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Published on: July 9, 2014
Evaluation of an abbreviated protocol for cytomegalovirus pp65 antigenemia testing
P Rocco LaSala1, Joe Yarsa, Dûng V Nguyen
1Section of Clinical Microbiology, Department of Laboratory Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
Abstract:
The cytomegalovirus antigenemia assay remains a useful tool for monitoring reactivation among transplant recipients. In this study, we compared protocols using direct lysis of small-volume, whole blood (WB) samples vs peripheral blood leukocyte (PBL)-enriched fractions. Of 363 evaluable samples, 51 (14.0%) were positive by one or both methods. Sensitivity, specificity, and negative and positive predictive values were similar (76%, 99%, 96%, and 95% vs 71%, 100%, 96%, and 100% for the WB and PBL methods, respectively). Stratification of qualitative results by WBC count revealed comparable detection rates by each method, although the total number of positive results from leukopenic samples was significantly lower than from nonleukopenic samples (P= .04). Correlation between quantitative results was high, yet the degree of clinical agreement was suboptimal. We conclude that the small-volume, WB lysis method yields results statistically comparable to that of a PBL fractionation method but with fewer technical steps and less complexity.
Insights
The whole blood (WB) lysis method for cytomegalovirus (CMV) antigenemia assay is comparable to peripheral blood leukocyte (PBL) methods. This simpler WB lysis approach offers similar diagnostic accuracy for monitoring CMV reactivation in transplant patients.
Area of Science:
- Virology
- Immunology
- Transplant Medicine
Background:
- Cytomegalovirus (CMV) antigenemia assays are crucial for monitoring reactivation in transplant recipients.
- Current protocols often involve peripheral blood leukocyte (PBL) enrichment, which can be complex and time-consuming.
Purpose of the Study:
- To compare the diagnostic performance of a direct lysis of small-volume whole blood (WB) method versus a PBL-enriched fraction method for CMV antigenemia detection.
- To evaluate the clinical utility and technical feasibility of the WB lysis method.
Main Methods:
- A comparative study involving 363 transplant recipients' samples.
- Analysis of CMV antigenemia using both direct WB lysis and PBL-enriched fraction protocols.
- Assessment of sensitivity, specificity, predictive values, and correlation of quantitative results.
Main Results:
- Fifty-one samples (14.0%) tested positive by at least one method.
- Both methods demonstrated similar diagnostic accuracy, with sensitivity, specificity, and predictive values being comparable.
- Quantitative results showed high correlation, but clinical agreement was suboptimal.
- Detection rates were similar across different white blood cell (WBC) counts, though fewer positive results were observed in leukopenic samples.
Conclusions:
- The small-volume WB lysis method provides statistically comparable results to the PBL fractionation method for CMV antigenemia monitoring.
- The WB lysis method is less complex and involves fewer technical steps, making it a potentially more efficient alternative.
- Despite high correlation, clinical agreement requires further investigation for optimal patient management.
