1. Daily Variation in Endotoxin Levels is Associated with Increased Organ Failure in Critically Ill Patients.
   Klein DJ, Derzko A, Foster D, Seely A, Brunet F, Romaschin A, Marshall JC.,
   Shock, November 2007 - Abstract
    

2. Endotoxin activity in whole blood measured by neutrophil chemiluminescence is applicable to canine whole blood.
   Mads Kjelgaard-Hansen, Bo Wiinberg, Bent Aalbæk, Lisbeth Olsen, David Harris, Alexander Romaschin, Annemarie T. Kristensen and Asger L. Jensen
   Comparative Immunology, Microbiology and Infectious Diseases, August 2007 - Abstract

3. LPS, TLR4 and Infectious Disease Diversity.
   SI Miller, RK Ernst and MW Bader. Nature Reviews, Vol. 3 p.36-42 January 2005.

4. A rapid assay of endotoxin in whole blood using autologous neutrophil dependent chemiluminescence.
   Romaschin AD, Harris DM, Ribeiro MB, et al., J. Immunol. Methods 1998; 212: 169-185.

5. Let the Cells Speak: neutrophils as biologic markers of the inflammatory response.
   Romaschin AD, Foster DM, Walker PM, Marshall JC., Sepsis 1998; 2: 119-125.

6. A Novel Method for rapid detection of human endotoxemia.
   Foster DM, Derzko AN & Romaschin AD. Clinical Laboratory International, April 2004.

7. Diagnostic and Prognostic Implications of Endotoxemia in Critical Illness: Results of the MEDIC Study.
   JC Marshall, D Foster, JL Vincent, DJ Cook, et al., Journal of Infectious Diseases, Aug. 2004. 

8. Measurement of endotoxin activity in critically ill patients using whole blood neutrophil dependent chemiluminescence.
   Marshall JC, Walker PM, Foster DM, et al. Critical Care 2002; 6(4): 342-348.

9. Can Sepsis be better defined? Contribution of a novel assay for endotoxin.
   Foster DM, Derzko AN & Keffer JH. Clinical Microbiology Newsletter 26: 3, 2004

Frequently Asked Questions

Why a whole blood test?

• Whole blood enhances assay sensitivity to endotoxin >1000 fold compared to  buffers

• LBP and sCD-14 disaggregate LPS and expose the Lipid A epitope for antibody binding
   

Is the EAA susceptible to contamination?

Compared to the LAL, the EAA™ is much less susceptible to contamination because only direct contamination of the blood will have the biggest impact on a false positive result.  With the LAL any of the reagents are about equally prone to contamination.
 

Why is there a “max” tube?

Endotoxin activity is expressed in arbitrary units derived from the integral of the sample chemiluminescent response over time, and calibrated so that 0 units represents endotoxin activity in the absence of antibody, and 1.0 represents activity following the addition of a maximally stimulatory dose of LPS (4600 pg/ml).
 

Can heparinised blood tubes be used?

The problem with heparinized tubes is the chance that the heparin is contaminated with endotoxin.  This has been documented in previous papers. Furthermore EDTA storage of PMN's prevents some cell to cell homotypic aggregation and is more appropriate for chemiluminescence.