Beyond Westgard Rules: Quality Control for Mass Spectrometry. Dr Russell Grant VP R&D Laboratory Corporation of America Holdings.

Transcription

1 Beyond Westgard Rules: Quality Control for Mass Spectrometry Dr Russell Grant VP R&D Laboratory Corporation of America Holdings.

2 Assay Validation Criteria and Acceptance Validation Process Accuracy (Intra and Interassay) Precision (Intra and Interassay) Standard Curve Fit Drug Selectivity Materials Selectivity Matrix Interference Materials Requirements and Acceptance Criteria Min. 2 levels of spiked QC s including LLOQ and ULOQ; Min 20 measurements each in a single run and across 25 days. Bias % <15% or Min. 2 levels of spiked QC s including LLOQ and ULOQ; Min 20 measurements each in a single run and across 25 days. CV % 6-10 levels run in each assay, evaluated over 5 assays (days), R>0.995, Slope CV<5% Up to 350 potentially interfering endogenous and exogenous analytes spiked supraphysiological concentrations, Response < 20% LLOQ when spiked at Maximum Normal x10 ideal, minimally <20% upper normal range. Blank matrix test 6 or more lots Response<20% LLOQ in 5 of 6. Effect of lipid, Icteria and Hemolysis. Bias % Test anticoagulants Bias % Alternate sample types Deming regression , R >0.9 for same reference interval. Matrix effects (sample mixing) Bias<15%

3 Validation Process Assay Validation Criteria and Acceptance Materials Requirements and Acceptance Criteria Carry-over After ULOQ 3 runs including <20% LLOQ Stress test (10-100x ULOQ), how many for <20% LLOQ Dilutional Linearity 5 Level sample mixing - Accuracy % 85% to 115% 1:1 1:50000 dilution - Accuracy % 85% to 115% Serial % dilution - Accuracy % 85% to 115%, (80/120%@LLOQ) Sample Stability Inter-assay Comparison Reference Interval All conditions tested from arm to final result Mean Bias < 15%/20%@ LLOQ, %CV < 15%/20%@ LLOQ, Deming regression , R >0.9 Min 20 External Disparate assays For information only Internal assays same cals Deming regression , R >0.9 Same assay different system Deming regression , R >0.95 Same assay Manual/Automation Deming regression , R > in each reference interval 20 (95% CI) for range transfer 1/20 outside existing range Transition ratio monitoring Bias from extracted calibrators in each batch <20% up to 3x LLOQ, < 15% after that for ratio>0.5 Batch Size Maximum 184 samples prior to recalibrate. Bias % % CV % Carry-over <20% LLOQ Repeat samples n = 2 (first and 2 nd plate) Deming regression , R >0.9

4 Assay Translation (R&D Ops) (Assay Viability QC Ranges Generation n=25 over 5 runs) Verification Process Materials Selectivity Standard Linearity Carry-over Precision (Intra and Interassay) Materials Requirements and Acceptance Criteria Blank matrix <20% LLOQ in 5 runs. All Cals used, Accuracy % 85% to 115%, 80 and R>0.995, Slope CV<5% After ULOQ 3 runs including <20% LLOQ Stress test (10-100x ULOQ), how many for <20% LLOQ Total 25 QC s over 5 runs %CV <15% or Inter-assay Comparison Minimum n=20 per batch Deming regression , R >0.90 Do not use best technicians for this step Add multiple columns/materials lots /systems, time to emulate reality

5 Assay Translation (R&D Ops) (Check Manufacturing Process) Plasma Metanephrine Slope = R = 1 Plasma Normetanephrine Slope = R = 1

6 Internal QC for LC-MS/MS LC System Power Failure Leak detection Pressure beyond pumping Air bubble Column Degradation Complete Sample volume injected Injector blockage Contamination Internal QC Action Shutdown (without UPS) Shutdown* Shutdown Shutdown or No monitoring No monitoring No monitoring No monitoring* No monitoring MS System Power Failure Gas failure Vacuum failure Temperature effects Contamination Resolution change Sensitivity drift Selectivity Internal QC Action Shutdown (without UPS) Shutdown Shutdown Shutdown in extreme conditions No monitoring No monitoring No monitoring No monitoring

