Page 1 / 14 Carnitine / Acylcarnitines Dried Blood Spots LC-MS/MS Analysis Kit User Manual ZV-3051-0200-15 200
Page 2 / 14 Table of Contents 1. INTENDED USE... 3 2. SUMMARY AND EXPLANATION... 3 3. TEST PRINCIPLE... 3 4. WARNING AND PRECAUTIONS... 3 5. STORAGE AND STABILITY... 4 6. MATERIALS SUPPLIED... 4 7. MATERIALS REQUIRED BUT NOT SUPPLIED... 5 8. PROCEDURE NOTES... 6 9. LIMITATIONS OF THE PROCEDURE... 6 10. PRE-TEST SET-UP INSTRUCTIONS... 7 11. TEST PROCEDURE... 7 12. QUALITY CONTROL... 8 13. CALCULATION OF RESULTS... 8 14. INTERPRETATION OF RESULTS... 8 15. EXPECTED VALUES... 9 16. LC-MS/MS PARAMETERS... 9 17. MS SCAN PARAMETERS... 10 18. ANALYTICAL PERFORMANCE... 11 19. SAMPLE CHROMATOGRAM... 12
Page 3 / 14 1. INTENDED USE Carnitine / Acylcarnitines LC-MS/MS analysis kit for dried blood spot samples. 2. SUMMARY AND EXPLANATION Carnitine / Acylcarnitines screening is the most important part of the clinical diagnosis of amino acid, fatty acid or organic acid metabolism. Carnitine / Acylcarnitines screening allows to the diagnosis of over 30 metabolic diseases from a drop of blood samples taken with a screening card. This screening test occurred by measurement of Carnitine / Acylcarnitins with isotope dilution tandem mass spectrometry. LC-MS/MS is a powerful tool for gives results Carnitine / Acylcarnitines in 1.5 minutes. Screening of following analytes can be performed by Zivak Carnitine / Acylcarnitine LC-MS/MS Analysis Kit and Zivak NeoZin Screening software. Main methods and procedures that have been selected are based on EN ISO 14971. By the quantitative analysis of carnitine esters including such as free carnitine, C0, C2, C4, C6, C8, C10, C12, C14, C16, C16 OH, C18, C18 OH carnitine disorders which are related with fatty acid oxidation. By the quantitative analysis of carnitine esters including such as C3, C3DC, C4OH, C5, C5OH, C5DC carnitine, disorders which are related with organic acid metabolism. 3. TEST PRINCIPLE Carnitine / Acylcarnitines are extracted from dried blood spot with an organic solvent contains internal standards. Then extracted analytes derivatised via reagents. Derivatisated Carnitine / Acylcarnitines are analysed by Tandem Mass spectrometry. 4. WARNING AND PRECAUTIONS For in-vitro diagnostic use only. For professional use only. Read the instructions carefully, before you start.
