Anti-HBc IgM

REF SYSTEM

MODULAR ANALYTICS E170

cobas e 411
11820567 119 100 cobas e 601
cobas e 602

English Reagents – working solution

System information The reagent rackpack (M, R1, R2) is labeled as A‑HBCIGM.
For cobas e 411 analyzer: test number 460 M Streptavidin-coated microparticles (transparent cap), 1 bottle, 6.5 mL:
For MODULAR ANALYTICS E170, cobas e 601 and cobas e 602 Streptavidin-coated microparticles 0.72 mg/mL; preservative.
analyzers: Application Code Number 086 R1 Pretreatment anti‑HBc IgM (gray cap), 1 bottle, 10 mL:
Intended use Sample pretreatment reagent: Anti‑human‑Fdγ‑antibody (sheep)
Immunoassay for the in vitro qualitative determination of IgM antibodies to the > 0.05 mg/mL; phosphate buffer 100 mmol/L, pH 7.4; preservative.
2+
hepatitis B core antigen in human serum and plasma. R2 Anti-h-IgM-Ab~biotin; HBcAg~ Ru(bpy)3 (black cap), 1 bottle, 10 mL:
The electrochemiluminescence immunoassay “ECLIA” is intended for use on Biotinylated monoclonal anti-h-IgM antibody (mouse) > 600 ng/mL;
Elecsys and cobas e immunoassay analyzers. HBcAg (E. coli, rDNA), labeled with ruthenium complex > 200 ng/mL;
phosphate buffer 100 mmol/L, pH 7.4; preservative.
Note: Please note that the catalogue number appearing on the package insert
retains only the first 8 digits of the licensed 11-digit Catalogue Number: A‑HBCIGM Cal1 Negative calibrator 1 (white cap), 2 bottles of 1.0 mL
11820567122 for the Anti-HBc IgM assay. The last 3 digits -122 have been each:
replaced by -119 for logistic purposes. Human serum, preservative.
Summary A‑HBCIGM Cal2 Positive calibrator 2 (black cap), 2 bottles of 1.0 mL
each:
References1,2,3,4,5,6,7,8,9,10 Anti‑HBc IgM (human) > 100 PEI-U/mLb) in human serum;
Hepatitis B core antigen (HBcAg) is a non‑glycosylated protein (p22) which forms preservative.
the nucleocapsid (virus core) of the hepatitis B virus. The virus core encloses the b) Paul‑Ehrlich‑Institute units
HBV‑DNA (virus genome) and the DNA‑polymerase. In the cytosol of virus‑
producing hepatocytes the nucleocapsid is enveloped by the hepatitis B surface Precautions and warnings
antigen (HBsAg) to form virions. Free HBcAg or non‑enveloped virus cores are For in vitro diagnostic use.
not detectable in serum. Exercise the normal precautions required for handling all laboratory reagents.
IgM antibodies to HBcAg occur in serum during proliferation of active hepatitis B Disposal of all waste material should be in accordance with local guidelines.
virus and can still be detected weeks to months after viral proliferation has Safety data sheet available for professional user on request.
ceased. High anti‑HBc IgM concentrations can be found in acute hepatitis B and This kit contains components classified as follows in accordance with the
in attacks during chronic hepatitis B. Regulation (EC) No. 1272/2008:
Tests for detecting anti‑HBc IgM antibodies are used, in conjunction with HBsAg n-Octyl-N,N-dimethyl-3-ammonio-1-propanesulfonate
determinations, to identify acute hepatitis B viral infections. An acute attack of EUH 208 May produce an allergic reaction.