7 System Suitability Test (SST) The Doctor Urine Cortisol SST Goal System check prior to analysis to confirm appropriateness of test system for analysis/ or DRIFT Design: Neat solution stored under stable conditions preferably at the assay LLOQ Acquired correctly? Retention time 5% variance Sensitivity S:N >20:1 Peak shape As Multi-channel acceptance column-column/channelchannel/system-system Urine Cortisol LLOQ SST is key part of troubleshooting experiments Ignore the first (or second) injection

8 HPLC Pressure Trace The Heartbeat Goal Pre-batch and per-injection check of appropriate LC performance Design: SOP Example Annotate an acceptable pressure trace Inject/Focus Detect Gradient Wash Recondition Pressure profile Start and overall maximum pressure Changes in pressure profile Air bubbles in A or B Dead volume differences Bubble in A Column dimensions change Full injection Injector/filter/column/lines blockage Post column blockage (bypass/source probe) Bubble in B

9 Internal QA Pre-Batch LC Solvent Contamination XIC of +MRM (6 pairs): 184.2/107.1 Da from Sample 2 (Double Blank) of Validation Batch 2.wiff (Turbo Spray) Max. 550 cps. XIC of +MRM (6 pairs): 184.2/107.1 Da from Sample 4 (Standard 1) of Validation Batch 2.wiff (Turbo Spray) Max. 645 cps. XIC of +MRM (6 pairs): 184.2/107.1 Da from Sample 1 (Blank) of SST wiff (Turbo Spray) Max. 1.5e4 cps. XIC of +MRM (9 pairs): 184.2/107.1 Da from Sample 3 (Standard 1) of wiff (Turbo Spray), Smoothed, Smoothed, Smoothed Max cps e4 1.4e4 1.3e4 1.2e C 0.26 E e4 1.0e Blank, Clean Epinephrine LLOQ Contaminant Resolved Air Bubble/Column or MP Degradation/Injector blockage XIC of +MRM (4 pairs): 166.1/134.1 Da from Sample 1 (SST) of SST sys 4.wiff (Turbo Spray) Max. 1.5e4 cps. XIC of +MRM (4 pairs): 166.1/134.1 Da from Sample 3 (SST) of SST sys 4.wiff (Turbo Spray) Max. 7.0e5 cps. XIC of +MRM (4 pairs): 166.1/134.1 Da from Sample 2 (SST) of SST sys 4.wiff (Turbo Spray) Max. 1.7e5 cps. XIC of +MRM (4 pairs): 166.1/134.1 Da from Sample 7 (SST) of SST sys 4.wiff (Turbo Spray) Max. 1.7e5 cps. 1.5e4 3.8e6 1.05e6 1.10e6 1.4e4 1.3e4 1.2e4 3.6e6 3.4e6 3.2e6 3.0e6 1.00e6 9.50e5 9.00e5 8.50e5 8.00e5 1.05e6 1.00e6 9.50e5 9.00e5 8.50e5 1.1e4 2.8e6 7.50e5 8.00e5 1.0e e6 2.4e6 2.2e6 2.0e6 1.8e6 1.6e6 1.4e6 1.2e6 1.0e6 8.0e5 6.0e5 4.0e5 2.0e e5 6.50e5 6.00e5 5.50e5 5.00e5 4.50e5 4.00e5 3.50e5 3.00e5 2.50e5 2.00e5 1.50e5 1.00e5 5.00e e5 7.00e5 6.50e5 6.00e5 5.50e5 5.00e5 4.50e5 4.00e5 3.50e5 3.00e5 2.50e5 2.00e5 1.50e5 1.00e5 5.00e Air Bubble SST SST Day 1 SST Day 4 SST Day 4 post LC flush/new MPB

