04366522001V10

Ferritin
Ferritin

REF 03737551 190 100 tests Application of a voltage to the electrode then induces chemiluminescent
emission which is measured by a photomultiplier.
• Indicates analyzers on which the kit can be used
• Results are determined via a calibration curve which is
MODULAR instrument-specifically generated by 2-point calibration and a
Elecsys 2010 cobas e 411 cobas e 601 master curve provided via the reagent barcode.
ANALYTICS E170
a) Tris(2,2’-bipyridyl)ruthenium(II)-complex (Ru(bpy)2+
3 )
• • • • Reagents - working solutions
M Streptavidin-coated microparticles (transparent cap), 1 bottle, 6.5 mL:
English Streptavidin-coated microparticles 0.72 mg/mL; preservative.
Intended use R1 Anti-Ferritin-Ab~biotin (gray cap), 1 bottle, 10 mL:
Immunoassay for the in vitro quantitative determination of ferritin Biotinylated monoclonal anti-ferritin antibody (mouse) 3.0 mg/L;
in human serum and plasma. phosphate buffer 100 mmol/L, pH 7.2; preservative.
The electrochemiluminescence immunoassay “ECLIA” is intended for R2 3 (black cap), 1 bottle, 10 mL:
Anti-ferritin-Ab~Ru(bpy)2+
use on Elecsys and cobas e immunoassay analyzers. Monoclonal anti-ferritin antibody (mouse) labeled with ruthenium
complex 6.0 mg/L; phosphate buffer 100 mmol/L, pH 7.2; preservative.
Summary
Ferritin is a macromolecule with a molecular weight of at least 440 kD Precautions and warnings
(depending on the iron content) and consists of a protein shell (apoferritin) For in vitro diagnostic use.
of 24 subunits and an iron core containing an average of approx. Exercise the normal precautions required for handling all laboratory reagents.
2500 Fe3+ ions (in liver and spleen ferritin).1 Disposal of all waste material should be in accordance with local guidelines.
Ferritin tends to form oligomers, and when it is present in excess in Safety data sheet available for professional user on request.
the cells of the storage organs there is a tendency for condensation to Avoid the formation of foam with all reagents and sample types
semicrystalline hemosiderin to occur in the lysosomes. (specimens, calibrators, and controls).
At least 20 isoferritins can be distinguished with the aid of isoelectric Reagent handling
focusing.2 This microheterogeneity is due to differences in the contents The reagents in the kit have been assembled into a ready-for-use
of the acidic H and weakly basic L subunits. The basic isoferritins unit that cannot be separated.
are responsible for the long-term iron storage function, and are found All information required for correct operation is read in via the
mainly in the liver, spleen, and bone marrow.1,3 respective reagent barcodes.
Acidic isoferritins are found mainly in the myocardium, placenta, and
tumor tissue. They have a lower iron content and presumably function as Storage and stability
intermediaries for the transfer of iron in various syntheses.4,5,6 Store at 2-8 °C.
The determination of ferritin is a suitable method for ascertaining the Store the Elecsys Ferritin reagent kit upright in order to ensure complete
iron metabolism situation. Determination of ferritin at the beginning availability of the microparticles during automatic mixing prior to use.
of therapy provides a representative measure of the body’s iron Stability:
reserves. A storage deficiency in the reticulo-endothelial system unopened at 2-8 °C up to the stated expiration date
(RES) can be detected at a very early stage.7
after opening at 2-8 °C 12 weeks
Clinically, a threshold value of 20 µg/L (ng/mL) has proved useful in
the detection of prelatent iron deficiency. This value provides a reliable on the analyzers 6 weeks
indication of exhaustion of the iron reserves that can be mobilized for Specimen collection and preparation
hemoglobin synthesis. Latent iron deficiency is defined as a fall below the Only the specimens listed below were tested and found acceptable.
