Beta‐2 transferrin is detectable for 14 days whether refrigerated or stored at room temperature

Zervos, Thomas M; Macki, Mohamed; Cook, Bernard; Schultz, Lonnie; Rock, Jack; Craig, John R.

doi:10.1002/alr.22136

Cited by 15 publications

(6 citation statements)

References 10 publications

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“…Regarding fluid storage, no studies have reported false results based on storage duration or temperature. On the contrary, two studies have demonstrated that B2‐Tf remains detectable in CSF after 1–2 weeks of storage at refrigerated or room temperatures 46,47 …”

Section: Discussionmentioning

confidence: 99%

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Systematic review of errors on beta‐2 transferrin gel electrophoresis testing of rhinorrhea and otorrhea

Eide,

Mason,

Ray

et al. 2023

Int Forum Allergy Rhinol

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BackgroundBeta‐2 transferrin (B2‐Tf) gel electrophoresis (GE) is the preferred non‐invasive diagnostic modality for confirming cerebrospinal fluid (CSF) in body fluids. While B2‐Tf GE testing is highly sensitive and specific for CSF, false‐positive (FP) and false‐negative (FN) results can lead to diagnostic and therapeutic dilemmas. Several series have demonstrated potential causes of false B2‐Tf GE results, but few studies have reported reasons for these errors. The purpose of this systematic review was to describe sources of B2‐Tf GE errors.MethodsA systematic review was performed by searching OVID, EMBASE, and Web of Science databases for B2‐Tf GE studies. After applying exclusion criteria, original research studies directly addressing erroneous B2‐Tf GE results underwent qualitative analysis.ResultsOf the 243 abstracts screened, 71 underwent full‐text review and 18 studies reporting B2‐Tf GE errors were included for analysis. There were 15 potential FPs, 12 actual FPs, 12 potential FNs, 19 actual FNs, and 14 indeterminate results. There were also 246 potentially indeterminate results from in vitro studies. Reasons for B2‐Tf GE errors included serum transferrin alterations (n = 17; all potential), infection related (n = 13; 9 potential), orbital or salivary contamination (n = 2; 1 potential), and collection related (n = 255; 246 potential). There were 31 false or indeterminate results with unspecified reasons. There were no reported errors due to laboratory processing.ConclusionsMultiple potential or actual reasons for false or indeterminate results have been reported for B2‐Tf GE testing of rhinorrhea and otorrhea. Future studies should explore reasons for B2‐Tf testing errors and how these may affect clinical decision making.

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Section: Discussionmentioning

confidence: 99%

“…On the contrary, two studies have demonstrated that B2-Tf remains detectable in CSF after 1-2 weeks of storage at refrigerated or room temperatures. 46,47…”

Section: Collection Relatedmentioning

confidence: 99%

Systematic review of errors on beta‐2 transferrin gel electrophoresis testing of rhinorrhea and otorrhea

Eide,

Mason,

Ray

et al. 2023

Int Forum Allergy Rhinol

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“…3 Patients can collect fluid at home over 1-2 weeks at room or refrigerated temperatures. 35,36 However there are logistical issues to consider. First, patients may not be able to obtain enough fluid for testing, as most studies suggest collecting 0.5-2 mL.…”

Section: Discussionmentioning

confidence: 99%

Using Ipratropium Bromide Nasal Spray Response as a Screening Tool in the Diagnostic Workup of Cerebrospinal Fluid Rhinorrhea