10 Internal QA Pre and During Batch MS System Source contamination Pre-run XIC of -MRM (8 pairs): 197.0/137.0 Da from Sample 1 (sst-3) of sst_072111_1.wiff (Turbo Spray) XIC of -MRM (8 pairs): 20/137.0 Da from Sample 1 (sst-1) of sst_072011a1_1.wiff (Turbo Spray) Max. 450 cps. Max. 610 cps. 1.7e5 1.6e5 1.8e6 1.7e6 1.5e5 1.6e6 1.4e5 1.5e6 1.3e5 1.4e6 1.2e5 1.3e6 1.2e6 1.1e5 1.1e6 1.0e5 9.0e4 8.0e4 7.0e4 1.0e6 9.0e5 8.0e5 7.0e5 6.0e4 6.0e5 5.0e4 5.0e5 4.0e4 4.0e5 3.0e4 3.0e5 2.0e4 2.0e5 1.0e5 1.0e HVA, VMA, 5-HIAA 1 st Sample, source fouling HVA, VMA, 5-HIAA Appropriate SST LC-MS/MS Column Degradation RT3 SST at LLOQ XIC of -MRM (8 pairs): 649.9/126.8 Da from Sample 3 (SST) of rt3 MD wiff (Turbo Spray) XIC of -MRM (8 pairs): 649.9/126.8 Da from Sample 9 (SST) of rt3 MD wiff (Turbo Spray) Max. 1.8e4 cps e e4 1.10e4 1.05e4 1.7e4 1.00e4 1.6e e e T3 rt Max. 1.1e4 cps. 1.3e4 1.2e4 1.1e4 1.0e SST at LLOQ - Acceptable Reduction in sensitivity and resolution of T3 from reverse T3 0.52

11 Internal QA Pre-Batch Checking Instrument Sensitivity with SST at LLOQ Date Unextract A D2 Unextract A D3 Std A D2 IS A D2 Std A D3 IS A D3 1/2/ /4/ /6/ /8/ /9/ /11/ /13/ /15/ /16/ /18/ /20/ /22/ /23/

12 Batch Data Review Formula #1 = Tr analyte / Tr internal standard, as a percentage

13 IS Contamination Internal QA LC-MS/MS Batch/Assay Review XIC of +MRM (4 pairs): 271.2/213.1 Da from Sample 1 (Double Blank) of wiff (Heated Nebulizer) Max. 132 cps. XIC of +MRM (4 pairs): 271.2/213.1 Da from Sample 13 (Blank w/is) of wiff (Heated Nebulizer) Max. 342 cps. XIC of +MRM (4 pairs): 271.2/213.1 Da from Sample 3 (Std 1 20 ng/dl) of wiff (Heated Nebulizer) Max. 278 cps DHEA Double Blank DHEA Blank with IS DHEA LLOQ 20ng/dL Sample recovery/injected IS Peak Area vs Index ( DHEA)- "Mean" Regression ("No" weighting): mean = 8.11e+004 x (std. dev. = 1.44e+004) rdb ( Androstenedione): "Linear" Regression ("1 / x" weighting): y = 0419 x (r = ) 1.00e5 9.50e e e e4 7.50e4 7.00e4 6.50e4 6.00e4 5.50e4 5.00e4 4.50e4 4.00e4 3.50e4 3.00e4 2.50e4 Analyte Area / IS Area Androstenedione Cal 5 Expected = 250 Measured = Accuracy (%) = e e e Index Analyte Conc. / IS Conc.