12 µg/L (ng/mL) ferritin threshold. These two values necessitate no further Serum collected using standard sampling tubes.
laboratory elucidation, even when the blood picture is still morphologically Li-, Na-heparin, K3-EDTA, and sodium citrate plasma.
normal. If the depressed ferritin level is accompanied by hypochromic, When sodium citrate is used, the results must be corrected by + 10 %.
microcytal anemia, then manifest iron deficiency is present.1 Criterion: Recovery within 90-110 % of serum value or slope 0.9-1.1 + intercept
When the ferritin level is elevated and the possibility of a distribution disorder within < ± 2 x analytical sensitivity (LDL) + coefficient of correlation > 0.95.
can be ruled out, this is a manifestation of iron overloading in the body. Stable for 7 days at 2-8 °C, 12 months at -20 °C.8
400 µg/L (ng/mL) ferritin is used as the threshold value. Elevated ferritin The sample types listed were tested with a selection of sample collection tubes
values are also encountered with the following tumors: acute leukemia, that were commercially available at the time of testing, i.e. not all available
Hodgkin’s disease and carcinoma of the lung, colon, liver and prostate. The tubes of all manufacturers were tested. Sample collection systems from
determination of ferritin has proved to be of value in liver metastasis. Studies various manufacturers may contain differing materials which could affect
indicate that 76 % of all patients with liver metastasis have ferritin values above the test results in some cases. When processing samples in primary tubes
400 µg/L (ng/mL). Reasons for the elevated values could be cell necrosis, (sample collection systems), follow the instructions of the tube manufacturer.
blocked erythropoiesis or increased synthesis in tumor tissue. Centrifuge samples containing precipitates before performing the
Two monoclonal mouse antibodies - M-4.184 and M-3.170 - are used assay. Do not use heat-inactivated samples. Do not use samples
to form the sandwich complex in the assay. and controls stabilized with azide.
Test principle Ensure the patients’ samples, calibrators, and controls are at ambient
Sandwich principle. Total duration of assay: 18 minutes. temperature (20-25 °C) before measurement.
• 1st incubation: 10 µL of sample, a biotinylated monoclonal ferritin-specific Because of possible evaporation effects, samples, calibrators, and controls
antibody, and a monoclonal ferritin-specific antibody labeled with a on the analyzers should be measured within 2 hours.
ruthenium complexa form a sandwich complex. Materials provided
• 2nd incubation: After addition of streptavidin-coated microparticles, See “Reagents - working solutions” section for reagents.
the complex becomes bound to the solid phase via interaction
of biotin and streptavidin. Materials required (but not provided)
• The reaction mixture is aspirated into the measuring cell where the • REF 03737586190, Ferritin CalSet, 4 x 1 mL
microparticles are magnetically captured onto the surface of the • REF 04415299190, PreciControl Anemia, for 2 x 2 mL each
electrode. Unbound substances are then removed with ProCell. of PreciControl Anemia 1, 2 and 3 or

2010-05, V 10 English 1/3 Elecsys and cobas e analyzers

Ferritin
Ferritin
REF 11776452122, PreciControl Tumor Marker, for 2 x 3 mL each Quality control
of PreciControl Tumor Marker 1 and 2 For quality control, use Elecsys PreciControl Anemia 1, 2 and 3 or
• REF 04415299160, PreciControl Anemia, for 2 x 2 mL each of Elecsys PreciControl Tumor Marker 1 and 2.
PreciControl Anemia 1, 2 and 3 (for USA) or Other suitable control material can be used in addition.
REF 11776452160, PreciControl Tumor Marker, for 2 x 3 mL each Controls for the various concentration ranges should be run as single
of PreciControl Tumor Marker 1 and 2 (for USA) determinations at least once every 24 hours when the test is in use, once
• REF 11732277122, Diluent Universal, 2 x 16 mL sample diluent or per reagent kit, and after every calibration. The control intervals and
REF 03183971122, Diluent Universal, 2 x 36 mL sample diluent limits should be adapted to each laboratory’s individual requirements.
Values obtained should fall within the defined limits.
• General laboratory equipment
Each laboratory should establish corrective measures to be taken
• Elecsys 2010, MODULAR ANALYTICS E170 or cobas e analyzer
if values fall outside the limits.
