FAQs Aspire 2017

S

FAQs

Thrombocheck Total 2-5

Fibrometer Virus/NAFLD 6-10

tTG/DGP 11-12

Phadiatop 13-14

Sepsiscreen 15-16

Holo Tc 17-18

Calprotectin 19-23

AEP
(Autoimmune Encephalitis Panel) 24-25

Kidney Biopsy 26-27

HLA 28-30

Liver Biopsy 31-32

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FAQs on considered to be the most common
Thrombocheck Total cause of Venous Thrombosis.

Q1: Why MTHFR mutation test is not Q4: In anti cardiolipin antibody which
included in Thrombocheck Total? antibodies are used?

A: Dr, most common cause of A: IgM & IgG
hyperhomocystenemia is Vit B12 &
B6 deficiency. MTHFR mutation is Q5: Do you have more relevent data on
a rare cause of high homocysteine factor VIII?
levels. We have included
homocysteine levels in the panel, if A: Yes we have more data on that, in
the levels are high then you can ask fact BJH has published one review
1st for holoTC test. article in 2014 where in they found
Factor VIII has dose dependent risk
Q2: How many parameters are included of Venous Thrombosis.
in Thrombocheck Total?
Q6: What is the benefit of Free Protein
A: 12 Parameters, this panel is S Antigen levels in Thrombocheck
scientifically validated & most cost Total?
effective.
A: To diagnose protein S deficiency
Q3: Which journal recommends that protein S activity is not
Factor VIII Levels increases the risk recommended that’s why free
of Venous Thrombosis? protein S antigens level are used.

A: British Journal of hematology. In fact Q7: What is the role of anti Beta 2
now a days Factor VIII high levels is Glycoprotein or Functional assay of
Protein S ?
2
3

A: It is the most specific marker international guidelines including
of antiphospholipid Antibody BJH. Doing lesser no. of parameters
Syndrome &recommended as one in little less price will not help the
of the parameters to diagnose APLA patient. In fact we are the only
syndrome. company which is giving these
parameters at this price.
Q8: Why have you not Included
Prothrombin-20210 mutation in 5
this panel?

A: Because no case has been reported
in India so far.

Q9: If a patient is taking Anticoagulant
drug, Is Thrombocheck Total
useful or not?

A: No, you have to stop the drug for
minimum 2 weeks & ideally for
4 weeks.

Q10: Why so many parameters are
required when I can get few most
important parameters at lesser
price?

A: Dr, these are the most common
causes of Thrombosis &
recommended by various

4

FAQs on Fibrometer immediately with antiviral drugs
Virus/NAFLD and patient belonging to F4 require
low interferon dose, where as for
Q1: Is Fibrometer Virus validated for patients in F0-F1 the treatment can
HIV co-infection Patient? be delayed.

A: Yes Q5: Do you have any comparison which
tells Fibrometer Virus is better test
Q2: Fibrometer Virus reduces number than Fibroscan?
of liver Biopsies by about 30%.
Which guideline support this A: EASL guideline clearly says that
statement? both are equally good, but fibroscan
has some limitations like in obese
A: APASL(Asian Pacific Association for patients or early stages of fibrosis
the study of liver Disease). where FMV has very good accuracy.

Q3: What is the role of Alpha 2 Q6: What Inflammatory score reflects
Macroglobulin ? in Fibrometer Virus ?

A: Alpha 2 macroglobulin is a marker A: Micro Inflammation in the liver.
of chronic Inflammation.
Q7: Why are you using Urea in
Q4: What is the need of checking Fibrometer Virus?
Fibrosis?
A: It is a marker of Hepatic Failure.
A: Sustain Virological response is
dependend on Fibrosis stage, as per 7
the guidelines patient belonging
to F2 stage should be treated

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Q8: Is Fibrometer Virus validated recommended in NASH or NASH
for patient having Antivitamin k with fibrosis.Dr this test gives you
therapy? an evidence to start Vit E & also to
tell the patient about liver disease
A: No, it is not recommended. status.
Because it will change the values of
prothrombin Index. Note: USG can only pick fatty liver when
33% of liver is filled with fat and It
Q9: Why do you include age &gender will not tell about NASH or fibrosis
as a parameter?
Q11: Where have you validated FMN &
A: Because more the age, higher the has it been compared with liver
stage of fibrosis and progression of biopsy?
fibrosis is faster in males as compare
to females. A: Yes , there is one study on 235
patients where it was compared
Q10: Why do I need to diagnose NAFLD with liver biopsy & accuracy of the
if there is no treatment available? test is the highest among all blood
based tests available.
A: Dr ,you are right but as you are
aware that Liver is the most Recently two studies were also
common organ to be affected by published on FMN comparing with
obesity & Diabetes. If patient’s liver biopsy in AASLD 2015.
disease progresses to NASH or
fibrosis then there are high chances Moreover this test is recommended
of developing cirrhosis. To check for by EASL, API & APASL.
fibrosis only two tests are available
Fibroscan & Fibrometer NAFLD. 9
Moreover Vit E therapy is only

