In blood, the serum is the component that is neither a blood cell (serum does not contain white or red blood cells) nor a clotting factor; it is the blood plasma not including the fibrinogens. Serum includes all proteins not used in blood clotting (coagulation) and all the electrolytes, antibodies, antigens, hormones, and any exogenous substances (e.g., drugs and microorganisms). A study of serum is serology, and may also include proteomics. Serum is used in numerous diagnostic tests, as well as blood typing.
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Serum
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Background
If the proper anticoagulant treatment is not applicable, the whole blood in vivo will naturally coagulate under the action of fibrinogen after being collected in vitro, and the liquid part after centrifugation is called blood serum. Except for fibrinogen and clotting factors, serum contains all metabolites produced by the body, such as proteins, hormones, biomarkers and circulating nucleic acids. Serum is easier to obtain than plasma and is considered to be a standard sample for clinical testing. Serum is also a type of sample selected by many laboratories. Due to the different composition of serum and plasma, the concentrations of many analytes in plasma and serum are different, so the experimental evaluation results should pay attention to the type of sample source to prevent major evaluation errors.
Figure 1. Outcomes of the survey on the use of serum and plasma tubes (Source: lebani M, et al. 2020)
The use of serum has the following advantages. First, there is less cellular contamination. After centrifugation there is almost no cellular component in the serum, whereas plasma still contains a large number of red blood cells, white blood cells, platelets and cellular debris. Second, some measurements are more stable, and studies have shown that the stability of glucose in serum is better than that in plasma samples stored at room temperature. Third, there is no anticoagulant, so as to reduce the interference caused by this kind of substance. For example, EDTA and heparin have an effect on immunoassay. Serum can also be used for clinical treatment, and the most common use is as an antitoxin or antivenom. One way to treat Ebola infections, for example, is to inject sera containing passive antibodies from survivors of previous infections.
The study of serum is called serology, the broad definition of serology refers to the study of humoral reactions, mainly serum reactions, and more strictly speaking, serology is the study of serum immune response. At present, there is basically only one purpose for the development of serological diagnostic test, which is to determine the reaction conditions so that it can provide the best diagnostic accuracy for a specific classification in a single measurement.
References
1. lebani M, et al. Serum or plasma? An old question looking for new answers. Clin Chem Lab Med. 2020 Jan 28;58(2):178-187.
2. Hifumi T, et al. Clinical Serum Therapy: Benefits, Cautions, and Potential Applications. Keio J Med. 2017 Dec 25;66(4):57-64.
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References
Serum or plasma? An old question looking for new answers
Clin Chem Lab Med
Authors: Plebani M, Banfi G, Bernardini S, Bondanini F, Conti L, Dorizzi R, Ferrara FE, Mancini R, Trenti T.
Serum or plasma? An old question looking for new answers. There is a continual debate on what type of sample a clinical laboratory should use. While serum is still considered the gold standard and remains the required sample for some assays, laboratories must consider turn-around time, which is an important metric for laboratory performance and, more importantly, plays a critical role in patient care. In addition, a body of evidence emphasise the choice of plasma in order to prevent modifications of some analytes due to the coagulation process and related interferences. Advantages and disadvantages of serum and plasma are discussed on the basis of current literature and evidence. In addition, data are provided on the current utilisation of the samples (serum or plasma) in Italy and in other countries. Finally, a rationale for a possible switch from serum to plasma is provided
A systematic review of maternal TORCH serology as a screen for suspected fetal infection
Background: The acronym 'TORCH' refers to well-recognised causes of perinatal infections: toxoplasmosis, rubella, cytomegalovirus (CMV) and herpes simplex virus (HSV). A TORCH serology panel is often used to test for maternal primary infection following detection of ultrasound abnormalities in pregnancy.
Aim: This review aims to estimate the diagnostic yield of maternal TORCH serology in pregnancy following fetal ultrasound abnormalities.
Materials and methods: Primary studies published since 2000 that assessed maternal TORCH serology for suspected fetal infection and included information on indications for testing, definition of positive TORCH serology results, and perinatal outcomes were included.
Results: Eight studies with a total of 2538 pregnancies were included. The main indications for testing were polyhydramnios, fetal growth restriction and hyperechogenic bowel. There were 26 confirmed cases of congenital CMV, of which 15 had multiple ultrasound abnormalities. There were no cases of congenital toxoplasmosis, rubella or HSV confirmed in any of the eight studies.
Conclusions: The clinical utility of TORCH serology for non-specific ultrasound abnormalities such as isolated fetal growth restriction or isolated polyhydramnios is low. It is time to retire the TORCH acronym and the reflex ordering of 'TORCH' panels, as their continued use obscures, rather than illuminates, appropriate investigation for fetal ultrasound abnormalities
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Figure 1. Outcomes of the survey on the use of serum and plasma tubes
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