Applications of mass spectrometry in clinical chemistry

Abstract

Mass spectrometry (MS) is now an essential technology for laboratory medicine. The most successful application of MS in laboratory medicine is the rapid identification of microorganisms using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) MS. However, the adoption of MS-based assays for routine testing in clinical chemistry is very slow in Japan. In this review, we summarize the current status of clinical mass spectrometry in the US, Europe, and Japan, and discuss the possible reasons why Japan is behind in this regard.

Liquid chromatography-tandem mass spectrometry (LC/MS/MS) is a highly accurate and reproducible analytical technique, but a number of challenges and pitfalls remain for routine use in clinical laboratories, such as the effects of various pre-analytical factors. Indeed, we observed a significant noise peak during routine measurements of vitamin D metabolites, most likely due to a separating gel in blood collection tubes used for particular specimens sent by another hospital. Ion suppression due to matrix effects and problems associated with stable isotope labeled internal standards should also be considered.

MS assays are typically laboratory developed tests at present. As LC/MS/MS procedures become more automated and more MS-related in vitro diagnostics become commercially available, the application of LC/MS/MS to laboratory medicine will be significantly accelerated.