III. Dried Blood Spots in Practice
Monitoring of creatinine and immunosuppressive drug concentrations is important in the follow-up of kidney transplant recipients. Dried Blood Spots (DBS) provide patients the opportunity to sample a drop of blood from a fingerprick at home, which can be send to the laboratory by mail.
- Please read this poster and give us a summary.
- What is the applicability of this new approach in your home country?
dried blood spots sampling can replace creatinine and tacrolimus ,CSA level in blood samples which is more easy and convenient for patients and health care facilities.
It is not available in my country currently
-This is study compared venous whole blood and dried blood spots ( DBS) finger prick samples for analyzing creatinine, tacrolimus, and cyclosporine A in transplanted recipients.
-Comparison was done using Passing & Bablok, bias was measured using Bland-Altman.
-Results showed cyclosporin A, tacrolimus, and creatinin, DBS analytical results are interchangeable with venous whole blood analytical results.
– Conclusion: Immunosuppressants and creatinine analysis can be done by DBS.
-It is not available in my country, but it is a good method for follow–up of transplant recipients.
Monitoring of Cr, tacrolimus and cyclosporine after transplantation is an essential practice for follow up of kidney transplant recipients. Using the dried blood spot (DBS) method with only one blood drop from a finger prick at home and e-mailing to the laboratory gives the patients an opportunity for more convenient follow up.
This study has been designed to evaluate the correlation between measures of the DBS method and venous whole blood. This study demonstrated that a) for Cr there was a significant bias of -2.1, and therefore, the creatinine conversion formula was calculated: Cr plasma concentration in µmol/L = Cr concentration in DBS in µmol/L/0.73 b) for tacrolimus the bias was 0.28 µg/L and for cyclosporin A there was no significant bias.
This study has concluded that for Cr, tacrolimus and cyclosporine A, results of DBS are interchangeable with venous whole blood results, and thus, DBS sampling can substitute venous sampling in daily routine follow up of Cr and these immunosuppression drugs in transplantation.
This method is not available in my country.
This poster summarise the trial of using sample of blood from fingerbrick to test serum creatinine , and immunosuppression drug level (tacrolimus and cyclosprine level), sending it by mail to the laboratory as an easy method for follow-up up of patients .
Comparison of test results with laboratory results of venous blood samples showed no difference.
In my country , it is not present but if it becomes available it would help patient for close daily monitor and help to adjust immunosuppression therapy
This poster summarize the study from single university centre to assess the clinical validity of the blood tests by using the dired spot sample and evaluated and asess the clinical validity of those tests with the regular routine blood sampling for serum creatinine , serum tacrolimus and cyclosprine level, they found no difference between two methods with insigifican bias for drug level monitoring ,such method will be good approach to fascilate the follow up for those living far-away from the ttansplant centre with less cost and need proper coordination and comminucation between the patients and the laberotries in ordere not to miss he samples or delay their testing prior to thier next visit to their physician , also need good education to the patinet with good social support as in elderly or childern will be an obsticales.
As the transplant recipients need frequent monitoring for immunosuppressant agents level as well as other parameters like creatinine, this study try to validate a new method of sampling of patients by using DBS by fingerbreck for monitoring of IS levels and creatinine level and take good photos for it and send by mail to the laboratories.the goal is to decrease the burden upon the patients from frequent hospital visiting and decrease the cost of investigation. They compare both DBS and whole blood sample for monitoring of creatinine, cyclosporine A and tacrolimus and found equal results.
If DBS was present in our country it will improve the monitoring strategy of renal transplant recipients as well as save money lost in traveling.
Patients with kidney transplant needs regular follow up with monitoring of their graft function including creatinine level, and immunosuppressant drugs blood level (atrocious, Cyclosporne A ..) these investigations needs blood samples. Blood sample collected by nurse or technician or doctor and needs technical issues, and regular clinic visits
Groningen University, raise and study a hypothesis of using dried blood spot in monitoring cr and IS drug level. And comparing this dried blood spot results with conventional blood sample results.
