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VALIDASI METODE KIMIA KLINIK...Linearity = Analytical Measurement Range (AMR) Assigned value...

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Curriculum Vitae Nama: Dr. Lucia Herminawati, Apt. TTL: Jakarta, 19 Agt 1979 Pekerjaan: QA Manager di PT Prodia Diagnostic Line (ProLine) Riwayat Pendidikan: 1997 2001 : S1 Farmasi Universitas Surabaya 2001 2002 : Program Profesi Apoteker 2010 2012 : S2 Kimia Klinik Universitas Hassanudin Makassar 2012 2015 : S3 Biomedik Universitas Hassanudin Makassar
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Page 1: VALIDASI METODE KIMIA KLINIK...Linearity = Analytical Measurement Range (AMR) Assigned value Measured value Rep. 1 Rep. 2 Rep.3 Mean 0 0 5 10 5 100 95 100 105 100 200 200 195 205 200

Curriculum Vitae

Nama: Dr. Lucia Herminawati, Apt.

TTL: Jakarta, 19 Agt 1979

Pekerjaan: QA Manager di PT Prodia Diagnostic Line (ProLine)

Riwayat Pendidikan:

1997 – 2001 : S1 Farmasi Universitas Surabaya

2001 – 2002 : Program Profesi Apoteker

2010 – 2012 : S2 Kimia Klinik Universitas Hassanudin Makassar

2012 – 2015 : S3 Biomedik Universitas Hassanudin Makassar

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VALIDASI

METODE

REAGEN KIMIA

KLINIK

Lucia Herminawati

Purwokerto, 06 Oktober 2019

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VALIDASI

Konfirmasi, melalui penyediaan bukti

objektif, bahwa persyaratan bagi

pemakaian atau persyaratan formal

dimaksud telah dipenuhi.

what?

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akreditasiPengakuan formal kepada suatu lembaga untukmelakukan kegiatan tertentu, yang telah memenuhistandar yang ditetapkan.

why?

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Apa persyaratan ISO 15189?

5.5.1.3 Validasi prosedur pemeriksaan

Laboratorium harus mem-validasi prosedur pemeriksaan yang berasal dari sumber-

sumber berikut:

a) Metode non-standar;

b) Metode yang dirancang atau dikembangkan oleh laboratorium;

c) Metode standar yang digunakan di luar lingkup yang dimaksudkan;

d) Metode tervalidasi yang kemudian dimodifikasi,

Validasi harus seluas yang diperlukan dan memastikan, dengan memberikan bukti

obyektif (dalam bentuk spesifikasi kinerja), bahwa persyaratan tertentu untuk

penggunaan yang diinginkan dari pemeriksaan telah terpenuhi.

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Non standard method

Laboratory design by developed method

Modified validated methode

VALIDATION

Before use as diagnostic test method

Define performance characteristic

Existing method

with defined performance

Existing methode used after repair

VERIFICATION

Before use as diagnostic test method

Compare performance characteristics with

specification

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REAGEN KIMIA KLINIK?

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Manufaktur sudah melakukan validasi metode, kemudian

mengapa laboratorium harus melakukan uji performa lagi ?

Beberapa faktor yang dapat mempengaruhi performa:- Efek pengiriman dan penyimpanan- Perbedaan lot kalibrator dan reagen- Perubahan pada persediaan & distributor komponen instrumen- Kondisi kontrol terhadap iklim lokal- Kualitas air- Stabilitas arus listrik- Ketrampilan operator

Verifikasi diperlukan untuk membuktikan bahwa metode yang digunakan bekerja dengan baik sesuai kondisi di Laboratorium memberikan hasil tes yang terpercaya bagi pasien.

