PubMed · 7370548
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R J Ratcliffe, P L Willan. 1980-02-16. Intermittent venous sampling during exercise.. https://doi.org/10.1136/bmj.280.6212.483-b
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We report a new method for the diagnosis of homocystinuria and other hypermethioninemias from dried blood spots on newborn screening cards, based on isotope-dilution tandem mass spectrometry. The mean concentration of methionine in 909 unaffected newborns was 19 micromol/L (CV 44%). The variability of results was reduced when the concentration of methionine was expressed relative to that of another amino acid in the same specimen. The mean ratio of methionine to leucine plus isoleucine for these same newborn blood spots was 0.16 (CV 25%). In newborn samples from a collection categorized by a Guthrie bacterial inhibition assay as true positive, unaffected, or falsely positive for hypermethioninemias, the ratio of methionine to leucine for each true-positive specimen was at least 2.5 times greater than for respective age-matched unaffected blood specimens. The ratio for falsely positive samples did not differ from that for unaffected blood samples. We predict that the ratio of methionine to leucine plus isoleucine determined by tandem mass spectrometry will successfully detect hypermethioninemias with very low rates for false positives and false negatives.
In response to the pressures of cost reduction, we established and evaluated a carefully integrated program to deliver clinical laboratory services more promptly and efficiently to the intensive care units (ICUs). The new protocol reduced the steps and turnaround time from ordering tests by physicians to reporting results by as much as 80% on all ICUs, permitting significant reductions in personnel (exceeding $400,000 per year). For the surgical ICU there were also fewer blood collections (mean preprotocol: 7.0 per patient per 24 h; mean last 12 months: 6.0; P= 0.002). The volume of blood collected fell from 8.1 to 3.5 mL per collection, primarily following an emphasis on small containers. Consequently, the amount of blood taken from each surgical ICU patient decreased from 56 to 21 mL per 24 h (P <0.001).
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