They conclude that,
DBS can replace conventional blood sample in transplant patients
In my country, It is practical approach as this method can help out the big cities patients
But, at time being, Its impossible due to our circumstances of shortages in internat and lack of education ..etc
In this study they emphasised on the importance of immunosuppressive drug monitoring for transplant patient .
They studied the possibility of obtaining dry blood sample DBS ,sending it by mail to the laboratories in order to obtain easy methods for following up patients .
They compared results obtained from whole venous blood samples and dry blood samples and found comparable results .
In our country , if it is applicable it would help patient living far away from Cairo, to follow up regularly easily and without consuming much time and money in travelling
1- Please read this poster and give us a summary.
2- What is the applicability of this new approach in your home country?
this new approach can be tried in my country as there are available satisfactory facilites for some training for proper finger-pricking, mail services, labortaory services and also financial support services.
Summary of the post:
The post represented a study in the University of Groningen validating clinically simultaneous analysis of CsA, TAC and Serum Creatinine in a
Dried blood sample(DBS). Paired whole venous blood sample and DBS were compared for measurement of SCr,CsA and TAC. Statistical analysis was used to validate results of the study and to assess bias and found interchangeable results with nonclinically relevant bias.
The post concluded that DBS is significantly useful in monitoring the SCr as well as the level of Immunosuppression drugs.
What is the applicability of this new approach in your home country?
Monitoring of serum creatinine and immunosuppressive drug level is very crucial for following up renal transplant patients and observing the post Transplant period. Many obstacles regarding laboratory work-up are facing KTRs in the post-transplant period such as transportation for testing which may not be available in time in centers where facilities are limited. The technique of DBS will help KTRs in my country to have feasible,accessible and significantly useful testing.
This poster explain the benefit of dried blood spot DBS in monitoring kidney transplant patient.
Every patient with kidney transplant needs close and regular monitoring of his renal parameters especially creatinine level and trough level of the medications especially tacrolimus and cyclosporin.
The poster compare between DBS and venous whole blood results for both creatinine and trough level of 210 samples which shows no difference in these results so DBS can be used for monitoring of our patients ,but till now this method is not widely used even in my country.
Please read this poster and give us a summary.
Kidney transplant patients require regular monitoring of serum creatinine and trough levels of immunosuppressive drugs which associated with the risk of rejection and toxicity. The authors compared the results of Dried Blood Spot sampling with the conventional venous sampling for the testing ciclosporin A, tacrolimus and creatinine . They found no significant difference in the method used to measure serum creatinine or CNI level .
What is the applicability of this new approach in your home country?
My country is very big .Many patient lived in rural area away from transplant center this will provide good chance for them to do regular follow up .
Please read this poster and give us a summary.
The authors compared the results of Dried Blood Spot sampling with the conventional venous sampling for the testing ciclosporin A, tacrolimus and creatinin in Netherlands. They found comparable results of both samples (Dried Blood Spot and the conventional venous).
The importance of this is it provide a chance for patients to send their samples ( a drop from a finger prick )by mail .
What is the applicability of this new approach in your home country?
For now it is difficult. But in the future it will help our patients living in far a way areas to do their tests easily.
THANK YOU All FOR YOUR CONTRIBUTIONS
1-Using dry blood spot in monitoring s creatinine ,and immunosuppressive drug levels was compared to conventional methods .No statistical significant difference was found in CNI levels but creatinine required a correction factor.
2-This method could add to facilitation of medical care in situation like geographical difficulties, need to minimizing contact in infection control for immuno-compromised patients and saving money and effort -specially in need for frequent monitoring.
Monitoring of creatinine and immunosuppressive drug concentrations is important in the follow-up of kidney transplant recipients. Dried Blood Spots (DBS) provide patients the opportunity to sample a drop of blood from a fingerprick at home, which can be send to the laboratory by mail.