14 IS Peak Area vs Index (Phenylalanine)- "Mean" Regression ("No" weighting): mean = 8.33e+005 x (std. dev. = 2.9e+004) Internal QA LC-MS/MS Batch/Assay Review MS System Sensitivity Drift - Internal Standard Response Plot IS Peak Area vs Index (Phenylalanine)- "Mean" Regression ("No" weighting): mean = 1.98e+006 x (std. dev. = 6.24e+005) 1.00e6 9.50e5 9.00e5 8.50e5 8.00e5 7.50e5 7.00e5 6.50e5 6.00e5 5.50e5 5.00e5 4.50e5 4.00e5 3.50e5 3.00e5 2.50e5 2.00e5 1.50e5 1.00e5 5.00e Index Phenylalanine D5 IS Plot, IS increase at 97 th aqueous calibrator injection (intra-assay inaccuracy batch, n=20 at 8 levels) 2.9e6 2.8e6 2.6e6 2.4e6 2.2e6 2.0e6 1.8e6 1.6e6 1.4e6 1.2e6 1.0e6 8.0e5 6.0e5 4.0e5 2.0e Index Phenylalanine D5 IS Plot, real samples MS System Source contamination within Run XIC of +MRM (10 pairs): 132.1/86.1 Da from Sample 3 (Standard 1_ ) of Validation Batch 3RP2.wiff (Turbo Spray), Smoothed, Smoothe... Max. 1.1e4 cps. XIC of +MRM (10 pairs): 132.1/86.1 Da from Sample 29 (Sample 7_ ) of Validation Batch 3RP2.wiff (Turbo Spray) Max. 4.4e6 cps. XIC of +MRM (10 pairs): 132.1/86.1 Da from Sample 30 (Sample 8_ ) of Validation Batch 3RP2.wiff (Turbo Spray) Max. 2.2e6 cps. XIC of +MRM (10 pairs): 132.1/86.1 Da from Sample 30 (Sample 8_ ) of Validation Batch 3RP2.wiff (Turbo Spray), Smoothed, Smoothe... Max. 2.0e6 cps e4 1.10e e e e6 4.2e6 4.0e6 3.8e6 3.6e6 3.4e6 3.2e6 3.0e6 2.8e6 2.6e6 2.4e6 2.2e6 2.0e6 1.8e6 1.6e6 1.4e6 1.2e6 1.0e6 8.0e5 6.0e5 4.0e5 2.0e e6 2.1e6 2.0e6 1.9e6 1.8e6 1.7e6 1.6e6 1.5e6 1.4e6 1.3e6 1.2e6 1.1e6 1.0e6 9.0e5 8.0e5 7.0e5 6.0e5 5.0e5 4.0e5 3.0e5 2.0e5 1.0e e4 4.6e4 4.4e4 4.2e4 4.0e4 3.8e4 3.6e4 3.4e4 3.2e4 3.0e4 2.8e4 2.6e4 2.4e4 2.2e4 2.0e4 1.8e4 1.6e4 1.4e4 1.2e4 1.0e LLOQ for allo-isoleucine (A,100nm/L) MSUD Patient Normal Patient following MSUD Expanded normal view

15 Internal QA LC-MS/MS Batch/Assay Review Matrix Effects in Individual samples Signal:Noise Sample Analyte Conc RT Analyte Peak Calc Ion Ratio IS Response Area conc Ratio Flag? Std D D NO Std C D NO Std B D NO Std A D NO Ctrl HI D NO Ctrl LO D NO M64598 D NO M67899 D NO M70133 D NO M70134 D NO M70135 D NO M71222 D NO M72090 D NO T80031 D NO T80100 D NO T81070 D NO T90909 D NO T91002 D NO T91114 D NO

