum group (Core serum group) and the micro blood group (Core micro blood group) which were detected in cyclic amplified fluorescence immunoassay method and the serum group (Roche serum group) which was detected by electrochemiluminescence immunoassay method.The data of three groups were compared with each other in paired t test,and correlation analysis,the relative sensitivity,the relative specificity,and Jorden index at the medical decision level (0.5 ng/mL and 2.0 ng/mL) were calculated and the Kappa Consistency Test was calculated.Results There were no statistical differences in three groups (P＞0.05).The Core serum group was positively correlated with the Roche serum group (r =0.993,P＜0.01).The linear regression equation was Y =-0.061+1.041X(0.04≤X≤60).The Core micro blood group was positively correlated with the Roche serum group(r=0.989,P＜0.01).The linear regression equation was Y=0.022+1.023X(0.04≤X≤60).The Core micro blood group was positively correlated with the Core serum group (r=0.986,P＜0.01).The linear regression equation was Y=0.129+0.973X(0.04≤X≤60).The relative sensitivity of the three comparison groups was greater than 92％ and the relative specificity was greater than 95％ at the medical decision level (0.5 ng/mL and 2.0 ng/mL),and the Jorden index and Kappa values were greater than 0.9.It indicated a better consistency.Conclusion Cyclic amplified fluorescence immunoassay and electrochemiluminescence immunoassay detection results were very consistent,which meet the clinical testing requirements.

The contrast research and application of electrochemiluminescence immuno-assay determination kits of human embryonic antigen / 国际检验医学杂志

Objective To evaluate the comparability of test results of self-built human carcinoembryonic antigen(CEA)electro-chemiluminescence immunoassay(ECLIA)and imported reagent.Methods A total of different concentrations 77 fresh serum speci-mens were collected and detected CEA by two kinds of ECLIA kit.The results were analyzed with Excel2003 and SPSS1 9.0 soft-ware.Results The difference between each dose was significant (P 0.05);the sensitivity of the assay was 0.3 ng/mL,the intra coefficient of variation was 4.58%-5.83%,the inter coefficient of variation was 5.07%-5.97%,the analytical recovery was 99.13%-107.28%,the specificity of the assay had no cross reaction with CA1 99 and AFP.The correlation coefficient between two kinds of reagents determination results was greater than 0.95,with imported reagent as reference test,self-built carcinoembryonic antigen ECLIA clinical performance evaluation was acceptable.Conclusion The precision of the two kinds of ECLIA in detection of CEA accord to clinical requirement.Comparability exists in evaluating the acceptability of clinical.

Analysis on results of HBsAg weakly positive and both HBsAg and HBsAb simultaneously positive / 国际检验医学杂志

Objective To analyze the results of HBsAg weakly positive and both HBsAg and HBsAb simultaneously positive in 5 items of hepatitis B detected by ELISA .Methods 115 cases of HBsAg weakly positive and 95 cases of both HBsAg and HBsAb simultaneously positive were screened out from 35 280 cases of 5 items detection results of hepatitis B .210 screened samples were performed the electrochemiluminescence immunoassay (ECLIA) quantitation .Results 115 cases of HBsAg weakly positive were re‐detected by using ECLIA ,90 cases had the consistent results with the coincidence rate of 78 .3% .After ECLIA re‐detection in 95 cases of HBsAg and HBsAb double positive results ,11 cases had the consistent results with the coincidence rate of 11 .6% .Conclu‐sion The results of HBsAg weakly positive and both HBsAg and HBsAb double positive in 5 items of hepatitis B detected by ELISA must be cautious .In the detection results of HBsAg weakly positive ,the majority are the samples of HBsAg ,HBeAb and HBcAb positive and HBsAg and HBcAb positive .The results of HBsAg and HBsAb simultaneously positive have poor reliability , which should be careful to issue the detection reports .

Evaluation on feasibility of Roche e601 for detecting hepatitis B virus surface antigen / 国际检验医学杂志

Objective To evaluate the of feasibility of Roche e601 for detecting hepatitis B virus surface antigen(HBsAg).Meth-ods To evaluate the feasibility of Roche e601 for detecting hepatitis B virus surface antigen(HBsAg).Results The coefficient of variation(CV)of inter-run and between-run from low and high value specimens was lower than the requirements of manufacturers;the negative and positive coincidence rates in detecting 60 external quality assessment controls were 100%(40/40)and 100%(20 /20),respectively;the detection threshold values of the system was 0.01 IU/mL;the results detected by this detecting system in 40 samples,in which the concentration of HBsAg was 0.8

Analysis of test results using residual reagents in electrochemiluminescence immunoassay analyzer / 国际检验医学杂志

Objective To evaluate the detection efficiency of residual reagent used in electrochemiluminescence immunoassay an-alyzer .Methods Alpha fetoprotein (AFP) ,carcino-embryonic antigen(CEA) and total prostate specific antigen(TPSA) were de-tected by using remaining reagents .The precision and recovery rate of remaining reagents were analyzed .Referring to the document of NCCLS EP9-A2 ,8 clinic samples were detected everyday by residual reagent and new reagent respectively .The test results of to-tal 40 samples were recorded within 5 days .The test results derived from 2 kinds of reagents were analyzed comparatively and their bias was evaluated by using new reagent as a control method and residual reagent as experimental methods .Results The within-run and between-run coefficients of variation(CV) of the 3 items measured by residual reagents in low and high levels of quality control products met the related standard .The recovery rate was variable from 90% to 110% .The test rewults of the 2 kinds of reagents were positively correlated(r2 >0 .95) .Their anticipated biases were within allowed biases on the medical decision level of CEA ,AFP and T PSA .Conclusion Residual reagent of electrochemiluminescence immunoassay analyzer can meet the clinical practice needs , which also can ensure the quality of measurement and the reduction of the cost .