1. Please read this poster and give us a summary.
Kidney transplant patients require regular monitoring of serum creatinine and trough levels of immunosuppressive drugs. Dried blood spots (DBS) can be utilized for these measurements. 210 paired samples (venous blood samples and DBS) were taken from 181 patients out of which 12 DBS samples were excluded. The analysis of DBS levels and blood levels of creatinine, tacrolimus and cyclosporine among the study group revealed comparable results. So the results were interchangeable and hence it was concluded that DBS can replace the standard protocol of using venous sample for OPD management of transplant patients on a routine basis.
2. What is the applicability of this new approach in your home country?
This is a potentially game-changing approach, helping patients especially for patients staying in remote areas more so in the current COVID-19 pandemic era. Although it involves training the patients to take samples on their own, it is not a big hurdle as most of the patients are diabetics and check their blood glucose levels themselves frequently at home.
The flipside is that there are many laboratories available even in remote areas which collect the samples even from home and in that scenario DBS is not of much use. In addition, patients are required to be tested for other parameters like complete blood count which will not be evaluated by DBS alone.
Please read this poster and give us a summary.
Achieving therapeutic levels of immunosuppressive therapies is crucial as low levels are associated with risk of rejection and high levels are associated with toxicity.
In real life, allograft recipients are followed up with GFR based on creatinine result and trough levels of CNI, which are usually done in laboratories. However, Dried Blood Spots as demonstrated in the given poster could be alternative method.
In order to compare accuracy of DBS, comparison between plasma creatinine levels and Dried Blood Spot creatinine levels was performed.
Comparison between venous whole blood tacrolimus/cyclosporine levels and Dried Blood Spot levels was performed.
Summary: No significant difference in the method used to measure serum creatinine or CNI level.
Conclusion: Dried Blood Spot sampling can replace conventional venous sampling in daily routine for the simultaneous analysis of immunosuppressants and creatinine.
What is the applicability of this new approach in your home country?
This approach could be of great impact in recipient living in remote areas. It is also helpful in busy patients. In the era of COVID19 pandemic and lock down, DBS could be a reliable alternative method measurement of Cr and CNI levels.
Dried Blood Spots in Practice
Please read this poster and give us a summary.
Monitoring of creatinine and immunosuppressive drug concentrations is important in the follow-up of kidney transplant recipients. Dried Blood Spots provide patients the opportunity to sample a drop of blood from a fingerpick at home, which can be send to the laboratory by mail. In the evaluation of creatinine, there is a statistically significant discrepancy between the two methods. There is no statistically significant difference between the two methods in terms of drug level
What is the applicability of this new approach in your home country?
It can be applied ,as it is costly effective . It can help in monitoring transplant patient in remote area (in my country a lot of patient are from rural area and have difficulties in reaching their transplant centre regularly ).It may help in monitoring transplant patient during pandemic (covid 19 ).
In this study, the main aim was to make it easy for patients to keep themselves followed up easily. for this purpose meanwhile fingertip blood spots were evaluated along with classic blood samples. The study concluded that fingertip samples have similar results and may replace classic blood sampling results.
Although this paper belongs to 2017, still are some practical considerations needed to widen its use. In Turkey according to my knowledge, there is no laboratory using this method for the aim of neither drug level nor creatinine measurement.
The poster is about the use of dried blood sample for measurement of serum creatinine and cyclosporine level and tacrolimus level .
The DBS measured creatinine was less than the measured serum creatinine and conversion formula is needed to get the serum creatinine from DBS.
The cyclosporine and TAC levels was correlating well with serum creatinine.
The use of DBS to measure serum creatinine and drug levels will ease the monitoring of post transplantation patients especially in the era of COVID19 outbreak , since the patient will send the samples by mail and avoid the contact with other people.
Monitoring of creatinine and immunosuppressive drug concentrations is important in the
follow-up of kidney transplant recipients.
Dried Blood Spots provide patients the opportunity to sample a drop of blood from a
fingerpick at home, which can be send to the laboratory by mail.
Comparison method was done using Passing & Bablok, bias was measured using Bland-
Altman.
The study reach a conclusion Dried Blood Spot sampling can replace conventional
venous sampling in daily routine for the simultaneous analysis of immunosuppressants
and creatinine.
