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Canine Lymphoma Diagnostic Assay Kit
Cat. No: TSC-501

Background

Lymphoma is one of the most common cancers to affect dogs, with certain breeds exhibiting an
extremely high prevalence. Incidence rates (like most neoplasms) increase dramatically with age,
and dogs from middle age onwards are most affected. The disease does however respond well to
treatment with chemotherapy, particularly if diagnosed early.

The disease usually presents with swollen lymph nodes which can ofte be confused with
                                                                            often
infection during initial differential diagnosis. Delays in diagnosis can therefore be common if the
practitioner treats with antibiotics and waits for the lymphadenopathy to subside. This approach
results in crucial delays since lymphoma develops very rapidly. Currently diagnosis of lymphoma
requires invasive procedures such as fine needle aspiration or excision of the affected lymph
node. Since the affected dog appears otherwise well, it is understandable that the vet would
choose to postpone invasive work until more information becomes available.
                tpone

The Tri-Screen Canine Lymphoma Assay helps overcome these difficulties by providing a same
day turnaround test which is able to differentiate between lymphadenopathy of non non-malignant
origin and lymphoma. Since the test requires only a small amount of blood, the test helps the vet
make rapid decisions about diagnostic procedures and treatments when confronted with a dog
exhibiting swollen lymph nodes.

Often lymphoma also presents in nonnon-peripheral lymph nodes. Under these circumstances, other
                                                 al
signs such as general malaise, hypercalcaemia or PU/PD indicate the disease. Furthermore, it is
extremely difficult to biopsy the affected node in non peripheral lymphoma. In these cases, the
                                                    non-peripheral
Tri-Screen Canine Lymphoma Assay provides the vet with a new, valuable tool to inform the
                 ne
decision on progressing to additional costly or invasive procedures.


The Tri-Screen Canine Lymphoma Diagnostic Kit represents a unique approach to the diagnosis
         creen
of Canine Lymphoma. The kit is a three part diagnostic system which utilizes assays for two acute
                                  three-part
phase proteins, Haptoglobin and CRP and then produces a diagnosis through t application of a
                                                                              the
patented algorithm to the Haptoglobin and CRP results which is accessed via the Tri
                                                                   ssed           Tri-Screen.net
website.

Full instructions follow on the methodologies for performing the assays and a
                                                                            accessing the Tri-
screen.net website.

Please note: each Tri-Screen Canine Lymphoma Diagnostic Kit contains a unique
                          Screen
identification code number on the inside of the kit box lid. This number is required every
time you wish to access the diagnostic algorithm on the website. This ID number must be
carefully recorded to allow access to your stored results and history
                                                              history.

To obtain a result from the Tri
                            Tri-Screen Canine Lymphoma Diagnostic Kit, all three components of
the assay must be performed.

The first time the kit is used, users must register as a u
                                                         user at www.tri-screen.net/register/
                                                                         screen.net/register/
The user can register on the website by completing a short registration procedure and set up their
  he                                         mpleting
own individual user name and password. This is designed to ensure that results and information
from each individual user are kept in a safe and secure manner. There is no need to follow this
       ach
procedure with every kit purchased, registration is a one-time procedure and the user name and
password remain the same once set up.

Further details of how to use the website to obtain results follow in section 3 of this manual.

Methodologies for the individual components of the kit follow

1. The Haptoglobin Assay Methodology
2. The Canine CRP Assay Methodology
3. Accessing the Tri-Screen.net website and obtaining a result.

The Haptoglobin assay has shown equivalence between serum and plasma samples. CRP has
not been fully investigated in this respect. It is therefore recommended that serum samples are
used for both tests in this assay.

Section 1: The Haptoglobin Assay

Intended Use

This is a colorimetric assay designed to quantitatively measure the concentration of the acute
phase protein Haptoglobin in serum and plasma.

Application

The activation of the body’s immune system-mediated defence mechanisms is termed the acute
phase response. Haptoglobin is one of a series of acute phase proteins that is found in the blood
of a range of animal species. Under normal conditions, it is either absent from the blood or
present at very low levels. Normal ranges can vary between species and in Canines the normal
range is 0.3 – 3.5mg/ml. However, Haptoglobin has been identified as a marker for lymphoma in
dogs when utilised as part of this kit. The individual result for Haptoglobin is not indicative of
lymphoma itself and a diagnosis of lymphoma may only be obtained through the completion of all
three parts of the process.

Test Principle

Free haemoglobin exhibits peroxidase activity, which is inhibited at a low pH. Haptoglobin present
in the specimen combines with haemoglobin and at a low pH preserves the peroxidase activity of
the bound haemoglobin. Preservation of the peroxidase activity of haemoglobin is directly
proportional to the amount of Haptoglobin present in the specimen. This assay can be performed
in manual or automated formats.

Reagents & Materials Provided

1. Reagent 1 (R1) 1 x 14ml stabilised Haemoglobin. (Ready to use)
2. Reagent 2 (R2) 1 x 20ml Chromogen reagent (Ready to use)
3. Calibrator 1 x 0.5ml Haptoglobin Calibrator (2.5mg/ml).
4. Sample/Calibrator Diluent 1 x 12ml Phosphate Buffered Saline Diluent (Ready to use).

Additional Materials Required

1. Serum or plasma collection equipment.
2. Automated analyser (A600nm) or Microplate reader (A630nm).
3. Accurate micropipettes or multichannel pipettes and disposable tips to deliver 0-10µl and 50-
   200µl
4. Test tubes.
5. Timer.
6. Graph paper: Linear (Cartesian)
7. 96 well microtitre plate or strips or alternative reaction chamber such as photometer cup etc.
8. Vortex
9. Centrifuge


                                                2
Reagent Preparation & Use

    Haemoglobin (R1)
    This reagent is provided in a ready to use format (Reagent 1).

    Chromogen (R2)
    This reagent is provided in a ready to use format (Reagent 2).

    Calibrator/sample diluent
    This reagent is provided in a ready to use format.



    Calibrator (Microplate Method)

    Calibration is run in the form of a standard curve for each assay. The standard curve dilution
    series is prepared manually or automatically on an automated analyser.

    For the manual method label five tubes with numbers C1-C5, corresponding to Haptoglobin
    standards 2.5, 1.25, 0.625, 0.312 and 0 mg/ml respectively. Calibrators for this test format are
    prepared by following the steps provided in the table:

                  Tube No:             Volume            Volume Diluent         Tube
                                      Calibrator                           Concentration
                     C1              50µl of stock             -             2.5 mg/ml
                     C2              50µl of stock            50µl           1.25mg/ml
                     C3                50µl C2                50µl          0.625mg/ml
                     C4                50µl C3                50µl          0.312mg/ml
                     C5                    -                  50µl             0mg/ml

    Calibrator (Automated Methods)

•   For automated procedures single point calibration may be used by dilution of the 2.5mg/ml
    standard 1:1 to give a 1.25mg/ml calibrator.
•   Alternatively, use only 0, 0.625 and 2.5mg/ml calibrator. (Haptoglobin standard of 0.625mg/ml can
    be prepared by adding 50ul of 2.5mg/ml standard to 150ul of calibrator diluent).
•   Multi-point calibration curves can also be used.
•   Note: Account should be taken of the fill volume of calibrator material which may be required
    depending on the automated system in use.