Accessories for Elecsys 2010 and cobas e 411 analyzers: Follow the applicable government regulations and local guidelines
• REF 11662988122, ProCell, 6 x 380 mL system buffer for quality control.
• REF 11662970122, CleanCell, 6 x 380 mL measuring cell cleaning solution Calculation
• REF 11930346122, Elecsys SysWash, 1 x 500 mL washwater additive The analyzer automatically calculates the analyte concentration of
• REF 11933159001, Adapter for SysClean each sample (either in µg/L or ng/mL).
• REF 11706802001, Elecsys 2010 AssayCup, 60 x 60 reaction vessels
Limitations - interference
• REF 11706799001, Elecsys 2010 AssayTip, 30 x 120 pipette tips The assay is unaffected by icterus (bilirubin < 1112 µmol/L or < 65 mg/dL),
Accessories for MODULAR ANALYTICS E170 and cobas e 601 analyzers: hemolysis (Hb < 0.31 mmol/L or < 0.5 g/dL), lipemia (Intralipid
• REF 04880340190, ProCell M, 2 x 2 L system buffer < 3300 mg/dL), and biotin < 205 nmol/L or < 50 ng/mL.
• REF 04880293190, CleanCell M, 2 x 2 L measuring cell cleaning solution Criterion: Recovery within ± 10 % of initial value.
In patients receiving therapy with high biotin doses (i.e. > 5 mg/day), no sample
• REF 03023141001, PC/CC-Cups, 12 cups to prewarm ProCell M
should be taken until at least 8 hours after the last biotin administration.
and CleanCell M before use
No interference was observed from rheumatoid factors up to
• REF 03005712190, ProbeWash M, 12 x 70 mL cleaning solution for
a concentration of 2500 IU/mL.
run finalization and rinsing during reagent change
There is no high-dose hook effect at ferritin concentrations of
• REF 12102137001, AssayTip/AssayCup Combimagazine M, 48 magazines up to 100000 µg/L (ng/mL).
x 84 reaction vessels or pipette tips, waste bags In vitro tests were performed on 19 commonly used pharmaceuticals.
• REF 03023150001, WasteLiner, waste bags No interference with the assay was found.
• REF 03027651001, SysClean Adapter M Iron2+- and iron3+-ions at therapeutic concentrations do not interfere
Accessories for all analyzers: with the Elecsys Ferritin assay.
In rare cases, interference due to extremely high titers of antibodies to
• REF 11298500316, Elecsys SysClean, 5 x 100 mL system cleaning solution
analyte-specific antibodies, streptavidin or ruthenium can occur. These
• REF 11298500160, Elecsys SysClean, 5 x 100 mL system effects are minimized by suitable test design.
cleaning solution (for USA) For diagnostic purposes, the results should always be assessed in conjunction
Assay with the patient’s medical history, clinical examination and other findings.
For optimum performance of the assay follow the directions given in Limits and ranges
this document for the analyzer concerned. Refer to the appropriate Measuring range
operator’s manual for analyzer-specific assay instructions. 0.500-2000 µg/L (ng/mL) (defined by the lower detection limit and the
Resuspension of the microparticles takes place automatically before use. maximum of the master curve). Values below the detection limit are reported
Read in the test-specific parameters via the reagent barcode. If in exceptional as < 0.500 µg/L (ng/mL). Values above the measuring range are reported as
cases the barcode cannot be read, enter the 15-digit sequence of numbers. > 2000 µg/L (ng/mL) (or up to 100000 µg/L (ng/mL) for 50-fold diluted samples).
Bring the cooled reagents to approx. 20 °C and place on the reagent disk Lower limits of measurement
(20 °C) of the analyzer. Avoid the formation of foam. The system automatically Lower detection limit
regulates the temperature of the reagents and the opening/closing of the bottles. Lower detection limit: 0.50 µg/L (ng/mL)
The detection limit represents the lowest measurable analyte level that
Calibration can be distinguished from zero. It is calculated as the value lying two
Traceability: The Elecsys Ferritin assay ( REF 03737551) has been standard deviations above that of the lowest standard (master calibrator,
standardized against the Elecsys Ferritin assay ( REF 11820982). The standard 1 + 2 SD, repeatability study, n = 21).