16 Internal QA LC-MS/MS Batch/Assay Review Selectivity Variance - Matrix Effects XIC of +MRM (4 pairs): 183.1/151.1 Da from Sample 16 (Calibrator 1_10pg/mL_6 ) of PMETS Validation Batch 2_ wiff (Turb... Max. 4.3e5 cps. XIC of +MRM (4 pairs): 183.1/151.1 Da from Sample 20 (LC_4 ) of PMETS Validation Batch 2_ wiff (Turbo Spray), Smoothe... Max. 1.7e5 cps. 4.3e5 4.2e e5 1.7e e5 3.8e5 3.6e5 1.6e5 1.5e5 3.4e5 3.2e5 3.0e5 2.8e5 2.6e5 2.4e5 2.2e5 2.0e5 1.8e5 1.6e5 1.4e5 1.3e5 1.2e5 1.1e5 1.0e5 9.0e4 8.0e4 7.0e4 Partial Suppression from co-elutor 1.4e5 6.0e4 1.2e5 5.0e4 1.0e5 4.0e4 8.0e4 6.0e4 3.0e4 4.0e4 2.0e4 2.0e4 1.0e D3-Metanephrine IS at 4.3 e5 cps D3-Metanephrine IS at 1.7 e5 cps 40% of earlier sample Selectivity Variance - Internal Standard Transition ratio plots

17 30 Internal QA LC-MS/MS Batch/Assay Review Transition Ratio Monitoring Exploring Outliers XIC of +MRM (4 pairs): 289.2/97.1 Da from Sample 27 (S1_5 2.5ng/dL_) of Validation Batch 1.wiff (Heated Nebulizer), Smoothed, S... Max cps LLOQ sample Calculated Conc 1.9ng/dL Transistion Ratio Bias (%) XIC of +MRM (4 pairs): 289.2/97.1 Da from Sample 113 (Sample 96 ) of SLE wiff (Heated Nebulizer), Smoothed, Smoothed Max cps Calculated Concentration (ng/dl) Concentration 5.3ng/dL

18 Internal QA LC-MS/MS Batch/Assay Review Transition Ratio Monitoring Exploring Outliers Sample Analyte Conc RT Analyte Peak Calc Ion Ratio IS Response Area conc Ratio Flag? Std D D NO Std C D NO Std B D NO Std A D NO Ctrl HI D NO Ctrl LO D NO W54634 D NO W58132 D NO W66023 D NO W62743 D NO W66817 D NO H66438 D NO H62633 D NO H78948 D NO H78388 D NO H74054 D NO H87727 D YES H89927 D NO H88721 D NO

19 External QC 3-Plex Linked Analytes Plasma Metanephrines The importance of Automation Manual Preparation First Run with SPE Automated First Run With SPE IS Peak Area vs Index (Normetanephrine)- "Mean" Regression ("No" weighting): mean = 1.15e+005 x (std. dev. = 5.54e+004) IS Peak Area vs Index (Normetanephrine)- "Mean" Regression ("No" weighting): mean = 6.16e+005 x (std. dev. = 1.62e+005) 2.2e5 2.1e5 2.0e5 1.9e5 1.8e5 1.7e5 1.6e5 1.5e5 1.4e5 1.3e5 1.2e5 1.1e5 1.0e5 9.0e4 8.0e4 7.0e4 6.0e4 5.0e4 4.0e4 3.0e4 2.0e4 1.0e4 8.5e5 8.0e5 7.5e5 7.0e5 6.5e5 6.0e5 5.5e5 5.0e5 4.5e5 4.0e5 3.5e5 3.0e5 2.5e5 2.0e5 1.5e5 1.0e5 5.0e Index Index Recovery Variance ADDS to Imprecision which makes Westgard Rules Impossible to apply Use Automation OR Train Technicians VERY well