    Assay the calibrators in the context of an internal calibration programme.

    Sample Preparation

•   This method has demonstrated serum/plasma equivalence using lithium-heparin blood collection
    tubes for plasma.
•   Blood samples may be kept for up to 24 hours before separation of serum.
•   It is recommended that serum is removed from the clot or cells as soon as possible after
                                               o
    collection. Serum may be stored at 2-8 C for up to 24 hours before screening or alternatively
                                    o
    stored long-term frozen at -20 C for up to one year.
•   For most species, samples are tested neat and only require dilution if the Haptoglobin level is
    above the highest calibrator concentration. However for canine, use of a starting sample dilution
    of 1:5 is recommended by adding 10µl of sample to 40µl of calibrator/sample diluent.
•   It is important that all samples are brought to room temperature and vortexed vigorously to ensure
    accurate determination of the Haptoglobin concentration.
•   Do not use grossly haemolysed or lipaemic samples.




                                                     3
Test Procedure

    A. Manual method (microplate or spectrophotometric)

    Note: Addition of Reagent 1 and Reagent 2 should be made with a multi-channel or repeating
    pipette.

1. Transfer 7.5ul of each prepared calibrator (0-2.5mg/ml) along with test specimens, in duplicate, to
   the blank microplate.
2. Add 100ul of Reagent 1 to each microwell. Tap the microplate gently to ensure mixing of
   calibrators/specimens and haemoglobin.
                                                                                               o
3. Add 140ul Reagent 2 to each microwell. Incubate for 5 minutes at room temperature (20-25 C).
4. Read immediately at 600-630nm.


    B. Automated Method (2 reagent procedure).

1. Dispense the required amount of Reagent 1 and Reagent 2 into the appropriate storage vessels
   on the instrument.
2. Aliquot the required volume of sample, controls and calibrator into the appropriate sample cups.
3. Read at 600-630nm while the calibration curve is developing, preferably at the peak of the
   calibration curve. Caution: Do not let the calibration curve ‘over-develop’ and undergo a
   wavelength shift (change in colour from blue to light brown)

    Test Temperature
                                    o      o       o
    The test can be performed at 25 C, 30 C or 37 C on analyzers or at room temperature on the
    manual format.

    Interpretation of Results

    •   Calculate the mean absorbance for each sample, control or standard.
    •   Generate a calibration curve by plotting absorbance (600-630nm) versus Haptoglobin
        concentration (mg/ml) to facilitate calculation of Haptoglobin concentration in test specimens.
    •   Draw the best smooth curve through these points to construct the standard curve.
    •   Determine the concentrations of the test samples and controls from the standard curve by
        reading specimen values directly from the calibrator curve and then multiplying the
        interpolated value by the appropriate dilution factor.
    •   Samples that have a signal greater than the highest standard, or fall on the non-linear part of
        the curve, should be further diluted in diluent buffer and re-analyzed.


    Waste Management

    Please refer to local legal requirements

    Quality Control

    Good laboratory practice suggests the use of control specimens to ensure proper assay
    performance.

    Laboratories should assess the Haptoglobin and CRP components of the Tri-Screen kit using
    Quality Control material. A separate set of additional Tri-Screen Quality Control sera are
    available specifically for use with this kit. In addition to values for both Haptoglobin and CRP at
    both Positive and Negative Lymphoma Levels, the use of this control material correlates with the
    Positive and Negative results range obtained when the results are input into the algorithm.
    Therefore the material acts to control both the diagnostic assay processes, the functioning of the
    algorithm and the overall result. This control may be purchased as a separate item (Catalogue no.
    TSC-501-CON).


                                                  4
It is recommended the controls be included in every assay. New lots of control material should be
   analysed in parallel with the control material in current use. Controls should be monitored and
   charted on a day-to-day basis to analyse values and trends.

   Storage and Stability

   The storage and stabilities for the Haptoglobin reagents and calibrators are as follows:
                                  0   0
   Unopened and stored at 2 C-8 C: Unopened Haptoglobin reagents are stable until the last day
   of the month of the expiration date printed on the product label.
                                    0   0
   1. Opened and stored at 2 C-8 C: Opened Haptoglobin reagents are stable until the last day of
        the month of the expiration date printed on the product label, if kept closed in their original
        containers, free from contamination and at the correct temperature.
   2. On-board stability: Opened Haptoglobin reagents (excluding prepared calibrators) have on-
                                                   o
        board stability at room temperature (20-25 C) for 1 week.
                                                                                                o
   3. Calibrators prepared are stable for 8 hours when stored at room temperature (20-25 C) in
        closed containers.
   4. Protect all reagents from extreme heat or freezing. In order to ensure maximum stability of the
        Haptoglobin reagents on each automated chemistry analyser, it is important to use proper
        boats and anti-evaporation tray covers.


   Performance Characteristics
                                              Haptoglobin Standard curve


            1

           0.9

           0.8

           0.7

           0.6
    Abs
           0.5                                                                                   Standard curve

           0.4

           0.3

           0.2

           0.1

            0
                 0       0.5        1            1.5            2           2.5         3
                                    Haptoglobin concentration mg/ml

   Note: An example of a typical standard curve is presented above.
   This should not be used in determination of Haptoglobin.

   Intra assay Variation, Haptoglobin Assay

( n=32 )              Mean Hp               Standard Deviation             Coefficient of Variation (%)
                 Concentration (mg/ml)
 Low                     0.59                          0.02                            5.3
 High                    1.30                          0.10                            6.3

   Inter assay Variation

( n=64 )              Mean Hp               Standard Deviation             Coefficient of Variation (%)
                 Concentration (mg/ml)
 Low                     0.59                          0.02                            5.7
 High                    1.26                          0.10                            4.1


                                                       5
Analytical Sensitivity
Analytical sensitivity has been determined as 0.005 mg/ml Haptoglobin. This value was
determined by the addition of two standard deviations of the mean OD obtained when the zero
calibrator was assayed 32 times.

Limitation of Test
• Serum or plasma samples are recommended for use in this test. However, to eliminate
   potential discrepancies it is recommended that any study which starts with a particular matrix
   i.e. serum or plasma, should continue to use the same matrix for the duration of the
   investigation.
• Mildly haemolysed samples may be used in the test. However, grossly haemolysed samples
   (haemoglobin >2.5 g/l) should be avoided as results may not be reliable.
• Ensure that serum samples are collected prior to administration of steroids.

Warnings and Precautions
• Avoid contact with eyes, skin and clothing. Wash hands thoroughly after handling and when
   finished. Avoid ingestion of reagents. Never pipette by mouth and wear disposable latex
   gloves and eye protection where appropriate.
• Reagent 2 contains reagents that may irritate the skin or mucous membranes. Any reagent
   which comes in contact with skin should be washed off with water immediately.
• Some reagents contain thimerosal and may be toxic if ingested.