Elecsys Ferritin assay ( REF 11820982) has been standardized against the
Enzymun-Test Ferritin method. This in turn has been standardized against Dilution
the 1st International Standard (IS) NIBSC (National Institute for Biological Samples with ferritin concentrations above the measuring range can be
Standards and Control) “Reagent for Ferritin (human liver)” 80/602. diluted with Elecsys Diluent Universal. The recommended dilution is 1:50
Recovery studies, including a published study9, to assess traceability (either automatically by the MODULAR ANALYTICS E170, Elecsys 2010 or
of the Elecsys Ferritin assay to more recent international standards cobas e analyzers or manually). The concentration of the diluted sample
(2nd IS 80/578 and 3rd IS 94/572) have been conducted, with must be > 40 µg/L (ng/mL). After manual dilution, multiply the result by the
results showing very good agreement. dilution factor. After dilution by the analyzers, the MODULAR ANALYTICS
Every Elecsys Ferritin reagent set has a barcoded label containing the specific E170, Elecsys 2010 and cobas e software automatically takes the dilution
information for calibration of the particular reagent lot. The predefined master into account when calculating the sample concentration.
curve is adapted to the analyzer by the use of Elecsys Ferritin CalSet. Expected values10
Calibration frequency: Calibration must be performed once per Results of a study with the Enzymun-Test Ferritin method on samples from 224
reagent lot using fresh reagent (i.e. not more than 24 hours since the healthy test subjects (104 women - mainly premenopausal - and 120 men) are
reagent kit was registered on the analyzer). given below. The values correspond to the 5th and 95th percentiles.
Renewed calibration is recommended as follows: Men, 20-60 years: 30-400 µg/L (ng/mL)
• after 1 month (28 days) when using the same reagent lot Women, 17-60 years: 13-150 µg/L (ng/mL)
• after 7 days (when using the same reagent kit on the analyzer) Each laboratory should investigate the transferability of the expected values to
• as required: e.g. quality control findings outside the specified limits its own patient population and if necessary determine its own reference ranges.

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Ferritin
Ferritin
Specific performance data References
Representative performance data on the analyzers are given below. 1. Wick M, Pinggera W, Lehmann P. Ferritin in Iron Metabolism -
Results obtained in individual laboratories may differ. Diagnosis of Anemieas (second edition). Springer-Verlag 1995;ISBN
3-211-82525-8 and ISBN 0-387-82525-8.
Precision 2. Arosio P, Levi S, Gabri E, et al. Heterogeneity of ferritin II: Immunological
Precision was determined using Elecsys reagents, pooled human aspects. In: Albertini A, Arosio P, Chiancone E, Drysdale J (eds). Ferritins
sera, and controls in a modified protocol (EP5-A) of the CLSI and isoferritins as biochemical markers. Elsevier, Amsterdam 1984;33-47.
(Clinical and Laboratory Standards Institute): 6 times daily for 10 days 3. Kaltwasser JP, Werner E. Serumferritin: Methodische und
(n = 60); repeatability on MODULAR ANALYTICS E170 analyzer, Klinische Aspekte. Springer Verlag (1980).
n = 21. The following results were obtained: 4. Morikawa K, Oseko F, Morikawa S. A role for ferritin in hematopoiesis
Elecsys 2010 and cobas e 411 analyzers and the immune system. Leuk-Lymphoma 1995;18(5-6):429-433.
Repeatabilityb Intermediate precision 5. Borch-Iohnson B. Determination of Iron status: brief review of physiological
Sample Mean SD CV SD CV effects on iron measures. Analyst 1995;120(3):891-903.
µg/L µg/L µg/L 6. Cook-JD, Skikne-BS, Baynes RD. Iron deficiency: the global
% %
perspective. Adv-Exp-Med-Biol 1994;356:219-228.
