Evaluation of high resolution gel ß(2)-transferrin for detection of cerebrospinal fluid leak.

BACKGROUND: Cerebrospinal fluid (CSF) leaks are potentially life-threatening conditions that can be diagnosed by detection of ß(2)-transferrin using protein electrophoresis. Another less commonly available test is ß-trace protein quantitation using immunoassay. The objectives of this study were to evaluate a new immunofixation-based ß(2)-transferrin test for detection of CSF leaks and to compare it to an existing agarose gel electrophoresis test and ß-trace protein immunoassay. METHODS: For method comparison, 63 consecutive samples from physician-ordered ß(2)-transferrin tests were analyzed using two different electrophoresis methods, agarose gel fractionation followed by acid-violet staining, and high resolution agarose gel electrophoresis followed by ß(2)-transferrin immunofixation. A subset of samples (16/63) were analyzed for ß-trace protein. Results were compared against patient chart data for the presence of a CSF leak. Additional studies were performed to assess the stability, detection limit, and analytical specificity of the ß(2)-transferrin immunofixation test. RESULTS: The ß(2)-transferrin immunofixation test had a sensitivity of 100 % (40/40) and specificity of 71 % (12/17) for detection of CSF leaks. By comparison, the agarose gel test had a sensitivity of 87 % (35/40) and specificity of 94 % (16/17). ß-trace protein had a sensitivity of 100 % (10/10) and specificity of 86 % (5/6). Serum and saliva could be differentiated from CSF by the ß(2)-transferrin immunofixation test based on their migration patterns. However, whole blood samples appeared positive for ß(2)-transferrin at a threshold of ~ 4 g/L hemoglobin. At a cut-off of 3 mg/L, ß-trace protein was increased in 10/10 cases with documented CSF leak and in 1/6 patients without CSF leak. CONCLUSIONS: Both the new immunofixation test for ß(2)-transferrin and the ß-trace protein were effective at detecting CSF leaks. Users of the ß(2)-transferrin immunofixation test should be cautioned against interpreting samples with blood contamination.

Quantification of beta-trace protein and detection of transferrin isoforms in mixtures of cerebrospinal fluid and blood serum as models of rhinorrhea and otorrhea diagnosis.

Different mixtures from a serum pool and a cerebrospinal fluid (CSF) pool were used as models to study CSF contamination in secretions by determining two CSF specific proteins: beta-trace protein (beta-TP) and the asialo-transferrin (a-Tf) band which was detected by isoelectric focusing (IEF) with Tf specific immunofixation. Beta-TP and total Tf were measured immunonephelometrically. Secretion/serum ratios of beta-TP content > 2.0 indicated CSF contaminations with > or = 5% (v/v) CSF; this was confirmed by detecting the a-Tf band by IEF. Reliable a-Tf bands were only revealed with secretion/serum rations of Tf contents < 0.1, indicating an interference of major sialo-Tf fractions with the a-TF band detection in the sample. For CSF detection in rhinorrhea and otorrhea, complementary use of beta-TP assay and a-Tf assay is recommended. Preanalytically, dilution or concentration of the sample as well as denaturation of Tf and beta-TP should be prevented by optimizing sample collection.

Detection of beta-2 transferrin in otorrhea and rhinorrhea in a routine clinical laboratory setting.

A simple, straightforward, and rapid method for the detection of beta-2 transferrin in otorrhea and rhinorrhea that can be used in a routine clinical laboratory is described. The beta-2 transferrin was detected by agarose gel electrophoresis of the fluid on Beckman Paragon equipment, followed by pressure transfer to a nitrocellulose membrane and then incubation with enzyme-labeled antitransferrin antibody and substrate. The procedure was fast (3.5 h) and sensitive (detected as little as 1 microgram/ml) and required only 3 microliters of fluid. Beta-2 transferrin was detected in cerebrospinal fluid diluted up to eightfold. No special training or expertise was needed, and all equipment and procedures used are commonly available in a routine clinical laboratory.