8

Q12: What is the use of Quantimeter? FAQs on tTG/DGP
A: Dr, this parameter has two
Q1: How is tTg/DGP better than plain
advantages tTg?
1. You can do a follow up of the
A: tTg is equally good screening test
patient on this score but in cases of IgA deficient patients
2. You can tell the patient this is falsely negative, thereby
leading to the misinterpretation
regarding degree of liver of the results. This combination
damage is better as it takes values for
antibodies-IgA IgG of ttg & IgA IgG
10 of DGP.

Q2: Any recommendations supporting
the usage of combination?

A: As per AJG-When screening
children younger than 2 years of
age for CD,the “IgA ttg ” test should
be combined with DGPs (IgA and
IgG).

A study from Postgraduate Institute
Of Medical Education and Research
,Chandigarh The IgG DGP and IgA
tTg in combination are an excellent
screening algorithm for suspected
cases of CD

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Q3: Can this combination of tTg DGP FAQs on Phadiatop
be used for monitoring also?
Q1: What is the advantage of Phadiatop
A: As this combination contains IgG over Total IgE as the “Screening
value also, it cannot be used for test”when atopic allergy is
monitoring purpose because once suspected?
IgG values are increased it takes
years to come down. A: Only Around 50% of patients with
respiratory allergies have total
12 IgE(>100KU/I) ,which in fact means
that 50% with normal total IgE will
not be identified by total IgE testing.
The Total IgE level is the sum of
all IgE in the blood. which can be
increased due to other reasons
than allergy. Instead Phadiatop is
recommended with its superior
performance, which only measures
allergen-specific IgE antibodies to
common allergens and not the total
amount where irrelevant IgE could
be included.

Total IgE can be Increased due
to reasons other than allergy.
Parasites(e.g Ascaris,Schistosoma)
Virus & bacterial infections(e.g
RSV,Staph.) Graft Versus Host

13

Disease (GVHD) Hyper–IgE FAQs on Sepsiscreen
Syndrome .
Q1: How is Sepsiscreen better than
Q2: Are the important local/native culture?
allergens included in the test?
A: The TAT is much faster for
A: The common allergens are in Sepsiscreen than for culture(13 to
principle the same worldwide such 75 h faster than BC).Also ,we are
as animal, mite and mold. Other detecting both cultivable and non
such as different pollen cross-react cultivable bacteria in Sepsiscreen
to a high degree within each group, those are missed in normal
so even if not exactly the specific culture method as well as fungi.
pollen for our local area/state/ Also,it detects 67% more relevant
country, Phadiatop has checked infections than culture.
locally in each market to ensure its
efficiency to indentify allergy. Q2: Are there any false positive results?

14 A: No false positive with dead
pathogen DNA ,because here we
take only the live bacterial DNA &
remove all human DNA as well as
dead bacteria DNA.

Q3: Can it detect mixed infections?

A: Yes. it identifies each organism
which is present in the sample as
it is a molecular test &we separate
DNA of live bacteria which is the

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mapped the gene library &thus FAQs on Holo Tc
there are chances of more than
one pathogens Q1: What is holo Tc?
Q4: What is the sensitivity and
specificity of Sepsiscreen? A: Holo Tc(Holotranscobalamin) is the
A: Sensitivity and specificity :88.5% and Biologically active form of Vit B12
85.8% respectively in comparison to
culture Q2: Do you have any supporting
Q5: Can tissue sample be used? guidelines\journals which say Holo
A: Tissue Sample can also be accepted Tc is more accurate marker of Vit
like Endocarditis biopsy or joint B12 deficiency?
infection biopsy.
A: American Journal of Clinical
16 Nutrition&British Journal of
Hematology says Holo Tc is more
accurate marker than Total Vit b12

Q3: What is the need of Holo Tc testing,
when Total Vit B12 is available
easily and its price is also low
compared to Holo Tc.

A: Because >50% of patient with Vit
B12 deficiency may have normal
Vit B12 levels. Holo Tc is the earliest
and more accurate marker of VitB12
Deficiency.