20 External QC - Calibrator Stability Cocaine Stability 1.0e C E B 5.0e6 4.0e6 3.0e6 2.0e6 C E B Concentration (ng/ml) Plasma QC e Cocaine Profile LOQ (1 ng/ml) Cocaine Profile ULOQ (1000 ng/ml) Days Plasma QC stability at 2-8C inc 1% NaF Need Alternate Matrix to assess Calibrator Stability XIC of +MRM (12 pairs): 304.2/82.0 Da from Sample 33 (Plasma Low QC_1) of Cocaine Validation Batch 2.wiff (Turbo Spray), Smoothe... Max. 2.2e4 cps. XIC of +MRM (12 pairs): 200.1/182.1 Da from Sample 34 (Urine QC_1) of Cocaine Validation Batch 2.wiff (Turbo Spray), Smoothed, Sm... Max. 7.7e5 cps. XIC of +MRM (12 pairs): 200.1/182.1 Da from Sample 36 (Organic QC_1) of Cocaine Validation Batch 2.wiff (Turbo Spray), Smoothed,... Max. 8.6e5 cps. XIC of +MRM (12 pairs): 304.2/82.0 Da from Sample 35 (Wh Blood QC_1) of Cocaine Validation Batch 2.wiff (Turbo Spray), Smoothed,... Max. 4.3e5 cps. 8.2e4 8.0e4 7.7e5 7.5e e e5 5.5e5 7.5e4 7.0e4 7.0e5 6.5e5 8.0e5 7.5e5 5.0e5 6.5e4 6.0e4 5.5e4 5.0e4 4.5e4 6.0e5 5.5e5 5.0e5 4.5e5 4.0e5 7.0e5 6.5e5 6.0e5 5.5e5 5.0e5 4.5e5 4.5e5 4.0e5 3.5e5 3.0e e4 3.5e4 3.0e4 2.5e4 2.0e e5 3.0e5 2.5e5 2.0e5 4.0e5 3.5e5 3.0e5 2.5e5 2.0e5 2.5e5 2.0e5 1.5e5 1.5e4 1.5e5 1.5e5 1.0e5 1.0e e5 5.0e4 1.0e5 5.0e4 5.0e Cocaine Profile Plasma QC1 (5 ng/ml) Cocaine Profile Urine QC ( ng/ml) Cocaine Profile Organic QC ( ng/ml) Cocaine Profile Blood QC ( ng/ml)

21 Column Verification CAP Checklist, Gas Chromatography and High Performance Liquid Chromatography Section CHM Column Verification Phase II New columns are verified for performance before use. Evidence of Compliance: Written procedure for column verification AND Records of column verification The 3 R s : Verifiable Column Performance Characteristics Retention Are all analytes properly adsorbed to the new stationary phase Resolution Are all analytes exhibiting appropriate desorption from the new stationary phase Response Are any components of the new column affecting MS ionization efficiency

22 Verification Procedure: 1. System Suitability Test Solutions (At concentrations slightly higher than the assay s extracted LLOQ) 2. Replicate Injections (More than 3) 3. DO NOT USE THE FIRST INJECTION (or the second, and possibly the third, dependent on the particular column passivation required). Set the appropriate limits. 4. Have confidence in a working system prior to column verification run Critical Data Features Sample Name Analyte Peak Name Analyte Peak Area (counts) Analyte Retention Time (min) Analyte Exp. RT (min) Analyte Peak Width (min) Analyte Peak Asym. IS Peak Name IS Peak Area (counts) IS Retention Time (min) IS Exp. RT (min) IS Peak Asym. Direct Observations Response Retention Peak Shape Response Retention Peak Shape Calculated Observations Response Retention Resolution Criteria Predefined from Working System/Validation Predefined T r of Analyte and Internal Standard in Validation Separation of Critical Pairs/Isobars (i.e. T r1 +0.5P w1 >T r2-0.5p w2 )