Procedural
• Do not use kit or individual reagents past their expiry date.
• Do not mix or substitute reagents from different kit lot numbers.
• Deviation from protocol provided may cause erroneous results.
• Samples should be stored refrigerated, or frozen if they are not to be analysed shortly after
   collection. Avoid repeated freeze thaw cycles.
• When possible avoid the use of haemolysed or lipaemic sera. If large amounts of particulate
   matter are present this should be removed by centrifugation prior to assay.
• It is recommended that all calibrators and samples are run in duplicate.
                                                               0
• Allow all reagents to come to room temperature (20 – 25 C) and mix well before use.
                                                             0
• Avoid leaving reagents in direct sunlight and/or above 4 C for extended periods.
• Cover or cap all reagents when not in use.
• Always use clean, preferably disposable, glassware for all reagent preparation.
• Care must be taken not to contaminate components and always use fresh tips for each
   sample and component.
• In manual format ensure that the bottom surface of the well is clean and dry before reading.
   Ensure no bubbles are present in the wells prior to reading.
• Before commencing the manual assay format, an identification and distribution plan should be
   established. It is also recommended labelling each strip to enable identification.
• Read absorbances immediately after completion of the assay. Do not allow the calibration
   curve to over-develop and undergo a wavelength shift (change from blue to light brown
   colour).




                                             6
Section 2: The CRP Assay

Assay principle

The Canine CRP kit is a solid phase sandwich Immunoassay. Samples, including calibrators of known
CRP content bind to coated microwells. After washing to remove any unbound material the HRP
labeled Anti-Canine CRP antibody is added to each well. After again washing to remove any unbound
material TMB substrate solution is added. The intensity of the colour produced is proportional to the
concentration of CRP present in the original specimen.

Components Supplied

1.    Coated microplate                    1 x 96 well plate
2.    C-Reactive protein calibrator        1 x 1.5ml (Ready to use)
3.    Standard/sample diluent buffer       1 x 50ml (20x concentrate)
4.    Anti-canine CRP Conjugate            1 x 11ml (Ready to use)
5.    Wash concentrate                     1 x 50ml (20x concentrate)
6.    TMB Substrate                        1 x 11ml (Ready to use)
7.    Stop solution                        1 x 11ml (Ready to use)

Additional materials required

1.    Serum collection equipment.
2.    Microtiter plate reader capable of measurement at 450nm with reference at 630nm if available.
3.    Accurate micropipettes and disposable tips to deliver 0-10µl, 20-200µl and 200-1000µl.
4.    A repeat or multichannel pipette (50-200µl) for large assays.
5.    Deionized or distilled H2O.
6.    Plate washer (automated or manual).
7.    Graph paper: Standard or semi-log.
8.    Glass or plastic test tubes.
9.    Absorbent paper towels
10.   96 well dust plate cover.
         o
11.   37 C incubator.
12.   Timer

Storage and Stability
                                                  o
The kit components are stable when stored at 2-8 C until the expiry date indicated on the kit label.

Safety

•     Never pipette by mouth.
•     Wear disposable latex gloves and eye protection where appropriate.
•     The stop solution and TMB substrate contain reagents that may irritate the skin or mucous
      membranes. Any reagent, which comes into contact with the skin, should be washed off with
      water immediately.

Procedural

•     Do not use kit or individual reagents past their expiry date.
•     Do not mix or substitute reagents from different kit lot numbers.
•     Deviation from protocol provided may cause erroneous results.
•     Samples should be stored refrigerated, or frozen if they are not to be analysed shortly after
      collection. Avoid repeated freeze thaw cycles.
•     When possible avoid the use of haemolysed or lipaemic sera. If large amounts of particulate
      matter are present this should be removed by centrifugation prior to assay.
•     It is recommended that all calibrators and samples are run in duplicate.
                                                                   0
•     Allow all reagents to come to room temperature (20 – 25 C) and mix well before use.
                                                                 0
•     Avoid leaving reagents in direct sunlight and/or above 4 C for extended periods.

                                                   7
•   Cover or cap all reagents when not in use.
•   Always use clean, preferably disposable, glassware for all reagent preparation.
•   Care must be taken not to contaminate components and always use fresh tips for each sample
    and component.
•   Before commencing the manual assay format, an identification and distribution plan should be
    established. It is also recommended labelling each strip to enable identification.


Sample Preparation

Specimens should be collected by venipuncture into serum collection tubes. Blood samples may be
kept for up to 24 hours before separation of serum. However, it is best to remove serum from the clot
                                                                              o
as soon as possible after collection. In general, serum may be stored at 2-8 C for up to 24 hours or
                     o
stored frozen at –20 C for longer periods without loss of CRP. It is important that all refrigerated
samples are brought to room temperature and mixed to assure accurate determination of the CRP
concentration.
All samples should be diluted 1:500 in sample diluent buffer (1x) prior to assay by addition of 10ul of
sample to 5.0 ml diluent buffer (1x).
Do not use grossly haemolysed or lipaemic samples.


Reagent Preparation
Diluent Buffer (1x)

Dilute 1 volume of diluent buffer concentrate (20x) with 19 volumes of distilled water. Store both the
diluent buffer concentrate and working diluent buffer (1x) in the refrigerator. Diluted diluent buffer is
                                         o
stable for up to 2 weeks when stored at 4 C.

Wash Buffer (1x)

Dilute 1 volume of wash buffer concentrate (20x) with 19 volumes of distilled water. Store both the
wash buffer concentrate and working wash buffer (1x) in the refrigerator. Diluted wash solution is
                                         o
stable for up to 2 weeks when stored at 4 C.
Calibration Curve Preparation

Label 6 tubes C1 to C6. To prepare the top calibrator, add 250ul of the calibrator supplied with the kit
to tube C1 (see table 1). Add 250ul 1x diluent buffer to each of the remaining tubes (C2-C6) as
directed in table 1. The top calibrator is serially diluted 4 times (tubes C2 to C5) to provide the working
calibrators as indicated in table 1 below. Tube C6 constitutes the assay blank and contains 1x diluent
buffer only.
Table 1: Preparation of working calibration curve

         Tube No.               CRP                  Volume of           Volume of 1x          Serial
                            Concentration            calibrator          diluent buffer       dilution
          C1 (Top              120ng/ml                 250µl                   -                 -
         calibrator)
             C2                 60ng/ml                 250µl                250µl                -
             C3                 30ng/ml                   -                  250µl          250µl of C2
             C4                 15ng/ml                   -                  250µl          250µl of C3
             C5                7.5ng/ml                   -                  250µl          250µl of C4
         C6 (Blank)              Blank                                       250µl                -



                                                    8
The range provided represents a CRP concentration of 3.75 – 60ug/ml when sample dilution
         of 1:500 is taken into account.