In case of damage of the kit package, please contact Zivak or your supplier. Do not use expired kits and components. Please check the batch no and expiry date before start. Protective gloves and goggles should be worn. Please take any necessary precautions to prevent infection with blood borne pathogens while working with biological fluids. Appropriate bio-safety precautions and disposal of bio-hazardous wastes should be followed. Please check the labels on reagent bottles. Reagents of this kit contain hazardous material may cause eye and skin irritations. All calibrators and controls of this kit which contain human blood or dried blood was tested and found negative for HIV 1/2 and HCV antibodies, HbsAg, HIV 1/2 and HCV genome. Nevertheless, the blood controls should be considered as potentially infectious and treated with appropriate care. It s recommended to work in a fume hood for your safety as Reagent 2 is volatile and please avoid inhaling. Page 4 / 14 5. STORAGE AND STABILITY It s recommended to work in a fume hood for your safety as Reagent 2 is volatile and please avoid inhaling. This analysis kit can be shipped at room temperature. Controls, Reagent 2, 3 should be stored at 2-8 C. Reagent 1 should be stored at -20 C. All other components of the kit can be stored at room temperature. All components are guaranteed until expiry date when stored at recommended temperatures and used as described in these instructions. 6. MATERIALS SUPPLIED Order No. Volume Symbol Component ZV-3051-02R1-15 1 x 40 ml R1 Reagent 1, Contains deuterated internal standards ZV-3051-02R2-15 1 x 12 ml R2 Reagent 2, Contains derivatization reagent ZV-3051-02R3-15 1 x 40 ml R3 Reagent 3, Contains acid
Page 5 / 14 ZV-3051-02WB-15 1 x 0,5 L WB Washing solution, Contains organic solvent ZV-3051-02MP-15 1 x 0,6 L MP Mobile Phase, Contains organic solvent KK ZV-3051-KK-15 1 x 1 pc User Manual 7. MATERIALS REQUIRED BUT NOT SUPPLIED Materials listed in the table below are required and should be ordered separately. Order No. Volume Symbol Component ZV-3051-02K1-15 1 x 1 Spot Control Level 1 Dried Blood Spot Control Level 1 ZV-3051-02K2-15 1 x 1 Spot Control Level 2 Dried Blood Spot Control Level 2 ZV-3051-02S1-15 1 x 1 Spot Calibrator Level 1 Dried Blood Spot Calibrator Level 1 ZV-3051-02S2-15 1 x 1 Spot Calibrator Level 2 Dried Blood Spot Calibrator Level 2 ZV-3051-02C1-15 1 x 1 pcs Zivak Carnitine / Acylcarnitines Dried Blood Spots LC- MS/MS Trap Column Holder ZV-3051-CSPE-15 1 x 1 pcs Carnitine / Acylcarnitines Dried Blood Spots LC- MS/MS Trap Column Cartridge 20-200 µl pipette Pipette tips 3.5 mm puncher Conical autosampler vial or vial insert
Page 6 / 14 8. PROCEDURE NOTES Any inappropriate handling of samples or modification of the test procedure may influence the results. The indicated pipetting volumes, incubation times, temperatures and pre-treatment steps have to be performed strictly according to the instructions. Use calibrated pipettes and devices only. Once the test has been started, all steps should be completed without interruption. Make sure that required reagents, materials and devices are prepared ready at the appropriate time. Leave aside all reagents and specimens to reach room temperature (18-25 C) and gently swirl each vial of liquid reagent and sample before use. Mix reagents without foaming. Avoid contamination of reagents, pipettes and wells/tubes. Use new disposable plastic pipette tips for each reagent, standard or specimen. Do not interchange the vial caps. Always keep vials closed when not been used. Do not re-use wells/tubes or reagents. Incubation time affects results. All tubes or wells should be handled in the same order and time sequences. 9. LIMITATIONS OF THE PROCEDURE Specimen collection and storage have a significant effect on the test results. Please always follow the universal safety precautions for accurate and safe DBS sampling given below. Universal Safety Precautions for DBS sampling: Treat all blood samples as though they are infectious Wash hands, wear gloves and apron/lab coat Take precaution to avoid needle injury Dispose of contaminated sharps and waste appropriately Clearly label each card with appropriate identification number. It is unacceptable to submit a blood card for testing that has not been properly labelled. Apply gentle pressure to the heel and allow a large drop of free flowing blood to collect at the puncture site. Working quickly, hold the filter paper by the edges and touch the filter paper gently against the large drop of blood and in one step allow a sufficient quantity of blood to soak through and completely fill or saturate a circle. A completed saturated spot will contain approx.100 µl of blood. Repeat, until you have collected enough blood to fill at least 3 circles on the blood collection card. It is critical that entire circle be uniformly saturated with blood. If collecting spots using a pipette, collect 100 µl of blood and gently apply to filter paper.