(ng/mL) (ng/mL) (ng/mL)
7. Albertini A, Arosio P, Chiancone E, Drysdale J (eds). Functional aspects
Human serum 1 30.7 0.55 1.8 0.92 2.9 of isoferritins. In: Jacobs A, Hodgetts J, Hoy TG. Ferritins and isoferritins
Human serum 2 232 4.26 1.8 7.52 3.2 as biochemical markers. Elsevier, Amsterdam 1984;113-127.
Human serum 3 1482 30.2 2.0 37.8 2.6 8. Guder WG, Narayanan S, Wisser H, Zawta B. List of Analytes;
PreciControl TMc1 22.2 0.48 2.1 0.71 3.2 Preanalytical Variables. Brochure in: Samples: From the Patient to the
PreciControl TM2 221 4.19 1.9 4.75 2.2 Laboratory. GIT-Verlag, Darmstadt 1996:14. ISBN 3-928865-22-6.
b) Repeatability = within-run precision 9. Thorpe SJ, et al. Automated immunoassay methods for ferritin:
c) TM = Tumor Marker recovery studies to assess traceability to an international standard.
Clin Chem Lab Med 2008;46(10):1450-1457.
MODULAR ANALYTICS E170 and cobas e 601 analyzers 10. Lotz J, Hafner G, Prellwitz W. Reference Study for Ferritin Assays.
Repeatability Intermediate precision Kurzmitteilung Clin Lab 1997;43(11):993-994.
Sample Mean SD CV Mean SD CV 11. Passing H, Bablok W, et al. A General Regression Procedure for Method
µg/L µg/L % µg/L µg/L % Transformation. J Clin Chem Clin Biochem 1988;26:783-790.
(ng/mL) (ng/mL) (ng/mL) (ng/mL)
For further information, please refer to the appropriate operator’s manual
Human serum 1 19.4 0.57 3.0 14.7 0.59 4.0 for the analyzer concerned, the respective application sheets, the product
Human serum 2 234 7.31 3.1 361 15.8 4.4 information, and the package inserts of all necessary components.
Human serum 3 1446 51.4 3.6 1655 68.5 4.1
PreciControl TM1 22.2 0.63 2.9 23.8 1.03 4.3 FOR US CUSTOMERS ONLY: LIMITED WARRANTY
Roche Diagnostics warrants that this product will meet the specifications
PreciControl TM2 226 5.22 2.3 247 12.2 4.9
stated in the labeling when used in accordance with such labeling and
Method comparison will be free from defects in material and workmanship until the expiration
A comparison of the Elecsys Ferritin assay, REF 03737551 (y) date printed on the label. THIS LIMITED WARRANTY IS IN LIEU OF ANY
with the Elecsys Ferritin assay, REF 11820982 (x) using clinical OTHER WARRANTY, EXPRESS OR IMPLIED, INCLUDING ANY IMPLIED
samples gave the following correlations: WARRANTY OF MERCHANTABILITY OR FITNESS FOR PARTICULAR
Number of samples measured: 134 PURPOSE. IN NO EVENT SHALL ROCHE DIAGNOSTICS BE LIABLE FOR
INCIDENTAL, INDIRECT, SPECIAL OR CONSEQUENTIAL DAMAGES.
Passing/Bablok11 Linear regression
y = 1.00x + 0.72 y = 0.99x + 4.11
τ = 0.984 r = 0.999
The sample concentrations were between approx. 2.68 and 1891 µg/L (ng/mL). COBAS, COBAS E, ELECSYS, ENZYMUN-TEST and MODULAR are trademarks of Roche. Other brand or
product names are trademarks of their respective holders. INTRALIPID is a trademark of Fresenius Kabi AB.
Analytical specificity Significant additions or changes are indicated by a change bar in the margin. Changes to reagent barcode
Human liver ferritin 100 % recovery test parameters which have already been read in should be edited manually.
© 2010, Roche Diagnostics
Human spleen ferritin 85 % recovery
Human heart ferritin 1 % recovery
Roche Diagnostics GmbH, Sandhofer Strasse 116, D-68305 Mannheim
www.roche.com
Distribution in USA by:
Roche Diagnostics, Indianapolis, IN
US Customer Technical Support 1-800-428-2336

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