New and fully automated workflow for alcohol consumption and drugs of abuse monitoring from one single blood droplet
Getting blood and urine samples from a large population is expensive and complicated, as the process requires trained staff, biohazardous sample labeling, cooling chains and tedious sample preparation processes within the laboratory. The blood donation is invasive and requires many consumables. An alternative strategy is to collect the samples on dried blood spot (DBS) cards, however proper analytical methods and protocols for a routine setup are missing.
Fully automated analysis of DBS and dried urine spot (DUS) cards was achieved by coupling a DBS autosampler from CAMAG online with liquid chromatography tandem mass spectrometry (LC-MS/MS) equipment. Depending on the analytes, direct LC-MS/MS separation was performed or an online solid phase extraction (SPE) was integrated into the process for lipophilic compounds.
Several methods in the fields of forensic toxicology and therapeutic drug monitoring were introduced lately. A fully automated DBS method to screen more than 1200 drugs of abuse from a single blood spot was introduced by Gaugler (Gaugler et al., JAT, 2018, doi: 10.1093/jat/bky074) and a method to detect long term alcohol biomarkers is within the publication process at the moment (M. Luginbühl et al., Alcohol, uploaded manuscript). The technology was also applied for monitoring HIV drugs or Ivermectin treatment in resource poor countries such as Tanzania, where the samples were shipped internationally and analyzed in Switzerland (Duthaler et al., JMS, 2017, doi: 10.1002/jms.3952).
The process of DBS is minimum invasive, insures post-sampling stability, allows shipping without biohazard labeling in a standard envelope, and does not require any sample cooling. The cards are collected within the laboratory and processed fully automated without any human interaction. DBS proved its concept in several studies and will emerge to other markets such as clinical and pre-clinical pharmacology in the near future.