23 Verification Data Column Verification XIC of +MRM (111 pairs): / amu Expected RT: 2.9 ID: Alprazolam-d5.IS from Sample 5 (SST 1) of SST wiff (T e5 2.6e5 2.4e5 2.2e5 2.0e5 1.8e5 1.6e5 1.4e5 1.2e5 1.0e5 8.0e4 6.0e4 4.0e4 2.0e4 Multi-analyte panel, API 3200 (Scheduled MRM) Col Verification, SST Injection #3 Max. 1.8e4 cps Test Name: Analyte Example Panel Analyte Retention Time IS Retention Time Retention Time Alignment Critical Pair Separation Analyte Asymmetry Sensitivity 6-MAM Pass Pass Fail NA Fail Fail 7-Aminoclonazepam Pass Pass Pass NA Pass Pass Alprazolam Pass Pass Pass NA Pass Pass Amphetamine Pass Fail Pass NA Fail Pass Benzoylecgonine Pass Pass Pass NA Fail Pass Buprenorphine Pass Pass Pass NA Pass Pass Carisoprodol Pass Pass Pass NA Pass Pass Clonazepam Fail Fail Pass NA Pass Pass Codeine Pass Pass Fail Pass Pass Pass Diazepam Fail Fail Pass NA Pass Pass EDDP Pass Pass Pass NA Pass Pass Fentanyl Pass Pass Pass NA Pass Pass Gabapentin Pass Pass Fail NA Fail Pass Hydrocodone Pass Pass Pass Pass Pass Pass Hydromorphone Pass Pass Fail Fail Fail Fail Hydroxyalprazolam Pass Pass Pass NA Pass Pass Lorazepam Pass Pass Pass NA Pass Pass MDMA Pass Pass Fail NA Fail Pass Meperidine Pass Pass Pass NA Fail Pass Meprobamate Pass Pass Pass NA Pass Pass Methadone Pass Pass Pass NA Fail Pass Methamphetamine Pass Pass Fail NA Fail Pass Morphine Pass Pass Pass Fail Fail Pass Naltrexone Pass Pass Pass NA Pass Pass Norbuprenorphine Pass Pass Pass NA Pass Pass Nordiazepam Pass Pass Pass NA Pass Pass Norfentanyl Pass Pass Pass NA Pass Pass Norhydrocodone Fail Fail Fail NA Pass Pass Noroxycodone Pass Pass Fail NA Pass Pass Oxycodone Pass Pass Pass NA Fail Pass Oxymorphone Pass Pass Pass NA Fail Pass PCP Pass Pass Pass NA Pass Pass Pregabalin Fail Fail Pass NA Fail Fail Tapentadol Pass Pass Pass NA Pass Pass Temazepam Pass Pass Pass NA Pass Pass Tramadol Pass Pass Pass NA Pass Pass Zolpidem Fail Fail Pass NA Pass Pass Number of Failures Column Serial Number FVM Date Installed 2/7/1964 Column Manufacturer Flintstones Vit-Min Initials JPGR Stationary Phase PolyPro-Dibenzophenol Taffy Dimensions (L x W, D p) 11 x mm, 6.2 um