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A practical validation approach

Performance CLIA CAP

AccuracyMethod comparison

+ +

PrecisionReplication experiment

+ +

Reportable rangeLinearity experiment

+ +

Reference range - Established + +

Analytical sensitivityLimit of detection study

Not required Not required

Analytical specifityInterference study

Not required Not required

Recovery to determine proportional systematic error Not required Not required

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precision

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standard

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presisi

– Hitung Mean, SD, dan CV untuk setiap tes CV yang

diperoleh secara statistik dibandingkan dengan klaim

manufaktur menggunakan signifikansi tes ANOVA

(umumnya pada tingkat kepercayaan 95%)

– Diterima jika CV within run < 1/4 TEaCV intermediate < 1/3 TEa

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Assume TEa = 10%, CV within run < 2.5%, CV Between Day < 3%

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METHOD

COMPARISON

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standard

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Studi minimal yang direkomendasikan

Dilakukan terhadap 40 sampel pasien

(bisa menggunakan 20 sampel jika memiliki rentang analitik

yang lebar)

Pengujian pada ≥ 5 hari yang berbeda;

Plot data pada grafik perbandingan;

Gunakan statistik regresi atau t-test

Westgard JO, Basic Method Validation, 3rd, 2008.

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Periksa nilai r (koefisien korelasi):

r < 0.975 analisis regresi linier mungkin tidak valid; Mungkin indikasi rentang data terlalu terbatas (r dipengaruhi rentang nilai).

r hanya dipengaruhi oleh RE, tidak oleh SE. r = istilah statistik = derajat hubungan linier antar metoda.

y = ax + ba = slope (indikasi proportional error) b = intercept (indikasi constant error)

Studi minimal yang direkomendasikan

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– Jika r > 0.975

Hitung SE pada kadar yang penting untuk membuat keputusan

klinis (medical decision level)

– y = ax + b

Contoh: y = 0.985 x - 4.69.

Pada decision level x = 200 mg/dL y = 192.31 mg/dL SE =

7.69 mg/dL atau 3.85 %.

Studi minimal yang direkomendasikan

SE = standard error

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y = 1.05 x + 0.680r = 0.9992

Pada decision level x = 120 mg/dL y = 126.68 mg/dL SE = 6.68 mg/dL atau 5.57 %.

Perbandingan Metode

Nama Produk : Glucose Hexokinase FSMaterial sampel : serum pasien, serum kontrolInstrument : respons 910

X: Hitachi 911 Glucose Hexokinase FS Unit: mg/dL

Y: respons910 Glucose Hexokinase FS Unit: mg/dL

Studi minimal yang direkomendasikan

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linearity

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CLSI Guidelines

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Linearity = Reportable Range / Analytical Measurement Range (AMR)

Reportable range = the span of test result values over which the laboratory can establish or verify the accuracy of the system.

AMR = range of analyte where results are proportional to the TRUE concentration of analyte in the sample.

HOW

Westgard JO, Basic Method Validation, 3rd, 2008.

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Linearity = Analytical Measurement Range (AMR)

Assigned value

Measured value

Rep. 1 Rep. 2 Rep.3 Mean

0 0 5 10 5

100 95 100 105 100

200 200 195 205 200

300 310 300 290 300

400 380 390 400 390

500 470 460 480 470

Example:Rentang pengukuran : 0 – 500 mg/dL Buat sampel dengan dilusi dari 500 hingga 0

Rentang dapat dilaporkan hingga 300 mg/dL hasil valid.Bagaimana untuk hasil 400 mg/dL dan 500 mg/dL?

Asumsi TEa yang ditetapkan untukCholesterol = 10% dan CV 3%

Sampel 500 mgTEa = 50 mg/dL; SD = 15 mg/dL RE = 30 mg/dL (2SD)Nilai terukur = 470 mg/dL SE = -30 mg/dL

TE = 60 mg/dL > TEa (50 mg/dL)

Sampel 400 mgTEa = 40 mg/dL; SD = 12 mg/dL RE = 24 mg/dL (2SD)Nilai terukur = 390 mg/dL SE = -10 mg/dL

TE = 34 mg/dL < TEa (40 mg/dL)

TE = SE + RE

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Characteristic of RE and SE

Random Error (RE) Systematic Error (SE)

Affect Precision Affect Accuracy

May be caused by (e.g.):o Variability in volume of sample or reagent

delivered; o Changes in environment; o Inconsistent handling of materials.

Types of SE: o Proportional- indicated by Slope o Constant – indicated by Intercepto Combination

Estimated by: − Standard Deviation (SD) − Coefficient of variation (CV) − Correlation coefficient (r)

Caused by (e.g.):Bad calibrators, bad reagents,interference

Yusmiati, HKKI, 2016

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Terima Kasih

Do the Right Thing, From the First

Time and Every Time!


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