Procedure

1.       Determine the number of 8-well strips needed for the assay. Re-bag extra strips, seal bag and
         store desiccated in a refrigerator.
2.       Add 100µl of the diluted sample or calibrator, in duplicate, to each well.
                  µ
                                                                                        o
3.       Cover the plate with a dust cover and incubate the plate for 15 minutes at 37 C.
4.       After incubation aspirate or decant and wash the plate four times with diluted wash buffer
         (400ul per well per wash). After the last wash tap the plate dry on absorbent paper.
5.       Add 100µl of conjugate to each of the wells.
                  µ
                                                                                        o
6.       Cover the plate with a dust cover and incubate the plate for 15 minutes at 37 C.
7.       After incubation aspirate or decant and wash the plate four times with diluted wash buffer
         (400ul per well per wash). After the last wash tap the plate dry on absorbent paper.
8.       Add 100µl of TMB Substrate.
                  µ
9.       Cover the plate with a dust cover and incubate the plate for 15 minutes at room
         temperature.
10.      Add 100µl of stop solution and tap gently to mix.
                  µ
11.      Read the absorbance of each well at 450nm using 630nm as a reference.


Interpretation of Test Results


1. Calculate the mean absorbance for each sample, control or calibrator.
2. Plot the absorbance of the calibrators against the calibrator concentration on standard or semi-
   logarithmic graph paper. (If necessary, the background absorbance for the 0ng/ml may be
   subtracted from each of the data points, including the calibrators, unknowns and controls prior to
   plotting). Draw the best smooth curve through these points to construct the calibration curve.
   Determine the concentrations of the test samples and controls from the calibration curve by
   multiplying the interpolated value by the appropriate dilution factor. Samples that have a signal
   greater than the top calibrator, or fall on the non-linear part of the curve, should be further diluted
   in diluent buffer and re-analysed.

      Typical Data

      An example of a typical calibration curve is represented below. This should not be used in
      the determination of Canine CRP

                                                   Canine CRP Calibration curve


                                         2.5


                                          2
                      Absorbance 450nm




                                         1.5


                                          1


                                         0.5


                                          0
                                               0        50               100      150
                                                        Canine CRP conc ng/ml



                                                              9
Assay Reproducibility

Two samples containing medium and low levels of Canine CRP were run in independent assays. To
determine inter assay reproducibility the mean and the coefficient of variation (%CV) were calculated.
                Inter assay variation

                         Control               Level 1           Level 2
                    n                            32                32
                    Mean (µg/ml)
                          µ                     14.9              34.6
                    Standard Deviation           1.2               2.7
                    %CV                         8.2%              7.8%

Two samples containing medium and low levels of Canine CRP were tested in a single assay. To
establish intra assay reproducibility the mean and the coefficient of variation (%CV) were calculated.

                Intra assay Variation

                         Control               Level 1           Level 2
                    n                            16                16
                    Mean (µg/ml)
                          µ                     15.4              35.8
                    Standard Deviation           1.1               2.3
                    %CV                         6.9%              6.5%

Limitations of Test

The use of this test for the analysis of plasma samples has not been fully investigated. Haemolysed or
lipaemic samples should not be used in the test.
Ensure that serum samples are collected prior to administration of steroids.

Waste Management

Please refer to local legal requirements

Quality Control

Good laboratory practice suggests the use of control specimens to ensure proper assay performance.

Laboratories should assess the Haptoglobin and CRP components of the Tri-Screen kit using Quality
Control material. A separate set of additional Tri-Screen Quality Control sera are available
specifically for use with this kit. In addition to values for both Haptoglobin and CRP at both Positive
and Negative Lymphoma Levels, the use of this control material correlates with the Positive and
Negative results range obtained when the results are input into the algorithm. Therefore the material
acts to control both the diagnostic assay processes, the functioning of the algorithm and the overall
result. This control may be purchased as a separate item (Catalogue no. TSC-501-CON).

It is recommended the controls be included in every assay. New lots of control material should be
analysed in parallel with the control material in current use. Controls should be monitored and charted
on a day-to-day basis to analyse values and trends.




                                                  10
Section 3: The Diagnostic Algorithm

When results for Haptoglobin and CRP are obtained for each individual sample (or Control)
the diagnostic interpretation is performed by accessing the patented Tri-Screen algorithm which is
hosted on our Registered User’s website at www.tri-screen.net.

The procedure for accessing and obtaining a diagnostic report is as follows:

The first time you purchase a Canine Lymphoma Kit, please visit the website and register as a
registered user. This will allow you to generate a unique user name and password which will allow
you access to the user’s area of the website where you can input your results to obtain a diagnostic
report. This is also designed to keep your own details, results and information confidential and secure.

You are now registered and set up to input data on the Tri-Screen website, the next step is to perform
your Haptoglobin and CRP assays and obtain results for both parameters. The same procedure
applies whether you are inputing patient samples or control serum samples.

When you have obtained results, sign in on the website using your username and password.
If you have forgotten either your user name or password, please follow the procedure listed on the
sign in page to retrieve them.

When you sign in you will then be taken to the input page.

Here you will be asked to input the unique identification code for your kit which can be found on the
label attached to the inside of the lid of the kit box.

You will then have access to the results page: here you can see the results from the tests you have
carried out using this particular kit. You can also access stored or archived data or results and
produce a report by selecting criteria from the data. Instructions for doing this are on the web page.

The web page will also show how many tests are remaining for the unique code number for the kit.
Each kit performs a maximum of 42 tests in duplicate and there are 55 result inputs for each kit to
allow for errors.
Input the data for your test samples:

                                         Name
                                         Age
                                         Breed
                                         Gender
                                         Date
                                         Clincal Signs
                                         Treatment

And input the CRP and Haptoglobin results.
Click “Calculate“
The Algorithm will produce one of three results with regard to the Lymphoma Diagnosis:

                                         Positive
                                         Negative
                                         Repeat In Two Weeks

Positive and Negative are self-explanatory.“Repeat In Two Weeks“ indicates that the result falls into a
range which is considered inconclusive and the recommendation is that the test is repeated in two
weeks time.

The Tri-Screen system of Haptoglobin, CRP and Algorithm produced a diagnostic efficiency for
Canine Lymphoma of:

                                         Specificity: 93%
                                         Sensitivity: 85%

                                                  11
Users should be aware that within the limits of the studies carried out, False Positive and False
Negative results may occur in a small percentage of cases and that diagnosticians and clinicians
should use the results obtained in conjunction with other symptoms to make a diagnosis. The
manufacturers and providers cannot be held responsible for any loss, damage or injury caused as a
result of reliance on the results of the Tri-Screen assay system.

Additional Products in the Tri-Screen Range

A specific Tri-Screen control material containing both CRP and Haptoglobin controls in the same
serum is available.
This consists of 2 x 1ml controls:

Positive: Contains Haptoglobin and CRP in the Positive Range when tested with the algorithm.
Negative: Contains Haptoglobin and CRP in the Negative Range when tested with the algorithm.

These controls should be treated as samples and a result obtained for both CRP and Haptoglobin
which should then be entered on the website as a Control Sample.
In addition to values for both Haptoglobin and CRP at both Positive and Negative Lymphoma Levels,
the use of this control material correlates with the Positive and Negative results range obtained when
the results are input into the algorithm. Therefore the material acts to control both the diagnostic
assay processes, the functioning of the algorithm and the overall result.
This allows for the Haptoglobin, CRP and Algorithm to be controlled as part of the process.

