Selection, preparation, and characterization of commutable frozen human serum pools as potential secondary reference materials for lipid and apolipoprotein measurements: study within the framework of the Dutch project "Calibration 2000".
BACKGROUND
The Dutch project "Calibration 2000" aims at harmonization of laboratory results via calibration by development of matrix-based secondary reference materials. We considered the selection, preparation, and characterization of 34 potential reference materials (PRMs).


METHODS
Sixteen PRMs were prepared either strictly according to the NCCLS C37-A protocol or in a less stringent and more convenient way. In addition, 18 commercial, so-called human serum-based calibrators or controls were purchased and tested. Lipoprotein integrity was evaluated by examining the physicochemical characteristics of the materials. Commutability of the PRMs was assessed in 86 Dutch clinical laboratories, using a multicenter split-patient-sample between-field-method (twin-study) design. Normalized residuals of the PRMs with respect to the patient regression lines were calculated; in addition, the extra contribution of each PRM to the total measurement uncertainty (CV(Netto)) was calculated. On the basis of these results, the most native PRM was selected to investigate its potential to reduce interlaboratory variation and to improve lipid and apolipoprotein standardization.


RESULTS
In general, only the NCCLS C37-A-type materials displayed normalized residuals below the decision limit for commutability and had small CV(Netto) values ranging between 0 and 3.8%. This contrasts with the findings in regularly pooled frozen sera and lyophilized cryoprotected PRMs. In two subsequent external quality assessment surveys, the NCCLS type C37-A materials contributed to reducing the intermethod lipid and (apo)lipoprotein variation to approximately 2-4%.


CONCLUSIONS
NCCLS C37-A materials have a strong potential as secondary reference materials, not only for cholesterol but also for HDL-cholesterol, LDL-cholesterol, triglyceride, and apolipoprotein measurements.
Department of Clinical Chemistry, Amphia Hospital Langendijk, Langendijk 75, 4819 EV Breda, The Netherlands. cobbaert@worldonline.nl
Christa
C
Cobbaert
Cas
C
Weykamp
Henk
H
Baadenhuijsen
Aldy
A
Kuypers
Jan
J
Lindemans
Rob
R
Jansen
D016632:Apolipoprotein A-I / Q000097:blood / Q000592:standards; D001055:Apolipoproteins B / Q000097:blood / Q000592:standards; D001800:Blood Specimen Collection; D002138:Calibration; D006801:Humans; D008055:Lipids / Q000097:blood / Q000592:standards*; D009426:Netherlands; D012015:Reference Standards
D016632:Apolipoprotein A-I; D001055:Apolipoproteins B; D008055:Lipids