hitherto non‑diagnosed chronic hepatitis B clinically resembles an acute hepatitis
B infection and cannot be distinguished from this with certainty by determining the Product safety labeling follows EU GHS guidance.
anti‑HBc IgM. Follow‑up studies, imaging procedures and liver biopsies are All human material should be considered potentially infectious.
useful in differentiating between these two clinical pictures. The negative calibrator (A‑HBCIGM Cal1) has been prepared exclusively from
Test principle the blood of donors tested individually and shown to be free from HBsAg and
µ‑Capture test principle. Total duration of assay: 18 minutes. antibodies to HCV and HIV. The testing methods used assays approved by the
FDA or cleared in compliance with the European Directive 98/79/EC, Annex II,
 1st incubation: Pretreatment of 10 µL of sample (automatically prediluted 1:400 List A.
with Diluent Universal) with anti‑Fdγ reagent to block specific IgG.
Positive calibrator (A‑HBCIGM Cal2): Materials of human origin were tested for
 2nd incubation: Biotinylated monoclonal h‑IgM‑specific antibodies, HBcAg HIV and hepatitis C. The findings were negative. The serum containing anti‑HBc
labeled with a ruthenium complexa) and streptavidin-coated microparticles are IgM was inactivated using β‑propiolactone and UV‑radiation.
added to the pretreated sample. Anti‑HBc IgM antibodies present in the sample
react with the ruthenium‑labeled HBc antigen and the biotinylated anti‑h‑IgM However, as no inactivation or testing method can rule out the potential risk of
to form a sandwich complex which becomes bound to the solid phase via infection with absolute certainty, the material should be handled with the same
interaction of biotin and streptavidin. level of care as a patient specimen. In the event of exposure, the directives of the
responsible health authorities should be followed.11,12
 The reaction mixture is aspirated into the measuring cell where the
microparticles are magnetically captured onto the surface of the electrode. Avoid foam formation in all reagents and sample types (specimens, calibrators
Unbound substances are then removed with ProCell/ ProCell M. Application of and controls).
a voltage to the electrode then induces chemiluminescent emission which is Reagent handling
measured by a photomultiplier. The reagents in the kit are ready‑for‑use and are supplied in bottles compatible
 Results are determined automatically by the software by comparing the with the system.
electrochemiluminescence signal obtained from the reaction product of the cobas e 411 analyzer: The calibrators should only be left on the analyzer during
sample with the signal of the cutoff value previously obtained by calibration. calibration at 20‑25 °C. After use, close the bottles as soon as possible and store
a) Tris(2,2'-bipyridyl)ruthenium(II)-complex (Ru(bpy) 2+
3 ) upright at 2‑8 °C.
Due to possible evaporation effects, not more than 5 calibration procedures per
bottle set should be performed.
MODULAR ANALYTICS E170, cobas e 601 and cobas e 602 analyzers: Unless
the entire volume is necessary for calibration on the analyzers,