Page 7 / 14 Due to it is a screening method any result with an elevated concentration has to be indicated as presumptive positive and has to be confirmed with further sampling and confirmatory testing. A false negative result of this assay cannot be excluded with absolute certainty. 10. PRE-TEST SET-UP INSTRUCTIONS Set-up the Instrument: Purge the HPLC pumps with a high flow rate of mobile phase(s). This should be done by pumping the mobile phase(s) through the system for 2 minutes at a flow rate of 4.0 ml/min. Switch off the pump and connect the column in flow direction. Activate the method and allow mobile phase(s) to flow through the pre-filter for 5 minutes. Make sure the bottle of mobile phase bottle is closed well, otherwise components of the mobile phase could evaporate; this alters the retention times. 11. TEST PROCEDURE Sample Pre-treatment (Manual) Take dried blood spot sample in 3.5 mm diameter by a puncher on a 96-well microplate. Add 200 L of R1 to each well. Incubate for 30 minutes at room temperature. After incubation, take the liquid phase on another well. Then dry with warm air flow. Add 60 L of R2 on dried samples. Cover microplate properly with alumina foil or appropriate seal And incubate for 20 minutes at 65 C. Remove alumina foil and dry the liquid phase completely with warm air flow. Add 200 µl of R3 to dissolve the dried wells.
Page 8 / 14 Take the liquid into a vial or directly inject 20 µl from 96 well plate to LC-MS/MS system. Note: The prepared sample is stable at 2-8 C for 24 hours. 12. QUALITY CONTROL The test results are only valid if the test has been performed by following the instructions. Moreover the user must strictly adhere to the rules of GLP (Good Laboratory Practice) or other applicable standards/laws. All standards and kit controls must be found within the acceptable ranges as stated on the QC (Quality Control) Certificate. If the criteria are not met, the run is not valid and should be repeated. Each laboratory should use known samples as further controls. In case of any deviation, the following technical issues should be proven: Expiry dates of (prepared) reagents, storage conditions, pipettes, devices, incubation conditions and washing methods. It is recommended to participate at appropriate quality assessment trials. 13. CALCULATION OF RESULTS Isotop dilution method is used for calculation of results. The analyte concentrations calculated against area of their internal standard with known concentrations. Using Zivak NeoZin Data Evaluation Software is very easy and effective software to analyse complex screening data. 14. INTERPRETATION OF RESULTS Various societies for Carnitine / Acylcarnitines screening recommend different Cut-Off values for repetition of the measurement and the application of confirmatory assays. Depending on the application of samples of different populations of newborns it is highly recommended that each laboratory establishes its own range of normal values and that this distribution of values is coordinated with the recommendations of the responsible society of this geographic region. The results themselves should not be the only reason for any therapeutic consequences. They have to be correlated to other clinical observations and diagnostic tests.
