Request for Evaluation of Suspected Antibody Interference in an Immunoassay

The CRED offers a service for evaluation of specimens with suspected antibody interference, resulting in an immunoassay inconsistent with the clinical picture. It is possible to submit directly patient specimens for interference evaluation. You must fill out the form belown and click on « send electronic data ». Please note that it is essential to advise the Centre before sending any specimen.


Sender Identification

Name of sender : 

Title of sender :

Name of laboratory :

Address1 of laboratory :

Address2 of laboratory :

Address3 of laboratory :

Postal Code :

Telephone :

Fax :

E-Mail address :




Specimen Features

Specimen identification number :

Date of taking of blood sample (yy/mm/dd) :

Volume of specimen supplied :

ml (see Transport section)

Freeze Thawed sample :

no yes

How many times :

Presence of anticoagulants :

no yes

If yes, which one  :



Clinical Information

This information must be relevant to the time the specimen was taken.

Sex :

M F

Age :

Diagnosis  :

Treatment  :


Immunoassay Investigations

List immunoassay(s) performed on specimen and which demonstrate interference, and result obtained (If possible, include the method insert description) :

Give details of reagents used in the method(s) described above (antibodies, wash solutions, substrate, etc., and their lot numbers)  :


Have PREVIOUS SAMPLES from this patient been assessed using the same assay  :
no yes

If yes, describe the result obtained and the dates of sample collections  :


Other immunoassays performed on the same specimen :
no yes

If yes, describe the method and the results obtained (If possible, include the method insert description)  :



Additional Clinical and Laboratory Investigations

Give relevant details if other clinical tests have been performed on this specimen (Serology, Hematology, Biochemistry, etc.,) :

Give relevant details if other diagnostic investigations have been performed on this patient (e.g. immunolocalisation, fluorescein angiography, etc.,) :


Others Details that May be of Special Interest



Transport

  • It is essential to advise the Centre before sending any specimen;

  • Our investigation strategy will depend on the information supplied with the specimen;

  • If possible, include all the method description inserts;

  • Adequate volume for investigation is essential. Sample(s) of at least 3 ml (and by preference 10 ml or more if available) must be sent on dry ice securely packed, with a "perishable" label, using a rapid transportation service to:

Collaborative Research for Effective Diagnostics
Département de biochimie clinique
Centre Hospitalier Universitaire de Sherbrooke
3001, 12e Avenue Nord
Sherbrooke, Québec J1H 5N4
a/s Dr Charaf Ahnadi
Telephone: (819) 820-6812
Fax: (819) 820-6853

If you have any questions, comments or suggestions about this form, send an email to
Charaf Ahnadi, Ph.D.

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