2018-04, V 19a Can English 1/4

Anti-HBc IgM
transfer aliquots of the ready‑for‑use calibrators into empty snap-cap bottles Materials required (but not provided)
(CalSet Vials). Attach the supplied labels to these additional bottles. Store the  REF 11876333122, PreciControl Anti‑HBc IgM, 16 x 1.0 mL
aliquots at 2‑8 °C for later use.
 REF 11732277122, Diluent Universal, 2 x 16 mL sample diluent or
Perform only one calibration procedure per aliquot.
 REF 03183971122, Diluent Universal, 2 x 36 mL sample diluent
All information required for correct operation is read in from the respective reagent
barcodes.  REF 11776576322, CalSet Vials, 2 x 56 empty snap-cap bottles
Please note: Both the vial labels, and the additional labels (if available) contain 2  General laboratory equipment
different barcodes. The barcode between the yellow markers is for cobas 8000  MODULAR ANALYTICS E170 or cobas e analyzer
systems only. If using a cobas 8000 system, please turn the vial cap 180° into the Accessories for cobas e 411 analyzer:
correct position so the barcode can be read by the system. Place the vial on the
instrument as usual.  REF 11662988122, ProCell, 6 x 380 mL system buffer
Storage and stability  REF 11662970122, CleanCell, 6 x 380 mL measuring cell cleaning solution
Store at 2‑8 °C.  REF 11930346122, Elecsys SysWash, 1 x 500 mL washwater additive
Do not freeze.  REF 11933159001, Adapter for SysClean
Store the Elecsys reagent kit upright in order to ensure complete availability of  REF 11706802001, AssayCup, 60 x 60 reaction cups
the microparticles during automatic mixing prior to use.  REF 11706799001, AssayTip, 30 x 120 pipette tips
Stability of the reagent rackpack  REF 11800507001, Clean‑Liner
Accessories for MODULAR ANALYTICS E170, cobas e 601 and
unopened at 2‑8 °C up to the stated expiration date cobas e 602 analyzers:
after opening at 2‑8 °C 8 weeks  REF 04880340190, ProCell M, 2 x 2 L system buffer
on cobas e 411 4 weeks  REF 04880293190, CleanCell M, 2 x 2 L measuring cell cleaning solution
on MODULAR ANALYTICS E170, 8 weeks  REF 03023141001, PC/CC‑Cups, 12 cups to prewarm ProCell M and
cobas e 601 and cobas e 602 CleanCell M before use
 REF 03005712190, ProbeWash M, 12 x 70 mL cleaning solution for run
finalization and rinsing during reagent change
Stability of the calibrators  REF 03004899190, PreClean M, 5 x 600 mL detection cleaning solution
unopened at 2‑8 °C up to the stated expiration date  REF 12102137001, AssayTip/AssayCup, 48 magazines x 84 reaction cups or
pipette tips, waste bags
after opening at 2‑8 °C 8 weeks  REF 03023150001, WasteLiner, waste bags
on cobas e 411 at 20‑25 °C up to 5 hours  REF 03027651001, SysClean Adapter M
on MODULAR ANALYTICS E170, Accessories for all analyzers:
use only once
cobas e 601 and cobas e 602 at  REF 11298500316, ISE Cleaning Solution/Elecsys SysClean,
20‑25 °C 5 x 100 mL system cleaning solution
Assay
Store calibrators upright in order to prevent the calibrator solution from adhering
to the snap‑cap. For optimum performance of the assay follow the directions given in this
document for the analyzer concerned. Refer to the appropriate operator’s manual
Specimen collection and preparation for analyzer‑specific assay instructions.
Only the specimens listed below were tested and found acceptable. Resuspension of the microparticles takes place automatically prior to use. Read in
Serum collected using standard sampling tubes or tubes containing separating the test‑specific parameters via the reagent barcode. If in exceptional cases the
gel. barcode cannot be read, enter the 15‑digit sequence of numbers (except for the
Li‑heparin, Na‑heparin, K2‑EDTA, K3‑EDTA, ACD, CPD, CP2D, CPDA and Na‑ cobas e 602 analyzer).
citrate plasma. Do not use plasma treated with sodium fluoride and potassium MODULAR ANALYTICS E170, cobas e 601 and cobas e 602 analyzers:
oxalate. PreClean M solution is necessary.
Criterion: Correct assignment of negative and positive samples. Bring the cooled reagents to approximately 20 °C and place on the reagent disk
Stable for 6 days at 2‑8 °C, 3 months at ‑20 °C. The samples may be frozen 5 (20 °C) of the analyzer. Avoid foam formation. The system automatically regulates
times. the temperature of the reagents and the opening/closing of the bottles.
The sample types listed were tested with a selection of sample collection tubes or Place the calibrators in the sample zone.
systems that were commercially available at the time of testing, i.e. not all All the information necessary for calibrating the assay is automatically read into
available tubes of all manufacturers were tested. Sample collection systems from the analyzer.
various manufacturers may contain differing materials which could affect the test After calibration has been performed, store the calibrators at 2‑8 °C or discard
results in some cases. When processing samples in primary tubes (sample (MODULAR ANALYTICS E170, cobas e 601 and cobas e 602 analyzers).
collection systems), follow the instructions of the tube manufacturer.
Calibration
Centrifuge samples containing precipitates and thawed samples before
performing the assay. Heat-inactivated samples may be used. Traceability: This method has been standardized against the “HBc Reference
Serum 84 (anti‑HBc IgM)” of the Paul‑Ehrlich‑Institute, Langen (Germany). For
Do not use samples and controls stabilized with azide. the Elecsys Anti‑HBc IgM assay, the cutoff (cutoff index 1.0) was set to
Ensure the samples, calibrators and controls are at 20‑25 °C prior to approximately 100 PEI‑U/mL.13
measurement. Calibration frequency: Calibration must be performed once per reagent lot using
Due to possible evaporation effects, samples and calibrators on the analyzers A‑HBCIGM Cal1, A‑HBCIGM Cal2 and fresh reagent (i.e. not more than 24
should be analyzed/measured within 2 hours. hours since the reagent kit was registered on the analyzer).
The performance of the Elecsys Anti‑HBc IgM assay has not been established
with cadaveric samples or body fluids other than serum and plasma.
Materials provided
See “Reagents – working solutions” section for reagents.
 2 x 6 bottle labels