The control is available from Tridelta Development Ltd. or your Local Distributor as:

Catalogue No. TSC-501-CON Tri-Screen Canine Lymphoma Control Serum.



Tri-Screen Canine Lymphoma Detection Kits are a joint venture product of:



Tridelta Development Ltd.                            PetScreen Ltd.
Unit 7 Block F                                       Biocity
Maynooth Business Campus                             Pennyfoot Street
Maynooth                                             Nottingham
County Kildare                                       NG1 1GF
Ireland                                              United Kingdom
Tel: +353 (0)1 6290635                               Tel: +44 (0) 115 9124430
Fax: +353 (0)1 6290687                               Fax: +44 (0) 800 6190280
www.trideltaltd.com                                  www.pet-screen.com

The dedicated Tri-Screen web site is at: www.tri-screen.net

For Sales & Marketing, please contact Tridelta Development Ltd. as above or by

Email to: sales@tri-screen.net

For Technical Support, please contact PetScreen Ltd. as above or by

Email to: technical@tri-screen.net




                                                  12

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Canine Lymphoma Diagnostic Assay

  • 1. Canine Lymphoma Diagnostic Assay Kit Cat. No: TSC-501 Background Lymphoma is one of the most common cancers to affect dogs, with certain breeds exhibiting an extremely high prevalence. Incidence rates (like most neoplasms) increase dramatically with age, and dogs from middle age onwards are most affected. The disease does however respond well to treatment with chemotherapy, particularly if diagnosed early. The disease usually presents with swollen lymph nodes which can ofte be confused with often infection during initial differential diagnosis. Delays in diagnosis can therefore be common if the practitioner treats with antibiotics and waits for the lymphadenopathy to subside. This approach results in crucial delays since lymphoma develops very rapidly. Currently diagnosis of lymphoma requires invasive procedures such as fine needle aspiration or excision of the affected lymph node. Since the affected dog appears otherwise well, it is understandable that the vet would choose to postpone invasive work until more information becomes available. tpone The Tri-Screen Canine Lymphoma Assay helps overcome these difficulties by providing a same day turnaround test which is able to differentiate between lymphadenopathy of non non-malignant origin and lymphoma. Since the test requires only a small amount of blood, the test helps the vet make rapid decisions about diagnostic procedures and treatments when confronted with a dog exhibiting swollen lymph nodes. Often lymphoma also presents in nonnon-peripheral lymph nodes. Under these circumstances, other al signs such as general malaise, hypercalcaemia or PU/PD indicate the disease. Furthermore, it is extremely difficult to biopsy the affected node in non peripheral lymphoma. In these cases, the non-peripheral Tri-Screen Canine Lymphoma Assay provides the vet with a new, valuable tool to inform the ne decision on progressing to additional costly or invasive procedures. The Tri-Screen Canine Lymphoma Diagnostic Kit represents a unique approach to the diagnosis creen of Canine Lymphoma. The kit is a three part diagnostic system which utilizes assays for two acute three-part phase proteins, Haptoglobin and CRP and then produces a diagnosis through t application of a the patented algorithm to the Haptoglobin and CRP results which is accessed via the Tri ssed Tri-Screen.net website. Full instructions follow on the methodologies for performing the assays and a accessing the Tri- screen.net website. Please note: each Tri-Screen Canine Lymphoma Diagnostic Kit contains a unique Screen identification code number on the inside of the kit box lid. This number is required every time you wish to access the diagnostic algorithm on the website. This ID number must be carefully recorded to allow access to your stored results and history history. To obtain a result from the Tri Tri-Screen Canine Lymphoma Diagnostic Kit, all three components of the assay must be performed. The first time the kit is used, users must register as a u user at www.tri-screen.net/register/ screen.net/register/ The user can register on the website by completing a short registration procedure and set up their he mpleting own individual user name and password. This is designed to ensure that results and information from each individual user are kept in a safe and secure manner. There is no need to follow this ach
  • 2. procedure with every kit purchased, registration is a one-time procedure and the user name and password remain the same once set up. Further details of how to use the website to obtain results follow in section 3 of this manual. Methodologies for the individual components of the kit follow 1. The Haptoglobin Assay Methodology 2. The Canine CRP Assay Methodology 3. Accessing the Tri-Screen.net website and obtaining a result. The Haptoglobin assay has shown equivalence between serum and plasma samples. CRP has not been fully investigated in this respect. It is therefore recommended that serum samples are used for both tests in this assay. Section 1: The Haptoglobin Assay Intended Use This is a colorimetric assay designed to quantitatively measure the concentration of the acute phase protein Haptoglobin in serum and plasma. Application The activation of the body’s immune system-mediated defence mechanisms is termed the acute phase response. Haptoglobin is one of a series of acute phase proteins that is found in the blood of a range of animal species. Under normal conditions, it is either absent from the blood or present at very low levels. Normal ranges can vary between species and in Canines the normal range is 0.3 – 3.5mg/ml. However, Haptoglobin has been identified as a marker for lymphoma in dogs when utilised as part of this kit. The individual result for Haptoglobin is not indicative of lymphoma itself and a diagnosis of lymphoma may only be obtained through the completion of all three parts of the process. Test Principle Free haemoglobin exhibits peroxidase activity, which is inhibited at a low pH. Haptoglobin present in the specimen combines with haemoglobin and at a low pH preserves the peroxidase activity of the bound haemoglobin. Preservation of the peroxidase activity of haemoglobin is directly proportional to the amount of Haptoglobin present in the specimen. This assay can be performed in manual or automated formats. Reagents & Materials Provided 1. Reagent 1 (R1) 1 x 14ml stabilised Haemoglobin. (Ready to use) 2. Reagent 2 (R2) 1 x 20ml Chromogen reagent (Ready to use) 3. Calibrator 1 x 0.5ml Haptoglobin Calibrator (2.5mg/ml). 4. Sample/Calibrator Diluent 1 x 12ml Phosphate Buffered Saline Diluent (Ready to use). Additional Materials Required 1. Serum or plasma collection equipment. 2. Automated analyser (A600nm) or Microplate reader (A630nm). 3. Accurate micropipettes or multichannel pipettes and disposable tips to deliver 0-10µl and 50- 200µl 4. Test tubes. 5. Timer. 6. Graph paper: Linear (Cartesian) 7. 96 well microtitre plate or strips or alternative reaction chamber such as photometer cup etc. 8. Vortex 9. Centrifuge 2
