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• Harmonization of lipid profiles across European laboratories is poor. • Two-thirds of laboratories use nonfasting lipid measurements. • Less than 50% of laboratories flag guideline-recommended LDLC thresholds. • Less than 50% of laboratories automatically calculate non-HDLC. • Less than one-fourth of laboratories apply alert values for FH. The CArdiac MARker Guidelines Uptake in Europe Study (CAMARGUE) initiated by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) aims to survey the current use of evidence-based guidelines for dyslipidemia testing in Europe. In 2019 a web-based questionnaire was distributed via EFLM National Societies to clinical laboratories in Europe. Questions covered pre-analytics, analytical methods, measurement units, flagging of decision thresholds, and use of decision-enhancing comments. Returns were obtained from 452 laboratories from 28 countries. Most laboratories always use nonfasting blood samples for lipid assays (66%). Lipid profiles are reported in mmol/L by 59% of the laboratories, mainly from 14 countries promoting the use of SI units. Important differences in flagging of decision thresholds were observed, with less than half of the laboratories applying the guideline-recommended LDL cholesterol threshold. Only 17% of the laboratories add an alert comment when familial hypercholesterolemia is suspected and 23% when risk of pancreatitis from hypertriglyceridemia is high. There are marked differences among laboratories in Europe in terms of pre-analytical, analytical, and post-analytical lipid management that could have an important clinical impact. This relates to different availability of assays or different laboratory practices on reporting and flagging of lipid profiles. [ABSTRACT FROM AUTHOR]

Abstract: Harmonisation is likely to be an important contributor to ensure high quality laboratory testing, thus potentially improving patient outcome. Efforts for harmonisation must be made in the total testing process, from test requesting to communication of the laboratory test results and its consequences to the patient. In this article, suggestions are given about what level of harmonisation is possible at the various steps of the testing process, who could be responsible for facilitating and monitoring the effects of harmonisation, and what are likely barriers to achieving harmonisation. Harmonisation can be achieved at local, national and international levels, and will be most challenging when it involves more than one profession as in the extra-analytical phases. Key facilitators will be laboratory associations, regulatory bodies and accreditation systems, whereas barriers are likely to be reimbursement systems or economic factors, opinion leaders and manufacturers. A challenge is to try to turn barriers into facilitators. Harmonisation effects can in most settings be monitored by external quality assurance organisations provided that schemes are expanded to cover all relevant steps and phases. We must combine our efforts, both within our profession as well as in cooperation with others, to achieve harmonisation of the total testing process, in the best interests of the patient. [Copyright &y& Elsevier]

The worldwide clinical and scientific interest in peptides belonging to the insulin-like growth factor (IGF) system has brought along a call for standardization of assays used to quantify the different IGF related proteins. This relates in particular to the measurement of IGF-I, which has stood the test of time as an important biochemical tool in the diagnosis and treatment of growth hormone (GH) related disorders. The first international consensus statement on the measurement of IGF-I in 2011 represents an important milestone and will undoubtedly improve commutability of reference ranges for IGF-I and clinically applicable cut-off values. By contrast, there is no consensus addressing the measurements of the other IGF-related peptides. Nevertheless, measurement of these peptides may be of interest, either as additional tools in GH disorders or as prognostic biomarkers of various diseases. Therefore, standardization of assays for the other IGF-related peptides is highly relevant. This chapter discusses the recent consensus on IGF-I measurements and how this approach may be applied to measurement of the other IGF-related peptides. In addition, assay pitfalls, pre- and post-analytical challenges, alternative methods for IGF-I measurements and potential assays of tomorrow will be discussed. [Copyright &y& Elsevier]

The endocrine laboratory must provide accurate and timely results for the critically ill patient. A number of pathophysiological factors affect assay systems for adrenal, thyroid and gonadal function tests. The effects are primarily on estimates of ‘free hormone’ concentration through abnormal binding protein concentrations and the effects of drugs and metabolites on hormone-protein binding. The limitations of the principal analytical techniques (immunoassay and chromatography-mass spectrometry) include drug effects, endogenous antibody interference and ion suppression. These effects are not always easily identified. Analytical specificity and standardisation result in differences in bias between assays and thus a requirement for assay specific decision limits and reference ranges. Good communication between clinician and laboratory is needed to minimise these effects. Developments in mass spectrometry should lead to greater sensitivity and wider applicability of the technique. International efforts to develop higher order reference materials and reference method procedures should lead to greater comparability of results. [Copyright &y& Elsevier]