Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Psychiatry Southwest, Stockholm Healthcare Services, Stockholm, Sweden; Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden.
Micro and Nanosystems, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden.
J Pharm Biomed Anal. 2023 Apr 1;227:115269. doi: 10.1016/j.jpba.2023.115269. Epub 2023 Jan 29.
Lithium is a cornerstone in the treatment of bipolar disorder and is considered one of the most effective treatments in psychiatry at large. Lithium treatment requires individual dosing with frequent serum concentration measurements due to the narrow therapeutic window and risk of toxicity. There is need for patient-centric methods for lithium monitoring and the use of dried blood spots has recently been proposed for determination of lithium concentration. The purpose of the current study was to assess feasibility of this method by introducing a volumetric technique developed for home-sampling.
Laboratory: Capillary blood was sampled by finger-prick using a volumetric device that collects 10 µL volumes as a dried blood spot. Lithium was measured in the dried blood spots using a validated atomic absorption spectroscopy method.
Thirty-nine lithium-treated patients were recruited, and dried blood spots and venous blood samples were collected. Routine serum analysis was performed for comparison.
The range of serum lithium concentrations was 0.41-1.22 mmol/L, and the dried blood spot/serum ratio was 0.78. A strong linear correlation between the two specimens was shown with Pearson's R = 0.95 (r = 0.90). Adding hematocrit as a variable only minimally improved prediction.
Volumetric dried blood spots is a promising technique for measurement of lithium concentrations. This will enable home-sampling and could potentially save resources, improve compliance, and make treatment safer. This may facilitate the use of lithium treatment in regions where monitoring via venous blood sampling remains difficult. However, the usability of dried blood spots for monitoring lithium treatment longitudinally remains to be examined.
锂是治疗双相情感障碍的基石，被认为是精神病学中最有效的治疗方法之一。由于治疗窗狭窄和毒性风险，锂的治疗需要进行个体化剂量，并经常进行血清浓度测量。需要以患者为中心的锂监测方法，最近已经提出了使用干血斑来确定锂浓度。本研究的目的是通过引入一种用于家庭采样的体积技术来评估这种方法的可行性。
实验室：使用一种可采集 10µL 体积的体积设备，通过手指穿刺采集毛细血管血，形成干血斑。使用经过验证的原子吸收光谱法测定干血斑中的锂。
招募了 39 名锂治疗患者，采集了干血斑和静脉血样本。进行常规血清分析以进行比较。
血清锂浓度范围为 0.41-1.22mmol/L，干血斑/血清比值为 0.78。两种标本之间显示出很强的线性相关性，Pearson R = 0.95（r = 0.90）。添加血细胞比容作为变量仅略微改善了预测。
体积式干血斑是测量锂浓度的一种很有前途的技术。这将使家庭采样成为可能，并有可能节省资源、提高依从性、使治疗更安全。这可能有助于在通过静脉血采样监测仍然困难的地区使用锂治疗。然而，干血斑在监测锂治疗的纵向使用方面的可用性仍有待检验。
