Lab Matters Fall 2024 | Page 90

APHL 2024 POSTER ABSTRACTS

method to perform opioids testing to monitor non-fatal overdoses for public health surveillance . This method detects a panel of eight prevalent opioids ( Fentanyl , Norfentanyl , Norcarfentanil , Acetyl Fentanyl , Acryl Fentanyl , 4-ANPP , para-Fluorofentanyl and Carfentanil ) using liquid chromatography tandem mass spectrometry ( LC-MS / MS ) to analyze urine samples donated from local hospitals . LC-MS / MS is a powerful analytical tool that can be used to accurately detect opioids in human urine even at low concentrations . The combination of liquid chromatography to effectively separate target opioid analytes and tandem mass spectrometry to achieve a high degree of sensitivity and selectivity , allows for robust qualitative detection down to a level of 0.015ppb . By identifying the opioids present at the time of non-fatal overdose , the resulting data will determine the trends of opioid usage . This valuable data could be used to protect communities by helping to inform harm reduction measures and public safety initiatives . In July of 2023 , the NH PHL launched a pilot study and has received over 300 urine samples to date through successful collaboration with area hospitals . The lab is looking to enlist more local hospital partners to ramp up sampling to produce a more representative dataset of the opioid crisis in the state . Additionally , the laboratory plans to include additional opioid analytes and validate a qualitative method for a plasma matrix to expand the surveillance study . This pilot study is a partnership between the NH PHL , NH DHHS Injury Prevention program , local hospitals , health departments , HAZMAT , FBI , CSTE and the Northern New England Poison Center .

Presenter : Benjamin Niemi , Benjamin . C . Niemi @ dhhs . nh . gov

Quantitation of an Oral Fluid Drug Panel Including THC Using with High Resolution Accurate-mass ( HRAM ) Mass Spectrometry

C . Patterson , K . Hassell , Thermo Fisher Scientific

Introduction : As clinical and forensic communities move towards oral fluid for ease of collection and roadside testing , it is important to be able to test for a wide range of analytes and achieve required sensitivity . With the SAMHSA guidelines providing LOQ levels for certain drugs , the extraction protocol and instrumentation need to be sensitive enough to accomplish these cutoffs . Including tetrahydrocannabinol ( THC ) into the assay provides challenges in the extraction as most drugs of abuse are basic and THC is neutral . This extraction workflow , which extracts THC alongside other drugs of abuse , coupled with the Orbitrap mass spectrometer generates high-resolution accurate mass data that offers improved sensitivity , selectivity and accuracy for detection and quantitation of drugs of abuse in oral fluid .

Methods : Eight calibration levels ( ranging from 0.5 to 200 ng / mL ) were made by spiking stock solution of the 31 target analytes into human oral fluid . Samples were diluted with a preserving buffer and spiked with their corresponding internal standard . 500 µ L of each sample were then extracted using DPX INTip™ SCX / WAX SPE . Drug analytes were separated with on a Thermo Scientific™ Accucore™ Biphenyl column connected to a Thermo Scientific™ Vanquish™ Horizon UHPLC system using a fast 6-minute method . Data was acquired on the Thermo Scientific™ Orbitrap™ Exploris™ 120 mass spectrometer using data dependent MS2 mode ( ddMS2 ) with an inclusion list for the 31 target drugs . Thermo Scientific™ TraceFinder™ 5.2 software was used for data acquisition and processing .

Preliminary Data : Chromatography exhibited ample separation for isomers including codeine / hydrocodone and morphine / hydromorphone . This study was able to overcome some of the issues commonly associated with THC including “ stickiness ” of the drug to consumables and its susceptibility to being suppressed by oral fluid collection device buffers . Limits of quantitation ( LOQ ) were determined for the 31 drugs . LOQ was defined as the back calculated concentration where % difference and % RSD were less than 20 %. Lower limits were acceptable and many of the drugs surpassed the sensitivity required by SAMHSA . All 31 drugs were confirmed with mass accuracy of less than 5ppm , retention times and library matching .

Presenter : Jingshu Guo , jingshu . guo @ thermofisher . com

NEWBORN SCREENING AND GENETICS

Adapting Prenatal Metals Screening Procedures to New NJ Partners

E . Bind , S . Mustaqali , S . Li , A . Steffens , C . Yu , T . Fan , New Jersey Department of Health

Lead and mercury cross the placenta and can severely harm fetal brains and bodies , causing developmental issues . Further , these metals are known to cause harm to expectant mothers , including the risk of preeclampsia and other conditions . Early interventions reduce maternal and fetal levels of these toxic metals and improve health outcomes . NJ Biomonitoring ( NJB ) partners with the University Hospital ( UH ) in Newark , NJ to offer prenatal and perinatal toxic metals screening as standard-of-care to the patient population . Expectant mothers receive support through educational materials , free screening , medical treatment and environmental interventions . To date , NJB has analyzed specimens from over 15,000 patients and identified over 1,000 patients above the health limits ( 3.5 µ g / dL for lead and 5 µ g / L for mercury ) that would have otherwise gone undiagnosed . These data are specific to UH and do not represent NJ as a whole ; therefore , NJB is expanding this model to other hospitals to gather data from additional populations in the state and test the transferability of the model .

The study team is applying the model established and implemented for UH in Newark to St . Peter ’ s University Hospital in New Brunswick , NJ . New Brunswick has a higher foreign-born population and higher poverty rate than Newark , both of which are risk factors for exposure to lead and mercury . Implementation of this model includes creating an orderable test in the electronic medical records system and establishing protocols for blood collection ( at the first prenatal visit and at delivery ), specimen transportation and data transfer . Once established , NJB will train hospital staff from multiple departments on program background and protocols . Challenges encountered so far include the lack of on-site phlebotomy services , a nursing shortage and turnover at the leadership level .

St . Peter ’ s has installed a phlebotomy station in the hospital ’ s OBGYN clinic . Staffing challenges were addressed through the hiring of more nurses and new department heads were appointed in December . The data use and materials transfer agreements have been revised based on new NJ Department of Health privacy and security requirements and are in the signing stage . The original program model has remains unchanged despite these challenges .