1. What is the applicability of this new approach in your home country?
It good practice to be applied, especially for patient in remote areas.
summary:
Patients undergoing renal transplantation need constant monitoring of their serum creatinine and medication levels (cyclosporine and tacrolimus)
There are two approaches that may be utilized to gather samples for these two investigations:
It is necessary to get a whole blood sample, and help is required.
Patient-supplied dried blood sample (DBS) that may be obtained through a fingerprick and submitted to the laboratory by mail.
The difference between the two approaches is as follows:
In the evaluation of creatinine, there is a statistically significant discrepancy between the two methods. There is no statistically significant difference between the two methods in terms of drug level.
need educated patients, who can take the sample by themselves, and upload the sample on the email.
This poster compared between the dried blood spot DBS sampling and the venous sampling regarding Tac . , cyclosporine and creatinine levels using198 paired samples of dried blood and whole blood .
They concluded that DBS can replace the usual venous sampling method for the routine analysis of immunosuppressants and creatinine .
Regarding it’s applicability in my country , the patients need to be trained who to use it on their own and to be sent to the lab as DBS can save time and effort and is as accurate as venous sampling.
Monitoring of IS level is important because high concentrate can cause drug toxicity & low drug level can cause acute rejection (inadequate immunosuppression).
The study aim is to assess the validity of dries blood spot in monitoring of drug level & creatinine when compared to venous whole blood sample to reduce the hospital attendance frequency & the social cost.
Venous whole blood & DBS were tested for Tac, Cyc A & creatinine during follow-up visit.
It was shown that the level of IS were comparable in both DBS & venous whole blood( no significant difference), but there were significant difference in creatinine level.
In conclusion DBS can be used instead of venous whole blood in monitoring of IS drug level.
This technique need patients training to get good photo that send by e-mail, so it may be applicable for some ( not all) recipients in my country.
Please read this poster and give us a summary.
Renal transplant patients are in need of continuous monitoring of serum creatinine and drug level (cyclosporine and tacrolimus)
2 ways can be used to obtain samples for these 2 investigations :
Difference between both ways :
What is the applicability of this new approach in your home country?
the study showed comparison between venous sampling and dried blood sample from fingerprick of the patient to serum creatinine and levels of immunosuppression drugs, and suggested to do it by dried blood spot which will replace venous sampling
applicability in my home country : it is not applicable nowadays but if becomes available , will be good service to the patient and physician fasten the decision and dosing of immunosuppression.
Please read this poster and give us a summary.
This study was done to evaluate the use of a drop of blood to measure serum creatinine and CNI level through dried blood spot method.
The study compare the result obtained from dried spot method to that obtained from venous blood sample, So paired venous blood sample and dried blood spot finger prick sample were obtained during the regular patient visit to measure serum creatinine level and CNI level( tacrolimus or cyclosporine),
210 paired samples were collected from 118 patients
10 dried blood spots were excluded due to poor quality
2 samples were excluded due to other causes
After comparison, the study found that the results obtained from dried blood spots were identical to that from venous blood, so that dried blood spots can replace the conventional venous sampling for simultaneous analysis of IS level and creatinine.
What is the applicability of this new approach in your home country?
it is more comfortable to the patient, provide high quality blood samples with easier shipping ,and it facilitates remote testing, but it requires simple training of the patient. Not sure if it is applicable.
Please read this poster and give us a summary.
Methods
Paired venous whole blood and DBS finger prick samples were obtained during regular visit of patients to the hospital. 210 paired samples were collected from 118 patients.
Method comparison was done using Passing & Bablok, bias was measured using Bland-Altman.
Conclusion
Dried Blood Spot sampling can replace conventional venous sampling in daily routine for the simultaneous analysis of immunosuppressants and creatinine .
What is the applicability of this new approach in your home country?
If cost is same as for CNI level in a venous sample can be useful when only levels need to be checked.
If concomitant other blood test needs to be done a single prick venous sample in vacutainer can be sent via courier by hospital which don’t have in house set up to check CNI levels.