2/4 2018-04, V 19a Can English

Anti-HBc IgM
Calibration interval may be extended based on acceptable verification of In rare cases, interference due to extremely high titers of antibodies to
calibration by the laboratory. immunological components, streptavidin and ruthenium can occur.
Renewed calibration is recommended as follows: For diagnostic purposes, the results should always be assessed in conjunction
 after 1 month (28 days) when using the same reagent lot with the patient’s medical history, clinical examination and other findings.
 after 7 days (when using the same reagent kit on the analyzer) Limits and ranges
 as required: e.g.: quality control findings with PreciControl Anti-HBc IgM outside Detection limit: ≤ 3.0 PEI‑U/mL
the defined limits
 more frequently when this is required by pertinent regulations. The detection limit represents the lowest measurable analyte level that can be
distinguished from zero. It is calculated as the value lying two standard deviations
Range for the electrochemiluminescence signals (counts) for the calibrators: above that of the negative calibrator (negative calibrator + 2 SD, repeatability
Negative calibrator (A‑HBCIGM Cal1): 600‑3500 (cobas e 411 analyzer), 400‑ study, n = 21).
3500 (MODULAR ANALYTICS E170, cobas e 601 and cobas e 602 analyzers). Dilution
Positive calibrator (A‑HBCIGM Cal2): 24000‑150000 (cobas e 411 analyzer), Use Diluent Universal for automatic sample predilution.
18000‑130000 (MODULAR ANALYTICS E170, cobas e 601 and cobas e 602
analyzers). Expected values
Quality control For the Elecsys Anti‑HBc IgM assay, the cutoff (cutoff index 1.0) was set to
approximately 100 PEI‑U/mL. In acute HBV infections the anti‑HBc IgM level is
For quality control, use PreciControl Anti‑HBc IgM. generally far above this limit. After recovery from hepatitis B disease the anti‑HBc
Controls for the various concentration ranges should be run individually at least IgM levels are below this. Chronic hepatitis can produce values in the vicinity of
once every 24 hours when the test is in use, once per reagent kit, and following the cutoff.
each calibration. Specific performance data
The control intervals and limits should be adapted to each laboratory’s individual Representative performance data on the analyzers are given below. Results
requirements. Values obtained should fall within the defined limits. Each obtained in individual laboratories may differ.
laboratory should establish corrective measures to be taken if values fall outside
the defined limits. Precision
If necessary, repeat the measurement of the samples concerned. Precision was determined using Elecsys reagents, human sera and controls.
Follow the applicable government regulations and local guidelines for quality cobas e 411 analyzer
control.
Note: Repeatabilityc) Intermediate precisiond)
For technical reasons re-assigned target values valid only for a specific reagent
and control lot combination must be entered manually on all analyzers (except for Sample Mean SD CV Mean SD CV