Nulty¹,

Mason²,

Peterson

et al. 2023

The Laryngoscope

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ObjectivesUnilateral clear thin rhinorrhea (UCTR) can be concerning for a nasal cerebrospinal fluid (CSF) leak. Beta‐2 transferrin electrophoresis has been the gold standard for initial non‐invasive confirmatory testing for CSF rhinorrhea, but there can be issues with fluid collection and testing errors. Ipratropium bromide nasal spray (IBNS) is highly effective at reducing rhinitis‐related rhinorrhea, and should presumably not resolve CSF rhinorrhea. This study assessed whether different clinical features and IBNS response helped predict presence or absence of CSF rhinorrhea.MethodsA prospective cohort study was conducted where all patients with UCTR had nasal fluid tested for beta‐2 transferrin, and were prescribed 0.06% IBNS. Patients were diagnosed with CSF rhinorrhea or other rhinologic conditions. Clinical variables like IBNS response (rhinorrhea reduction), positional worsening, salty taste, postoperative state, female gender, and body‐mass index were assessed for their ability to predict CSF rhinorrhea. Sensitivity, specificity, and predictive values and odds ratios were calculated for all clinical variables.ResultsTwenty patients had CSF rhinorrhea, and 53 had non‐CSF etiologies. Amongst clinical variables assessed for predicting CSF absence or presence, significant associations were shown for IBNS response (OR = 844.66, p = 0.001), positional rhinorrhea worsening (OR = 8.22, p = 0.049), and body‐mass index ≥30 (OR = 2.92, p = 0.048). IBNS response demonstrated 96% sensitivity and 100% specificity, and 100% positive and 91% negative predictive values for predicting CSF rhinorrhea.ConclusionsIn patients with UCTR, 0.06% IBNS response is an excellent screening tool for excluding CSF rhinorrhea, and should be considered in the diagnostic workup of CSF rhinorrhea.Level of Evidence2 Laryngoscope, 2023

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“…Though originally thought to be 7 days, 24 recent analysis suggests the fluid may be stable up to 14 days after collection at room temperature. 25 Assuming the fluid is tested within this time frame, the results relies on a qualitative analysis and interpretation of the presence of bands that may suggest B2T. That lack of quantitative testing can lead to human error.…”

Section: Current Methods In Diagnosismentioning

confidence: 99%

“…This can lead to a multiday interval between collection and test result, which raises concerns about the time interval that the fluid can accurately be tested after collection, especially in cases where the specimen is collected and returned on the patient's own time. Though originally thought to be 7 days, 24 recent analysis suggests the fluid may be stable up to 14 days after collection at room temperature 25 . Assuming the fluid is tested within this time frame, the results relies on a qualitative analysis and interpretation of the presence of bands that may suggest B2T.…”

Section: Current Methods In Diagnosismentioning

confidence: 99%

Multimodal diagnosis of cerebrospinal fluid rhinorrhea: State of the art review and emerging concepts

Torabi,

Abiri,

Chen

et al. 2024

Laryngoscope Investig Oto

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ObjectiveCurrently, diagnosis of cerebrospinal fluid (CSF) rhinorrhea relies on a multimodal approach, increasing costs and ultimately delaying diagnosis. In the United States and internationally, the crux of such a diagnosis relies on confirmation testing (via biomarkers) and localization (e.g., imaging). Biomarker testing may require analysis at an outside facility, resulting in delays diagnosis and treatment. In addition, specialized imaging may be nonspecific and often requires an active leak for diagnosis. There remains a clear need for innovative new technology.MethodsA comprehensive review was conducted on both foundational and innovative scholarly articles regarding current and emerging diagnosis modalities for CSF.ResultsCurrent modalities in CSF rhinorrhea diagnosis and localization include laboratory tests (namely, B2T immunofixation), imaging (CT and/or MRI) with or without intrathecal administration, and surgical exploration. Each of these modalities carry flaws, risks, and benefits, ultimately contributing to delays in diagnosis and morbidity. Promising emerging technologies include lateral flow immunoassays (LFI) and biologically functionalized field‐effect transistors (BioFET). Nevertheless, these carry some drawbacks of their own, and require further validation.ConclusionCSF rhinorrhea remains a challenging diagnosis, requiring a multimodal approach to differentiate from nonpathologic causes of rhinorrhea. Current methods in diagnosis are imperfect, as the ideal test would be a readily accessible, inexpensive, rapid, highly accurate point‐of‐care test without the need for excess fluid or specialized processing. Critical work is being done to develop promising, new, improved tests, though a clear successor has not yet emerged.Level of EvidenceN/A

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Beta‐2 transferrin is detectable for 14 days whether refrigerated or stored at room temperature

Abstract: Beta-2 transferrin remained detectable for 14 days in all CSF samples, regardless of being stored at 4°C or room temperature.

Cited by 15 publications

References 10 publications

Systematic review of errors on beta‐2 transferrin gel electrophoresis testing of rhinorrhea and otorrhea

Systematic review of errors on beta‐2 transferrin gel electrophoresis testing of rhinorrhea and otorrhea

Using Ipratropium Bromide Nasal Spray Response as a Screening Tool in the Diagnostic Workup of Cerebrospinal Fluid Rhinorrhea

Multimodal diagnosis of cerebrospinal fluid rhinorrhea: State of the art review and emerging concepts

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