  • 3. Reagent Preparation & Use Haemoglobin (R1) This reagent is provided in a ready to use format (Reagent 1). Chromogen (R2) This reagent is provided in a ready to use format (Reagent 2). Calibrator/sample diluent This reagent is provided in a ready to use format. Calibrator (Microplate Method) Calibration is run in the form of a standard curve for each assay. The standard curve dilution series is prepared manually or automatically on an automated analyser. For the manual method label five tubes with numbers C1-C5, corresponding to Haptoglobin standards 2.5, 1.25, 0.625, 0.312 and 0 mg/ml respectively. Calibrators for this test format are prepared by following the steps provided in the table: Tube No: Volume Volume Diluent Tube Calibrator Concentration C1 50µl of stock - 2.5 mg/ml C2 50µl of stock 50µl 1.25mg/ml C3 50µl C2 50µl 0.625mg/ml C4 50µl C3 50µl 0.312mg/ml C5 - 50µl 0mg/ml Calibrator (Automated Methods) • For automated procedures single point calibration may be used by dilution of the 2.5mg/ml standard 1:1 to give a 1.25mg/ml calibrator. • Alternatively, use only 0, 0.625 and 2.5mg/ml calibrator. (Haptoglobin standard of 0.625mg/ml can be prepared by adding 50ul of 2.5mg/ml standard to 150ul of calibrator diluent). • Multi-point calibration curves can also be used. • Note: Account should be taken of the fill volume of calibrator material which may be required depending on the automated system in use. Assay the calibrators in the context of an internal calibration programme. Sample Preparation • This method has demonstrated serum/plasma equivalence using lithium-heparin blood collection tubes for plasma. • Blood samples may be kept for up to 24 hours before separation of serum. • It is recommended that serum is removed from the clot or cells as soon as possible after o collection. Serum may be stored at 2-8 C for up to 24 hours before screening or alternatively o stored long-term frozen at -20 C for up to one year. • For most species, samples are tested neat and only require dilution if the Haptoglobin level is above the highest calibrator concentration. However for canine, use of a starting sample dilution of 1:5 is recommended by adding 10µl of sample to 40µl of calibrator/sample diluent. • It is important that all samples are brought to room temperature and vortexed vigorously to ensure accurate determination of the Haptoglobin concentration. • Do not use grossly haemolysed or lipaemic samples. 3
  • 4. Test Procedure A. Manual method (microplate or spectrophotometric) Note: Addition of Reagent 1 and Reagent 2 should be made with a multi-channel or repeating pipette. 1. Transfer 7.5ul of each prepared calibrator (0-2.5mg/ml) along with test specimens, in duplicate, to the blank microplate. 2. Add 100ul of Reagent 1 to each microwell. Tap the microplate gently to ensure mixing of calibrators/specimens and haemoglobin. o 3. Add 140ul Reagent 2 to each microwell. Incubate for 5 minutes at room temperature (20-25 C). 4. Read immediately at 600-630nm. B. Automated Method (2 reagent procedure). 1. Dispense the required amount of Reagent 1 and Reagent 2 into the appropriate storage vessels on the instrument. 2. Aliquot the required volume of sample, controls and calibrator into the appropriate sample cups. 3. Read at 600-630nm while the calibration curve is developing, preferably at the peak of the calibration curve. Caution: Do not let the calibration curve ‘over-develop’ and undergo a wavelength shift (change in colour from blue to light brown) Test Temperature o o o The test can be performed at 25 C, 30 C or 37 C on analyzers or at room temperature on the manual format. Interpretation of Results • Calculate the mean absorbance for each sample, control or standard. • Generate a calibration curve by plotting absorbance (600-630nm) versus Haptoglobin concentration (mg/ml) to facilitate calculation of Haptoglobin concentration in test specimens. • Draw the best smooth curve through these points to construct the standard curve. • Determine the concentrations of the test samples and controls from the standard curve by reading specimen values directly from the calibrator curve and then multiplying the interpolated value by the appropriate dilution factor. • Samples that have a signal greater than the highest standard, or fall on the non-linear part of the curve, should be further diluted in diluent buffer and re-analyzed. Waste Management Please refer to local legal requirements Quality Control Good laboratory practice suggests the use of control specimens to ensure proper assay performance. Laboratories should assess the Haptoglobin and CRP components of the Tri-Screen kit using Quality Control material. A separate set of additional Tri-Screen Quality Control sera are available specifically for use with this kit. In addition to values for both Haptoglobin and CRP at both Positive and Negative Lymphoma Levels, the use of this control material correlates with the Positive and Negative results range obtained when the results are input into the algorithm. Therefore the material acts to control both the diagnostic assay processes, the functioning of the algorithm and the overall result. This control may be purchased as a separate item (Catalogue no. TSC-501-CON). 4
  • 5. It is recommended the controls be included in every assay. New lots of control material should be analysed in parallel with the control material in current use. Controls should be monitored and charted on a day-to-day basis to analyse values and trends. Storage and Stability The storage and stabilities for the Haptoglobin reagents and calibrators are as follows: 0 0 Unopened and stored at 2 C-8 C: Unopened Haptoglobin reagents are stable until the last day of the month of the expiration date printed on the product label. 0 0 1. Opened and stored at 2 C-8 C: Opened Haptoglobin reagents are stable until the last day of the month of the expiration date printed on the product label, if kept closed in their original containers, free from contamination and at the correct temperature. 2. On-board stability: Opened Haptoglobin reagents (excluding prepared calibrators) have on- o board stability at room temperature (20-25 C) for 1 week. o 3. Calibrators prepared are stable for 8 hours when stored at room temperature (20-25 C) in closed containers. 4. Protect all reagents from extreme heat or freezing. In order to ensure maximum stability of the Haptoglobin reagents on each automated chemistry analyser, it is important to use proper boats and anti-evaporation tray covers. Performance Characteristics Haptoglobin Standard curve 1 0.9 0.8 0.7 0.6 Abs 0.5 Standard curve 0.4 0.3 0.2 0.1 0 0 0.5 1 1.5 2 2.5 3 Haptoglobin concentration mg/ml Note: An example of a typical standard curve is presented above. This should not be used in determination of Haptoglobin. Intra assay Variation, Haptoglobin Assay ( n=32 ) Mean Hp Standard Deviation Coefficient of Variation (%) Concentration (mg/ml) Low 0.59 0.02 5.3 High 1.30 0.10 6.3 Inter assay Variation ( n=64 ) Mean Hp Standard Deviation Coefficient of Variation (%) Concentration (mg/ml) Low 0.59 0.02 5.7 High 1.26 0.10 4.1 5
  • 6. Analytical Sensitivity Analytical sensitivity has been determined as 0.005 mg/ml Haptoglobin. This value was determined by the addition of two standard deviations of the mean OD obtained when the zero calibrator was assayed 32 times. Limitation of Test • Serum or plasma samples are recommended for use in this test. However, to eliminate potential discrepancies it is recommended that any study which starts with a particular matrix i.e. serum or plasma, should continue to use the same matrix for the duration of the investigation. • Mildly haemolysed samples may be used in the test. However, grossly haemolysed samples (haemoglobin >2.5 g/l) should be avoided as results may not be reliable. • Ensure that serum samples are collected prior to administration of steroids. Warnings and Precautions • Avoid contact with eyes, skin and clothing. Wash hands thoroughly after handling and when finished. Avoid ingestion of reagents. Never pipette by mouth and wear disposable latex gloves and eye protection where appropriate. • Reagent 2 contains reagents that may irritate the skin or mucous membranes. Any reagent which comes in contact with skin should be washed off with water immediately. • Some reagents contain thimerosal and may be toxic if ingested. Procedural • Do not use kit or individual reagents past their expiry date. • Do not mix or substitute reagents from different kit lot numbers. • Deviation from protocol provided may cause erroneous results. • Samples should be stored refrigerated, or frozen if they are not to be analysed shortly after collection. Avoid repeated freeze thaw cycles. • When possible avoid the use of haemolysed or lipaemic sera. If large amounts of particulate matter are present this should be removed by centrifugation prior to assay. • It is recommended that all calibrators and samples are run in duplicate. 