the cobas e 602 analyzer). Therefore always refer to the value sheet included in COIe) COI % COI COI %
the reagent kit or PreciControl kit to make sure that the correct target values are
used. HSf), negative 0.123 0.003 2.2 0.069 0.002 2.8
When a new reagent or control lot is used, the analyzer will use the original HS, weakly positive 1.14 0.040 3.5 1.15 0.021 1.8
values encoded in the control barcodes.
Calculation HS, positive 3.58 0.131 3.7 3.98 0.135 3.4
The analyzer automatically calculates the cutoff based on the measurement of A‑ PCg) A‑HBCIGM1 0.053 0.001 1.7 0.063 0.002 3.3
HBCIGM Cal1 and A‑HBCIGM Cal2.
PC A‑HBCIGM2 1.39 0.063 4.5 1.55 0.056 3.6
The result of a sample is given either as reactive or non-reactive as well as in the
form of a cutoff index (signal sample/cutoff). c) Repeatability = within-run precision (n = 20/21)
Interpretation of the results d) Intermediate precision = between-run precision (n = 10)
e) COI = cutoff index
Samples with a cutoff index ≥ 1.0 are reactive in the Elecsys Anti‑HBc IgM
assay. These samples are considered positive for anti‑HBc IgM. f) HS = human serum
Samples with a cutoff index < 1.0 are non‑reactive in the Elecsys g) PC = PreciControl
Anti‑HBc IgM assay. These samples are considered negative. MODULAR ANALYTICS E170, cobas e 601 and cobas e 602 analyzers
Note: According to the recommendations of the Paul‑Ehrlich‑Institute, Langen
(Germany), an equivocal range should be allowed for the assessment of results Repeatabilityc) Intermediate precisioni)
from anti‑HBc IgM tests.
For the Elecsys Anti‑HBc IgM assay the equivocal cutoff index range is Sample Mean SD CV Mean SD CV
0.9‑1.1. COI COI % COI COI %
Limitations - interference
HS, negative 0.037 0.001 3.4 0.037 0.002 3.9
The assay is unaffected by icterus (bilirubin < 428 µmol/L or < 25 mg/dL),
hemolysis (Hb < 1.2 mmol/L or < 2.0 g/dL), lipemia (Intralipid
HS, weakly positive 1.32 0.032 2.4 1.33 0.054 4.1
< 1500 mg/dL) and biotin (< 409 nmol/L or < 100 ng/mL).
Criterion: Correct assignment of negative and positive samples. HS, positive 4.91 0.080 1.6 5.11 0.171 3.3
Samples should not be taken from patients receiving therapy with high biotin PC A‑HBCIGM1 0.032 0.001 1.5 0.042 0.001 1.9
doses (i.e. > 5 mg/day) until at least 8 hours following the last biotin
administration. PC A‑HBCIGM2 1.67 0.043 2.6 1.80 0.069 3.8
As with many μ‑capture assays, an interference with unspecific human IgM is h) Intermediate precision = within-laboratory (modified protocol (EP5-A) of the CLSI (Clinical and
observed. Increasing amounts of unspecific human IgM may lead to a decrease in Laboratory Standards Institute): 6 times daily for 10 days (n = 60))
the recovery of positive samples with the Elecsys Anti‑HBc IgM assay. Analytical specificity
No interference was observed from rheumatoid factors up to a concentration of No cross-reactions with HAV, HCV, HIV 1+2, CMV, EBV, HSV, E. coli,
4200 IU/mL. Toxoplasma gondii, Rubella, and Treponema pallidum were observed.
In vitro tests were performed on 19 commonly used pharmaceuticals. No
interference with the assay was found.