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Q4: WhatisthecutofpointvalueofHoloTc? FAQs on Calprotectin

A: 35pm\l Q1: What is Calprotectin?

Q5: What is the hematological effect of A: Calprotectine is a protein and
Vit B12 deficiency? is produced from Neutrophil of
inflamed intestine.
A: Patient with Vit B12 deficiency leads
to Macrocytic Anemia Q2: Why to use Calprotectin ?

Q6: If a patient is taking Metformin is A: Calprotectininstoolofferssignificant
there any effect on Vit B12? advantages in the evaluation of
intestinal inflammation. It has
A: Yes Dr, Metformine reduces Vit B12 been observed that Calprotectin
absorption and patient develops Vit is extremely stable in faeces, even
B12 deficiency. for more than 7 days, at room
temperature. In the presence
Q7: What is clinical utility of HoloTC? of inflammatory processes,
Calprotectin is concentrated in
A: • To diagnose Vit B12 deficiency inflamed tissues and the increased
early & accurately level of faecal Calprotectin in IBD
is an index of neutrophils excretion
• Screening, monitoring and from the intestinal mucosa into the
detecting the absorption intestinal lumen and, therefore,
defect of Vit 12. into stool.

Q8: Which type of patients are at high 19
risk of Vit B12 deficiency?

A: Pure vegetarians are at high risk of
Vit B12 deficiency

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Q3: What advantages does Calprotectin • In few cases, fever and
offer? weight loss caused by
decrease in appetite or
A: Calprotectininstoolofferssignificant malabsorption (decrease of
advantages in the evaluation of 10-15 kg may occur in a short
intestinal inflammation. In IBD time)
patients, the level of Calprotectin
is very high, while in IBS patients Q5: Why Calprotectin levels in stool
Calprotectin level is higher than may be elevated in case of acute
healthy patients but definitely infection of the upper respiratory
lower than concentration found in tract?
active IBD patients.
A: The presence of an inflammatory
Q4: What symptoms would suggest to process of the upper respiratory
assay Calprotectin in stool ? tract involves the formation of
mucus that contains Calprotectin.
A: The most common symptoms are as After swallowing, mucus reaches
follows: the bowel and may lead to
an increased concentration
• Recurrent diarrhea, regardless of Calprotectin, not due to an
of the amount and/or the inflammatory bowel disease. Before
presence of blood performing the Calprotectin assay,
it is useful to know the possible
• Presence of mucus in stool presence of inflammation in the
upper respiratory tract in order to
• Diarrhea often presenting avoid a false positive result.
with even severe abdominal
pains (in some cases may be 21
mistaken as appendicitis)

20

Q6: How often Calprotectin can be may increase the concentration
used in the follow-up IBD patients? of Calprotectin. It is therefore
necessary to know whether the
A: The follow-up of IBD patients patients use this kind of drug.
subjected to drug treatment is Q8: How Calprotectin is useful in
carried out according to criteria relapse of IBD?
that may vary depending upon the A: In IBD patients, there are instances
status of the patient, response to when the patients have an episode
treatment and clinical remission. of diarrhea without blood or
Under average conditions, increase stool frequency which can
Calprotectin assay should be or cannot be the relapse cases of
done 2-3 times/year to check the IBD. So to confirm the IBD relapse in
trend of the fecal Calprotectin such state we use Calprotectin.
concentration. The decrease of
Calprotectin values down to normal 23
levels in a short period of time is
usually an indication of a better
prognosis.

Q7: Is Calprotectin concentration
influenced by the use of NSAID
(Non- Steroid anti inflammatory
Drugs) ?

A: The intake of large quantities of
non-steroidal anti-inflammatory
drugs (NSAIDs) may lead to
inflammatory processes that

22

FAQs on AEP A: You are correct doctor. But, though
(Autoimmune the majority of cases are related to
Encephalitis Panel) NMDA and VGKC, there are cases
those are due to Type AMPA 1 Abs,
Q1: What are the components of AEP? ANTI- GABA RECEPTOR (GABARB1/
B2) ABS. It will help you not to miss
A: • ANTI- GLUTAMATE RECEPTOR out on the exact etiology.
(TYPE NMDA) ABS
Q3: The incidences of AMPA or GABA
• ANTI-CASPR2 (CONTACTIN- related AIE is low, so can I do these
ASSOCIATED PROTEIN 2) ABS, in stepwise after a NMDA Plus Rx ?

• ANTI GLUTAMATE RECEPTOR A: Yes but in that case you will lose
(TYPE AMPA1) ABS, time and will repeat testing for
NMDA AND VGKC as test for AMPA
• ANTI LGI1 (LEUCIN-RICH and GABA antibodies are not done
G L I O M A - I N A C T I VAT E D alone but along with NMDA and
PROTEIN) ABS, VGKC in AEP.