24 Verification Data, New Guard Column Column Verification XIC of +MRM (111 pairs): / amu Expected RT: 2.9 ID: Alprazolam-d5.IS from Sample 10 (SST 1) of SST wiff e5 1.3e5 1.2e5 1.2e5 1.1e5 1.1e5 1.0e5 9.5e4 9.0e4 8.5e4 8.0e4 7.5e4 7.0e4 6.5e4 6.0e4 5.5e4 5.0e4 4.5e4 4.0e4 3.5e4 3.0e4 2.5e4 2.0e4 1.5e4 1.0e4 500 Multi-analyte panel, API 3200 (Scheduled MRM) Col Verification, SST Injection #3 Post- Guard Column Replacement Max cps Test Name: Analyte Example Panel Analyte Retention Time IS Retention Time Retention Time Alignment Critical Pair Separation Analyte Asymmetry Sensitivity 6-MAM Pass Pass Pass NA Pass Pass 7-Aminoclonazepam Pass Pass Pass NA Pass Pass Alprazolam Pass Pass Pass NA Pass Pass Amphetamine Pass Pass Pass NA Pass Pass Benzoylecgonine Pass Pass Pass NA Pass Pass Buprenorphine Pass Pass Pass NA Pass Pass Carisoprodol Pass Pass Pass NA Pass Pass Clonazepam Pass Pass Pass NA Pass Pass Codeine Pass Pass Pass Pass Pass Pass Diazepam Pass Pass Pass NA Pass Pass EDDP Pass Pass Pass NA Pass Pass Fentanyl Pass Pass Pass NA Pass Pass Gabapentin Pass Pass Pass NA Pass Pass Hydrocodone Pass Pass Pass Pass Pass Pass Hydromorphone Pass Pass Pass Pass Pass Pass Hydroxyalprazolam Pass Pass Pass NA Pass Pass Lorazepam Pass Pass Pass NA Pass Pass MDMA Pass Pass Pass NA Pass Pass Meperidine Pass Pass Pass NA Pass Pass Meprobamate Pass Pass Pass NA Pass Pass Methadone Pass Pass Pass NA Pass Pass Methamphetamine Pass Pass Pass NA Pass Pass Morphine Pass Pass Pass Pass Pass Pass Naltrexone Pass Pass Pass NA Pass Pass Norbuprenorphine Pass Pass Pass NA Pass Pass Nordiazepam Pass Pass Pass NA Pass Pass Norfentanyl Pass Pass Pass NA Pass Pass Norhydrocodone Pass Pass Pass NA Pass Pass Noroxycodone Pass Pass Pass NA Pass Pass Oxycodone Pass Pass Pass NA Pass Pass Oxymorphone Pass Pass Pass NA Pass Pass PCP Pass Pass Pass NA Pass Pass Pregabalin Pass Pass Pass NA Pass Pass Tapentadol Pass Pass Pass NA Pass Pass Temazepam Pass Pass Pass NA Pass Pass Tramadol Pass Pass Pass NA Pass Pass Zolpidem Pass Pass Pass NA Pass Pass Number of Failures Column Serial Number FVM Date Installed 2/7/1964 Column Manufacturer Stationary Phase Flintstones Vit-Min PolyPro-Dibenzophenol Taffy Initials JPGR Dimensions (L x W, D p) 11 x mm, 6.2 um

25 XIC of +MRM (59 pairs): / Da ID: GABA D6 from Sample 18 (Pickering Neat) of RP1_ wiff (Turbo Spray), Smoo... When Accuracy based QC isn t accurate Neat Pickering QC No IS added Max. 4.1e6 cps. External Accuracy based mixture (>50 analytes) in Phenol/water 6.5e5 6.0e5 5.5e5 5.0e5 4.5e5 4.0e5 * e5 3.0e5 2.5e5 Supra-physiological ~250uM 2.0e5 1.5e5 1.0e5 5.0e Measure Neat (no IS), Neat diluted (class A) Methionine D3 Cystathionine D8 GABA D6 XIC of +MRM (59 pairs): / Da ID: Methionine D3 from Sample 35 (Pickering x10) of RP1_ wiff (Turbo Spray), e6 2.3e6 10 x Diluted Pickering QC + IS * Max. 8.7e5 cps. 2.2e6 Determine how to deploy accuracy based materials that do not represent the clinically observed concentrations of mixtures 2.1e6 2.0e6 1.9e6 1.8e6 1.7e6 1.6e6 1.5e6 1.4e6 1.3e6 1.2e6 1.1e6 1.0e6 9.0e5 8.0e5 7.0e5 6.0e5 5.0e5 4.0e5 3.0e5 2.0e * * e

26 Inter-Laboratory Correlation LabCorp and St Pauls, BC Concentrations < 45ng/dL N= 52 Intercept: -96 CI Intercept: [-0.557,0.488] Slope: CI Slope: [0.954,1.014] R-squared: Mean Difference: -2.49% SD Difference: 5.304% Acknowledgement: Dr Daniel Holmes, Grace Van Der Gugten

27 Automated Data review If [examined value] exceeds [a threshold], then flag with [text string].

28 Acknowledgements Patricia Holland, Matt Crawford, Stacy Dee, Mary Morr, Dr Marcia Eisenberg, Dr Walt Chandler Brian Rappold Randy Julian Dr Andy Hoofnagle S L I D E 28