0 • Allow all reagents to come to room temperature (20 – 25 C) and mix well before use. 0 • Avoid leaving reagents in direct sunlight and/or above 4 C for extended periods. • Cover or cap all reagents when not in use. • Always use clean, preferably disposable, glassware for all reagent preparation. • Care must be taken not to contaminate components and always use fresh tips for each sample and component. • In manual format ensure that the bottom surface of the well is clean and dry before reading. Ensure no bubbles are present in the wells prior to reading. • Before commencing the manual assay format, an identification and distribution plan should be established. It is also recommended labelling each strip to enable identification. • Read absorbances immediately after completion of the assay. Do not allow the calibration curve to over-develop and undergo a wavelength shift (change from blue to light brown colour). 6
  • 7. Section 2: The CRP Assay Assay principle The Canine CRP kit is a solid phase sandwich Immunoassay. Samples, including calibrators of known CRP content bind to coated microwells. After washing to remove any unbound material the HRP labeled Anti-Canine CRP antibody is added to each well. After again washing to remove any unbound material TMB substrate solution is added. The intensity of the colour produced is proportional to the concentration of CRP present in the original specimen. Components Supplied 1. Coated microplate 1 x 96 well plate 2. C-Reactive protein calibrator 1 x 1.5ml (Ready to use) 3. Standard/sample diluent buffer 1 x 50ml (20x concentrate) 4. Anti-canine CRP Conjugate 1 x 11ml (Ready to use) 5. Wash concentrate 1 x 50ml (20x concentrate) 6. TMB Substrate 1 x 11ml (Ready to use) 7. Stop solution 1 x 11ml (Ready to use) Additional materials required 1. Serum collection equipment. 2. Microtiter plate reader capable of measurement at 450nm with reference at 630nm if available. 3. Accurate micropipettes and disposable tips to deliver 0-10µl, 20-200µl and 200-1000µl. 4. A repeat or multichannel pipette (50-200µl) for large assays. 5. Deionized or distilled H2O. 6. Plate washer (automated or manual). 7. Graph paper: Standard or semi-log. 8. Glass or plastic test tubes. 9. Absorbent paper towels 10. 96 well dust plate cover. o 11. 37 C incubator. 12. Timer Storage and Stability o The kit components are stable when stored at 2-8 C until the expiry date indicated on the kit label. Safety • Never pipette by mouth. • Wear disposable latex gloves and eye protection where appropriate. • The stop solution and TMB substrate contain reagents that may irritate the skin or mucous membranes. Any reagent, which comes into contact with the skin, should be washed off with water immediately. Procedural • Do not use kit or individual reagents past their expiry date. • Do not mix or substitute reagents from different kit lot numbers. • Deviation from protocol provided may cause erroneous results. • Samples should be stored refrigerated, or frozen if they are not to be analysed shortly after collection. Avoid repeated freeze thaw cycles. • When possible avoid the use of haemolysed or lipaemic sera. If large amounts of particulate matter are present this should be removed by centrifugation prior to assay. • It is recommended that all calibrators and samples are run in duplicate. 0 • Allow all reagents to come to room temperature (20 – 25 C) and mix well before use. 0 • Avoid leaving reagents in direct sunlight and/or above 4 C for extended periods. 7
  • 8. Cover or cap all reagents when not in use. • Always use clean, preferably disposable, glassware for all reagent preparation. • Care must be taken not to contaminate components and always use fresh tips for each sample and component. • Before commencing the manual assay format, an identification and distribution plan should be established. It is also recommended labelling each strip to enable identification. Sample Preparation Specimens should be collected by venipuncture into serum collection tubes. Blood samples may be kept for up to 24 hours before separation of serum. However, it is best to remove serum from the clot o as soon as possible after collection. In general, serum may be stored at 2-8 C for up to 24 hours or o stored frozen at –20 C for longer periods without loss of CRP. It is important that all refrigerated samples are brought to room temperature and mixed to assure accurate determination of the CRP concentration. All samples should be diluted 1:500 in sample diluent buffer (1x) prior to assay by addition of 10ul of sample to 5.0 ml diluent buffer (1x). Do not use grossly haemolysed or lipaemic samples. Reagent Preparation Diluent Buffer (1x) Dilute 1 volume of diluent buffer concentrate (20x) with 19 volumes of distilled water. Store both the diluent buffer concentrate and working diluent buffer (1x) in the refrigerator. Diluted diluent buffer is o stable for up to 2 weeks when stored at 4 C. Wash Buffer (1x) Dilute 1 volume of wash buffer concentrate (20x) with 19 volumes of distilled water. Store both the wash buffer concentrate and working wash buffer (1x) in the refrigerator. Diluted wash solution is o stable for up to 2 weeks when stored at 4 C. Calibration Curve Preparation Label 6 tubes C1 to C6. To prepare the top calibrator, add 250ul of the calibrator supplied with the kit to tube C1 (see table 1). Add 250ul 1x diluent buffer to each of the remaining tubes (C2-C6) as directed in table 1. The top calibrator is serially diluted 4 times (tubes C2 to C5) to provide the working calibrators as indicated in table 1 below. Tube C6 constitutes the assay blank and contains 1x diluent buffer only. Table 1: Preparation of working calibration curve Tube No. CRP Volume of Volume of 1x Serial Concentration calibrator diluent buffer dilution C1 (Top 120ng/ml 250µl - - calibrator) C2 60ng/ml 250µl 250µl - C3 30ng/ml - 250µl 250µl of C2 C4 15ng/ml - 250µl 250µl of C3 C5 7.5ng/ml - 250µl 250µl of C4 C6 (Blank) Blank 250µl - 8
  • 9. The range provided represents a CRP concentration of 3.75 – 60ug/ml when sample dilution of 1:500 is taken into account. Procedure 1. Determine the number of 8-well strips needed for the assay. Re-bag extra strips, seal bag and store desiccated in a refrigerator. 2. Add 100µl of the diluted sample or calibrator, in duplicate, to each well. µ o 3. Cover the plate with a dust cover and incubate the plate for 15 minutes at 37 C. 4. After incubation aspirate or decant and wash the plate four times with diluted wash buffer (400ul per well per wash). After the last wash tap the plate dry on absorbent paper. 5. Add 100µl of conjugate to each of the wells. µ o 6. Cover the plate with a dust cover and incubate the plate for 15 minutes at 37 C. 7. After incubation aspirate or decant and wash the plate four times with diluted wash buffer (400ul per well per wash). After the last wash tap the plate dry on absorbent paper. 8. Add 100µl of TMB Substrate. µ 9. Cover the plate with a dust cover and incubate the plate for 15 minutes at room temperature. 10. Add 100µl of stop solution and tap gently to mix. µ 11. Read the absorbance of each well at 450nm using 630nm as a reference. Interpretation of Test Results 1. Calculate the mean absorbance for each sample, control or calibrator. 2. Plot the absorbance of the calibrators against the calibrator concentration on standard or semi- logarithmic graph paper. (If necessary, the background absorbance for the 0ng/ml may be subtracted from each of the data points, including the calibrators, unknowns and controls prior to plotting). Draw the best smooth curve through these points to construct the calibration curve. Determine the concentrations of the test samples and controls from the calibration curve by multiplying the interpolated value by the appropriate dilution factor. Samples that have a signal greater than the top calibrator, or fall on the non-linear part of the curve, should be further diluted in diluent buffer and re-analysed. Typical Data An example of a typical calibration curve is represented below. This should not be used in the determination of Canine CRP Canine CRP Calibration curve 2.5 2 Absorbance 450nm 1.5 1 0.5 0 0 50 100 150 Canine CRP conc ng/ml 9