Comparison of HBsAg Results between Roche Cobas e601 and Abbott Architect i2000 analysis systems / 国际检验医学杂志

Objective To compare the difference of the HBsAg detected results between the Roche cobas e601 electrochemilumi-nescence immunoassay instrument and the Abbott Architect i2000chemiluminescent microparticle immunoassay instrument.Methods The HBsAg positive specimens with the quantitation results of lower than 250IU/mL detected by the Abbott Architect i2000 were selected and simultaneously detected by the Roche cobas e601.The differences of detected results were compared and per-formed the linear correlation and analysis regression.Results 46 clinical specimens were detected.The detected results had best correlation between the two instruments by getting rid of 1 specimen with unconformable reactivity of detected results.15 speci-mens had the HBsAg detected result of 0.05-1.00 IU/mL by the Abbott Architect i2000,the linear regression equation was Y =17.49X+0.843(r=0.979);15 specimens had the HBsAg detected result of 1.1 -10.00 IU/mL IU/mL by the Abbott Architect i2000,the linear regression equation was Y =15.72X +21.06(r=0.952);15 specimens had the HBsAg detected result of 11 -250 IU/mL by the Abbott Architect i2000,the linear regression equation was Y =29.17X -129(r=1.000).Conclusion The detected results have better correlation between the two instruments and can be mutually converted by the formulas.

Performance Evaluation of 3 Kinds of HBsAg Qualitative Assays and 2 Kinds of Quantitative Assays

BACKGROUND: Currently used techniques for quantitation of HBsAg often yield discordant results; therefore, development of quantitation techniques that can detect HBsAg with high accuracy has become very important. Recent advances have led to the development of several HBsAg detection systems. Here, we evaluated the performance of 3 newly developed detection systems, which can detect HBsAg both qualitatively and quantitavely, and determined the concordance among their results. METHODS: Four hundred and thirty two samples assigned to 4 groups-patient group, dilution group, weakly reactive group, and linearity group- were subjected to qualitative and quantitative detection of HBsAg by using the 3 systems developed by 3 major manufacturers; Abbott Architect, Roche E170 and Siemens Centaur XP. RESULTS: The results for the qualitative analyses were closely concordant among the three systems (98.3%) for all 432 samples. In 123 samples that were determined as HBsAg-negative, E170 (76%) distributed frequently at the upper half level (0.5-1.0) of negative reference range, compared with Architect (11%) and Centaur XP (22%). In particular, in 65 samples that were diluted from the strongly positive samples to obtain weakly positive samples, the average index values obtained using Architect (3.6 S/CO), E170 (4.2 COI) and Centaur XP (11.4 index value) differed significantly (P<0.0001). In the antiviral treatment group and the post-liver transplantation group, no inconsistency was observed among the results of the qualitative and quantitative assays. In the 18-fold serially diluted samples, no linearity was observed. CONCLUSIONS: Because of the possibility of false-positive detection in the HBsAg-negative samples, regular management of equipment and appropriate selection of reagents are very important. In weakly positive samples, quantitative assay has not to be replaced for qualitative assay. Therefore, the qualitative assays should be used for screening the samples, whereas the quantitative assays should be used for monitoring the Hepatitis B virus (HBV) load in the samples determined as HBsAg-positive. The qualitative index value should not be interpreted as a quantitative measure of HBV load.

Performance Evaluation of Immunoassay Detection of HBsAg Mutants and Their Clinical Significance in the High Risk Groups

BACKGROUND: False negative results have been reported in the immunodetection of hepatitis B virus (HBV) because of the existence of the various mutants of the virus, causing most suppliers to try to develop superior reagents by using highly sensitive and specific monoclonal or polyclonal antibodies. In this study, we evaluated the effectiveness of 3 newly developed reagents by major manufacturers by adopting automated methods with increased sensitivity and specificity in the detection and discrimination of native and recombinant mutant antigens. METHODS: We analyzed samples confirmed positive for hepatitis B surface antigen (HBsAg), high-risk samples from chronic hepatitis patients treated with antiviral agents, and samples from patients who had undergone liver transplantation and were treated with high-dose hepatitis B immunoglobulin (HBIG) by using reagents and systems newly developed by Abbott Laboratories (USA), Roche Diagnostics (Germany), and Siemens Healthcare Diagnostics (USA). Recombinant sample panels from these manufacturers with low and high concentrations were also analyzed for comparing the 3 reagents. RESULTS: There were no discrepant results among the various selected patient groups; however, for the recombinant mutant panels, all of the 3 reagents showed highly positive detection rates for their corresponding mutant panels, but showed relatively discrepant mutant detection rates when cross-tested with the other mutant panels. Detection rates of the HBsAg mutant panels were higher at a higher concentration of the mutant samples, but were lower for the same mutant receptor sites at a lower concentration. CONCLUSIONS: The 3 major detection methods seem to recognize the major native mutants commonly encountered in clinical practice. However, in the case of recombinant mutants, we believe that our data are not to be interpreted as a reference standard for any reagent, because the results can only be validated for the reagents' corresponding mutant panels; such results tend to be mutually exclusive, and the enough concentration of mutants was required to be adjusted for a comparative analysis.