The application of fully automated dried blood spot analysis for liquid chromatography-tandem mass spectrometry using the CAMAG DBS-MS 500 autosampler.

In the past decade, dried blood spot (DBS) sampling has been used increasingly for microsampling in various fields. This is predominantly driven by the significant advantages DBS offers regarding simple sample retrieval and shipment, combined with increased analyte stability. However, the manual handling of DBS samples is laborsome and prevents the use of a high-capacity bioanalytical workflow. The recent introduction of robotic DBS extraction systems in combination with liquid chromatography-tandem mass spectrometry (LC-MS/MS) has enabled the full automation of the analytical process. This results in overall higher sample throughput, minimal user interaction, and a significant reduction in consumables. Different instrumental setups are currently available which differ with respect to the extraction process, extract processing strategy, and internal standard application. This review article provides an overview of fully automated DBS analysis for one of these instruments, the DBS-MS 500 autosampler from CAMAG. The automated processes are described in detail and various applications are presented. Emphasis is placed on the advantages that the use of DBS, in combination with automation, brings - such as speed, reliability, and user-friendliness. Discussing DBS solutions for newborn screening, workplace drug testing, forensic screening, direct alcohol marker analysis, antiretroviral drugs, anti-epileptic drugs, and mass drug administration, the versatility and applicability of DBS are demonstrated in detail. In conclusion, this article shows how and why fully automated DBS analysis has penetrated the routine laboratory environment.