2018-04, V 19a Can English 3/4

Anti-HBc IgM
Measurements were performed on each of the pathogens listed above using ≥ 8 9 Frösner G. Moderne Hepatitisdiagnostik. Kilian Verlag, Marburg 1996.
serum or plasma samples which were positive for antibodies to the above- 10 Hoofnagle Bisceleglie MD. Serologic diagnosis of acute and chronic viral
mentioned pathogens or contained autoantibodies (SLE, ANA). hepatitis. Seminars in Liver Disease 1991;11(2):73-83.
Cutoff sensitivity 11 Occupational Safety and Health Standards: Bloodborne pathogens.
Approx. 100 PEI‑U/mL for the Elecsys Anti‑HBc IgM assay. Assays of other (29 CFR Part 1910.1030). Fed. Register.
manufacturers may be set differently. 12 Directive 2000/54/EC of the European Parliament and Council of September
Clinical sensitivity 2000 on the protection of workers from risks related to exposure to biological
agents at work.
Elecsys Anti‑HBc IgM Anti‑HBc IgM comparison
assay test 13 Hadziyannis JS, Hadziyannis AS, Dourakis S, et al. Clinical Significance of
Quantitative Anti-HBc IgM assay in Acute and Chronic HBV Infection. Hepato
posi) negj) discrepant pos neg discrepant Gastroenterol 1993;40:588-592.
Acute HBV For further information, please refer to the appropriate operator’s manual for the
48 - - 48 - - analyzer concerned, the respective application sheets, the product information
infection
clinically and and the Method Sheets of all necessary components (if available in your country).
serologically A point (period/stop) is always used in this Method Sheet as the decimal
manifested separator to mark the border between the integral and the fractional parts of a
decimal numeral. Separators for thousands are not used.
Acute HBV 31 4 3 (neg) 31 4 3 (pos)k)
infection Symbols
clinically Roche Diagnostics uses the following symbols and signs in addition to those
manifested listed in the ISO 15223‑1 standard (for USA: see https://usdiagnostics.roche.com
for definition of symbols used):
Acute HBV 57 6 16 (neg) 57 6 16 (pos)
infection CONTENT Contents of kit
serologically 1 (pos) 1 (neg) SYSTEM Analyzers/Instruments on which reagents can be used
manifested REAGENT Reagent
Serologically 145 292 44 (neg) 145 292 44 (pos) CALIBRATOR Calibrator
manifested no
Volume after reconstitution or mixing
clinical
information GTIN Global Trade Item Number
i) positive COBAS, COBAS E, ELECSYS and PRECICONTROL are trademarks of Roche. INTRALIPID is a
j) negative trademark of Fresenius Kabi AB.
k) In the comparison test, the discrepant samples were weakly positive. All other product names and trademarks are the property of their respective owners.
Clinical specificity Additions, deletions or changes are indicated by a change bar in the margin.
To investigate the specificity, samples from randomly selected blood donors were © 2017, Roche Diagnostics
tested with the Elecsys Anti‑HBc IgM assay in comparison to licensed enzyme
immunoassays.
1003/1003 samples from blood donors were negative with the Elecsys Anti‑HBc Roche Diagnostics GmbH, Sandhofer Strasse 116, D-68305 Mannheim
IgM assay (100 % specificity for this cohort). www.roche.com

990/1003 were negative with a comparison test (98.7 % specificity).

242/242 samples from hospitalized patients, pregnant women, and dialysis
patients with no indication of a HBV infection were negative with both the Elecsys
Anti‑HBc IgM assay and the comparison test (100 % specificity for this cohort).
References
1 Gudat F, Bianchi L, Sonnabend W, et al. Pattern of core and surface
expression in liver tissue reflects state of specific immune response in
hepatitis B. Laboratory investigations 1975;32(1):1-9.
2 Gerlich WH, Robinson WS. Hepatitis B virus contains protein attached to the
5’ terminus of its complete DNA strand. Cell 1980;21:801-809.
3 Gerlich WH, Goldmann U, Müller R, et al. Specificity and localization of the
hepatitis B virus-associated protein kinase. Journal of Virology
1982;42(3):761-766.
4 Roossinck MJ, Siddiqui A. In vivo phosphorylation and protein analysis of
hepatitis B virus core antigen. J Virol 1987;61:955-961.
5 Gallina A, Bonelli F, Zentilin L, et al. A recombinant hepatitis B core antigen
polypeptide with the protamine-like domain deleted self- assembles into
capsid particles but fails to bind nucleic acids. J Virol 1989;63(11):4645-4652.
6 Zhou S, Stranding DN. Hepatitis B virus capsid particles are assembled from
core-protein dimer precursors. Proc Natl Acad Sci USA 1992;89:10046-
10050.
7 Birnbaum BS, Nassal M. Hepatitis B virus nucleocapsid assembly: primary
structure requirements in the core protein. J Virol 1990;64(7):3025-3330.
8 Hollinger FB. Hepatitis B virus. In Fields BN, Knipe DM (eds) Virology 2nd
ed., New York, Raven Press 1990:2171-2236.

4/4 2018-04, V 19a Can English