• ANTI GLUTAMATE RECEPTOR Q4: Do you also test for paraneoplastic
(TYPE AMPA2) ABS, limbic encephalitis?

• ANTI- GABA RECEPTOR A: Yes.
(GABARB1/B2) ABS
25
Q2: Your NMDA PLUS ( NMDA+VGKC)
is good enough as most of AIE is
due to these auto antibodies. Why
should I prescribe AEP then?

24

FAQs on Kidney Biopsy diagnostic method particularly in
biopsies with glomerulonephritis
Q1: What are the different types of with monoclonal IgG deposits
Kidney biopsies we perform?
Q4: What reflexes do we have in Kidney
A: • Kidney Biopsy Native Biopsy Transplant?

• Kidney Biopsy Transplant A: SV 40 and IF

Q2: What are the two reflexes that we Q5: In which media the sample are
provide in Kidney Biopsy Native? preserved/transported ?

A: IGG Subclasses and PLA2R A: • For LM – Tissue in Formalin

Q3: Are IgG subclasses required in all • For IF – Tissue in Michel’s
cases ? media / Normal saline

A: IgG subclass staining is useful • For EM – Tissue in
in differentiating primary Glutaraldehyde
from secondary membranous
glomerulonephritis. Q6: What does IF and IHC stand for?
Which one is better?
In proliferative glomerulonephritis
with polyclonal IgG deposition, A: • IF stands for
IgG1 dominance/codominance with
concomitant IgG3 and IgG2 but I m m u n o f l o u r e s c e n c e
weak or absent IgG4 staining favors
an underlying autoimmune disease. and IHC stands for
IgG subclass staining is a very useful
Immunohistochemistry.
26
• IF is better than IHC.

27

FAQs on HLA Q3: What are the advantages of
Histospot?
Q1: What tests are performed in HLA
Centre of Excellence A: High sensitivity and specificity than
standard serology method Provides
A: • HLA typing, automation for more reliable
• CDC- Crossmatch and accurate results upto 4 digit
• Recipient Antibody status A*02:01 Fully automated human
(Pos/ Neg) error free.
• Class I Antibody detection
(PRA%) & Class II Antibody Q4: By which technique Antibodies (
detection (PRA%) SAB and DSA) are detected in COE?
• DSA (donor specific IgG
antibodies to Class I & II) A: Luminex
• Single antigen Class I (A B C
loci) & (B) Single antigen Class Q5: What is the difference between
II (DR DQ loci) CDC and Flow Cytometery?

Q2: By which method HLA testing is A: Flow is more sensitive than CDC and
done by us? can detect low levels of antibodies

A: Histospot SSO PCR Q6: What is MFI

28 A: MFI (Mean Flouroscence Intensity)
to measure the antibody status

Q7: What does more MFI signify?

A: Strong antibody status.

29

Q8: What resolution COE provides in FAQs on Liver Biopsy
HLA typing?
Q1: What are the indications for Liver
A: Intermediate resolution (Upto Biopsy?
4 digits)
A: • Chronic Liver Disease
Q9: What are the documents required • Assessment of fibrosis
for CDC cross match, Flow cross • Liver transplant dysfunction
match, DSA and SAB • Systemic disease with Liver
dysfunction
A: Photocopy of-PAN card/AAdhar
Card/Passport etc. And Centre of Q2: What are the tests included in
Excellence TR with colour photo complete evaluation of Liver
affixed and attested by referring biopsy?
doctor with sign and stamp.
A: • Light microscopy
Q10: What is the TAT of HLA typing • Special Stains
A: 2 days Daily run except on Sundays • Immunohistochemistry
Q11: What is TAT Single antigen Bead • Immunofluorescence
A: Run days- Wednesday and Saturday.
Q3: What are the different stains used
Report- 2 days for?

30 A: Fibrosis/ copper / iron / amyloid

31

Q4: What is PFIC?
A: Progressive familial intrahepatic

cholestasis  .
Q5: What panel we do for PFIC?
A: MDR3 and BSEP
Q6: What are the antibodies we are

testing for?
A: Alpha1 antitrypsin, Glypican 3,

Glutamine synthetase, Arginase, CK
8/18
Q7: What is the TAT?
A: 3 working days.

32 33

Name: ........................................................
HQ: .............................................................
Mob.: ..........................................................
Emergency No.: ..........................................
Blood Group: .............................................
Address: .....................................................
....................................................................
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