  • 10. Assay Reproducibility Two samples containing medium and low levels of Canine CRP were run in independent assays. To determine inter assay reproducibility the mean and the coefficient of variation (%CV) were calculated. Inter assay variation Control Level 1 Level 2 n 32 32 Mean (µg/ml) µ 14.9 34.6 Standard Deviation 1.2 2.7 %CV 8.2% 7.8% Two samples containing medium and low levels of Canine CRP were tested in a single assay. To establish intra assay reproducibility the mean and the coefficient of variation (%CV) were calculated. Intra assay Variation Control Level 1 Level 2 n 16 16 Mean (µg/ml) µ 15.4 35.8 Standard Deviation 1.1 2.3 %CV 6.9% 6.5% Limitations of Test The use of this test for the analysis of plasma samples has not been fully investigated. Haemolysed or lipaemic samples should not be used in the test. Ensure that serum samples are collected prior to administration of steroids. Waste Management Please refer to local legal requirements Quality Control Good laboratory practice suggests the use of control specimens to ensure proper assay performance. Laboratories should assess the Haptoglobin and CRP components of the Tri-Screen kit using Quality Control material. A separate set of additional Tri-Screen Quality Control sera are available specifically for use with this kit. In addition to values for both Haptoglobin and CRP at both Positive and Negative Lymphoma Levels, the use of this control material correlates with the Positive and Negative results range obtained when the results are input into the algorithm. Therefore the material acts to control both the diagnostic assay processes, the functioning of the algorithm and the overall result. This control may be purchased as a separate item (Catalogue no. TSC-501-CON). It is recommended the controls be included in every assay. New lots of control material should be analysed in parallel with the control material in current use. Controls should be monitored and charted on a day-to-day basis to analyse values and trends. 10
  • 11. Section 3: The Diagnostic Algorithm When results for Haptoglobin and CRP are obtained for each individual sample (or Control) the diagnostic interpretation is performed by accessing the patented Tri-Screen algorithm which is hosted on our Registered User’s website at www.tri-screen.net. The procedure for accessing and obtaining a diagnostic report is as follows: The first time you purchase a Canine Lymphoma Kit, please visit the website and register as a registered user. This will allow you to generate a unique user name and password which will allow you access to the user’s area of the website where you can input your results to obtain a diagnostic report. This is also designed to keep your own details, results and information confidential and secure. You are now registered and set up to input data on the Tri-Screen website, the next step is to perform your Haptoglobin and CRP assays and obtain results for both parameters. The same procedure applies whether you are inputing patient samples or control serum samples. When you have obtained results, sign in on the website using your username and password. If you have forgotten either your user name or password, please follow the procedure listed on the sign in page to retrieve them. When you sign in you will then be taken to the input page. Here you will be asked to input the unique identification code for your kit which can be found on the label attached to the inside of the lid of the kit box. You will then have access to the results page: here you can see the results from the tests you have carried out using this particular kit. You can also access stored or archived data or results and produce a report by selecting criteria from the data. Instructions for doing this are on the web page. The web page will also show how many tests are remaining for the unique code number for the kit. Each kit performs a maximum of 42 tests in duplicate and there are 55 result inputs for each kit to allow for errors. Input the data for your test samples: Name Age Breed Gender Date Clincal Signs Treatment And input the CRP and Haptoglobin results. Click “Calculate“ The Algorithm will produce one of three results with regard to the Lymphoma Diagnosis: Positive Negative Repeat In Two Weeks Positive and Negative are self-explanatory.“Repeat In Two Weeks“ indicates that the result falls into a range which is considered inconclusive and the recommendation is that the test is repeated in two weeks time. The Tri-Screen system of Haptoglobin, CRP and Algorithm produced a diagnostic efficiency for Canine Lymphoma of: Specificity: 93% Sensitivity: 85% 11
  • 12. Users should be aware that within the limits of the studies carried out, False Positive and False Negative results may occur in a small percentage of cases and that diagnosticians and clinicians should use the results obtained in conjunction with other symptoms to make a diagnosis. The manufacturers and providers cannot be held responsible for any loss, damage or injury caused as a result of reliance on the results of the Tri-Screen assay system. Additional Products in the Tri-Screen Range A specific Tri-Screen control material containing both CRP and Haptoglobin controls in the same serum is available. This consists of 2 x 1ml controls: Positive: Contains Haptoglobin and CRP in the Positive Range when tested with the algorithm. Negative: Contains Haptoglobin and CRP in the Negative Range when tested with the algorithm. These controls should be treated as samples and a result obtained for both CRP and Haptoglobin which should then be entered on the website as a Control Sample. In addition to values for both Haptoglobin and CRP at both Positive and Negative Lymphoma Levels, the use of this control material correlates with the Positive and Negative results range obtained when the results are input into the algorithm. Therefore the material acts to control both the diagnostic assay processes, the functioning of the algorithm and the overall result. This allows for the Haptoglobin, CRP and Algorithm to be controlled as part of the process. The control is available from Tridelta Development Ltd. or your Local Distributor as: Catalogue No. TSC-501-CON Tri-Screen Canine Lymphoma Control Serum. Tri-Screen Canine Lymphoma Detection Kits are a joint venture product of: Tridelta Development Ltd. PetScreen Ltd. Unit 7 Block F Biocity Maynooth Business Campus Pennyfoot Street Maynooth Nottingham County Kildare NG1 1GF Ireland United Kingdom Tel: +353 (0)1 6290635 Tel: +44 (0) 115 9124430 Fax: +353 (0)1 6290687 Fax: +44 (0) 800 6190280 www.trideltaltd.com www.pet-screen.com The dedicated Tri-Screen web site is at: www.tri-screen.net For Sales & Marketing, please contact Tridelta Development Ltd. as above or by Email to: sales@tri-screen.net For Technical Support, please contact PetScreen Ltd. as above or by Email to: technical@tri-screen.net 12