Point of Care Devices for Troponine and Creatinine †Free Sample

Question: Discuss about thePoint of Care Devices for Troponine and Creatinine. Answer: Recommendation for Best Assay Device for Measurement of Troponin The measurement of the cardiac-specific troponins, troponin T (cTnT) and troponin I (cTnI), concentrations in our blood is a fundamental element of the assessment of patients who aresuspected to be having coronary ailments. Point-of-care test devices for assessment of cardiac troponin has the possibility of reducing turnaround time for assay results when comparison is done with core laboratory test methods[i]. Accelerated protocols have paved the way for success of these point-of-care devices in their field. Among the five assay devices for troponin measurement, that is i-Stat Troponin I/Abbott, Triage troponin I/Alere, RAMP troponin I/Response Biomedical Corp, Cardiac Reader Troponin T/Roche and AQT90 Flex troponin I/Radiometer, the recommended device is i-Stat Tropnin I/Abbott due to the number of advantages it has over the other devices. The most desirable feature of this device is that the sample amount 16L required for this device to work is least when compared to other devices. The ability of this device to measure troponin at low concentrations leads to better therapeutic intervention. The technique used by this device is ELISA which is an accurate and highly sensitive test method. The specificity for ELISA is also more in comparison to other techniques[ii]. Heparin, the normal anti-coagulant of blood can be used for preparation of the sample, that makes the process of sample preparation easier[iii]. In order to be implemented properly, any point-of-care device, assessing cardiac troponine, must reduce the turnaround time in a significant manner while not hampering the analytical performance, and on the whole the diagnostic performance. The i-Stat Troponin I/Abbott has the analytical turnaround timeof 10 minutes which is less when compared to the other devices. Recommendation for Best Assay Device for Measurement of Creatinine Chronic kidney disease (CKD) is a global health issue as the number of patients suffering from this ailment has doubled in the recent years. Creatinine is the important biochemical marker for assessing functioning of the kidney and this marker is being used across the globe for estimating the glomerular filtration rate (eGFR)[iv]. The assessment of creatinine level in blood has being getting attention in the recent times for aligning the lates methods, like, point-of-care devices, with other techniques[v]. Among the five point-of-care devices for creatinine measurement, that is Reflectron Plus, Piccolo xpress, DRI-CHEM 4000, Pentra C200 and i-STAT, Piccolo xpress is the recommended device that can be used. The preferred type of sample for device is whole blood and Piccolo xpress uses whole blood as the sample type. In addition, this device can also measure creatinine in plasma. Plasma can give results that are more reliable in comparison to whole blood due to the fact that the sample is cleaner[vi]. However, the sample centrifugation requires additional 10 minutes and therefore is not a desirable process for point-of-care devices. The Piccolo xpress has the advantage that the sample is spun to separate out the plasma and as a result measurement of creatinine is carried out on plasma from the sample of whole blood. The centrifugation process of Piccolo xpress gives effectiveness to the device. In spite of the fact that 12 minutes is the time for analysis, the device is recommended as the time includes that required for centrifugation. Reference [i] Bingisser R, Cairns C, Christ M, Hausfater P, Lindahl B, Mair J, Panteghini M, Price C, Venge P. Cardiac troponin: a critical review of the case for point-of-care testing in the ED. The American journal of emergency medicine. 2012 Oct 31;30(8):1639-49. [ii] Gan SD, Patel KR. Enzyme immunoassay and enzyme-linked immunosorbent assay. Journal of Investigative Dermatology. 2013 Sep 30;133(9):1-3. [iii] Linkins LA, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S, Crowther M. Treatment and prevention of heparin-induced thrombocytopenia: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. CHEST Journal. 2012 Feb 1;141(2_suppl):e495S-530S. [iv] Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, Saran R, Wang AY, Yang CW. Chronic kidney disease: global dimension and perspectives. The Lancet. 2013 Jul 26;382(9888):260-72. [v] Shephard MD. Point-of-care testing and creatinine measurement. [vi] Suganda S, Tang L, Carr J, Sun Y, Pounds S, Hayden R. Comparative evaluation of whole blood versus plasma for quantitative detection of cytomegalovirus using an automated system. Diagnostic microbiology and infectious disease. 2016 May 31;85(1):23-5.