Page 9 / 14 15. EXPECTED VALUES Expected values are set in the Zivak NeoZin Data Evaluation Software. It is recommended that each laboratory establishes its own range of normal values. 16. LC-MS/MS PARAMETERS Device Column Injection Volume 20 µl Pump Program Flow LC-MS/MS Analysis System Zivak Carnitine / Acylcarnitines Screening Dried Blood Spots LC-MS/MS Trap Column Housing - Cartridge 00:00 min 100% B 01:30 min 100% B 0.30 ml/min Ionization Mode: CID Gas API Nebulizing Gas Scan Time SIM Width Drying Gas ESI positive 2.0 mtorr 55 psi 1.519 sec 1.5 amu 30 psi Drying Gas Temp. 350 C Needle Shield Capillary Detector 5000V 600V 30V 1500 V
Page 10 / 14 17. MS SCAN PARAMETERS N o Analyte MH+ (m/z) MS/MS Capillary (ev) CE (ev) 1 C0 Carnitine 218.30 85.00 30 20 2 C0 Carnitine-D9 227.30 85.00 30 20 3 C2 Carnitine 260.30 85.00 30 20 4 C2 Carnitine-D3 263.30 85.00 30 20 5 C3 Carnitine 274.30 85.00 30 20 6 C3DC Carnitine 360.30 85.00 30 20 7 C3 Carnitine-D3 277.30 85.00 30 20 8 C4 Carnitine 288.30 85.00 30 20 9 C4OH Carnitine 304.30 85.00 30 20 10 C4 Carnitine-D3 291.30 85.00 30 20 11 C5 Carnitine 302.30 85.00 30 20 12 C5DC Carnitine 388.30 85.00 30 20 13 C5OH Carnitine 318.30 85.00 30 20 14 C5 Carnitine-D9 311.30 85.00 30 20 15 C6 Carnitine 316.50 85.00 30 20 16 C8 Carnitine 344.30 85.00 30 20 17 C8 Carnitine-D3 347.30 85.00 30 20 18 C10 Carnitine 372.30 85.00 30 20 19 C12 Carnitine 400.30 85.00 30 20 20 C14 Carnitine 428.30 85.00 30 20 21 C14 Carnitine-D9 437.50 85.00 30 20 22 C16 Carnitine 456.40 85.00 30 20 23 C16OH Carnitine 472.40 85.00 30 20 24 C16 Carnitine-D3 459.50 85.00 30 20 25 C18 Carnitine 484.50 85.00 30 20 26 C18OH Carnitine 500.50 85.00 30 20 Zivak Carnitine / Acylcarnitines Screening Dried Blood LC-MS/MS Analysis Kit contains above analytes in controls. INTERNAL STANDARD CONCENTRATIONS Analyte Final Concentration (µmol/l) C0 Carnitine-D9 1.52 C2 Carnitine-D3 0.38 C3 Carnitine-D3 0.076 C4 Carnitine-D3 0.076 C5 Carnitine-D9 0.076 C8 Carnitine-D3 0.076 C14 Carnitine-D9 0.076 C16 Carnitine-D3 0.152
Page 11 / 14 18. ANALYTICAL PERFORMANCE No Analyte LOD (µmol/l) LOQ (µmol/l) Accuracy (%) Intra-Assay Precision (%CV) Inter-Assay Precision (%CV) Linearity (R 2 ) 1 C0 Carnitine 0,023 0,070 98,7 4,02 0,14 0,9983 2 C2 Carnitine 0,042 0,126 99,7 3,21 0,04 0,9984 3 C3 Carnitine 0,024 0,073 99,7 2,30 0,01 0,9994 4 C4 Carnitine 0,054 0,163 98,8 4,44 0,12 0,9993 5 C5 Carnitine 0,023 0,070 99,0 3,44 0,00 0,9937 6 C4OH Carnitine 0,047 0,142 95,0 3,12 0,08 0,9997 7 C6 Carnitine 0,041 0,122 100,6 2,50 0,14 0,9978 8 C5OH Carnitine 0,022 0,066 102,4 3,40 0,15 0,9957 9 C8 Carnitine 0,088 0,263 99,7 3,41 0,06 0,9943 10 C3DC Carnitine 0,068 0,205 104,6 3,66 0,23 0,9989 11 C10 Carnitine 0,088 0,265 105,3 4,95 0,21 0,9962 12 C5DC Carnitine 0,076 0,227 101,7 2,87 0,15 0,9969 13 C12 Carnitine 0,068 0,205 104,7 4,08 0,52 0,9984 14 C16OH Carnitine 0,090 0,269 96,7 4,45 0,14 0,9967 15 C14 Carnitine 0,067 0,200 95,3 3,78 0,08 0,9945 16 C16 Carnitine 0,077 0,232 100,2 1,39 0,02 0,9943 17 C18OH Carnitine 0,091 0,273 95,0 3,84 0,19 0,9936 18 C18 Carnitine 0,042 0,127 100,4 3,67 0,37 0,9948 Analytical Specificity (Cross Reactivity): No cross-reactivity was found with the typical substances tested.
Page 12 / 14 19. SAMPLE CHROMATOGRAM for Carnitine / Acylcarnitines
Page 13 / 14 Sample chromatograms are taken from Carnitine / Acylcarnitines Screening Neozin Data Evaluation Software.
Page 14 / 14 ACYL CARNITINES: C0-Carnitine: