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A clinical and laboratory approach used to elucidate discordant results of high-sensitivity troponin T and troponin I

J. Franeková, M. Bláha, J. Bělohoubek, M. Kotrbatá, P. Sečník, Z. Kubíček, J. Kettner, A. Jabor,

. 2015 ; 446 (-) : 128-31. [pub] 20150417

Jazyk angličtina Země Nizozemsko

Typ dokumentu kazuistiky, časopisecké články

Perzistentní odkaz   https://www.medvik.cz/link/bmc16010291

BACKGROUND: Careful interpretation of discordant results in high-sensitivity troponin measurements is necessary in cases of suspect immunoassay interferences. We describe several procedures taken in a case of a polymorbid patient with chest pain, without clear evidence of myocardial necrosis and with increased high-sensitivity cardiac troponin T (hs-cTnT). We checked the Vafaie's algorithm for the evaluation of suspect interference in troponin measurements. METHODS: We conducted a case report analysis, additional measurements, a dilution test and pretreatment of plasma with blocking agents. RESULTS: Concentration of hs-cTnT (99 th percentile of "healthy" population 14 ng/L) increased from 120.1 ng/L to 280.4 ng/L during an 8-month period and decreased to 216.3 ng/L during the following month with repeatedly negative troponin I (TnI), hs-cTnI, myoglobin and creatine kinase MB (CK-MB). Suspected false positivity of hs-cTnT was further confirmed by treatment of plasma with an antiheterophile blocking agent (hs-cTnT before treatment 280.4 ng/L, after 16.53/16.23 ng/L). This outcome was further confirmed by the manufacturer's experiments. CONCLUSIONS: The false-positive results of hs-cTnT were caused by the presence of extremely rare high molecular weight protein, presumably IgM, most likely HAMA (human anti-mouse antibody). Only the pre-treatment of plasma with a blocking agent provided a reliable indication of the interference. Cooperation among clinicians, laboratory personnel and the manufacturer is essential.

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$a A clinical and laboratory approach used to elucidate discordant results of high-sensitivity troponin T and troponin I / $c J. Franeková, M. Bláha, J. Bělohoubek, M. Kotrbatá, P. Sečník, Z. Kubíček, J. Kettner, A. Jabor,
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$a BACKGROUND: Careful interpretation of discordant results in high-sensitivity troponin measurements is necessary in cases of suspect immunoassay interferences. We describe several procedures taken in a case of a polymorbid patient with chest pain, without clear evidence of myocardial necrosis and with increased high-sensitivity cardiac troponin T (hs-cTnT). We checked the Vafaie's algorithm for the evaluation of suspect interference in troponin measurements. METHODS: We conducted a case report analysis, additional measurements, a dilution test and pretreatment of plasma with blocking agents. RESULTS: Concentration of hs-cTnT (99 th percentile of "healthy" population 14 ng/L) increased from 120.1 ng/L to 280.4 ng/L during an 8-month period and decreased to 216.3 ng/L during the following month with repeatedly negative troponin I (TnI), hs-cTnI, myoglobin and creatine kinase MB (CK-MB). Suspected false positivity of hs-cTnT was further confirmed by treatment of plasma with an antiheterophile blocking agent (hs-cTnT before treatment 280.4 ng/L, after 16.53/16.23 ng/L). This outcome was further confirmed by the manufacturer's experiments. CONCLUSIONS: The false-positive results of hs-cTnT were caused by the presence of extremely rare high molecular weight protein, presumably IgM, most likely HAMA (human anti-mouse antibody). Only the pre-treatment of plasma with a blocking agent provided a reliable indication of the interference. Cooperation among clinicians, laboratory personnel and the manufacturer is essential.
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$a Bláha, Martin $u Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 140 21 Prague 4, Czech Republic. Electronic address: martin.blaha@ikem.cz.
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$a Bělohoubek, Jiří $u Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 140 21 Prague 4, Czech Republic. Electronic address: jiri.belohoubek@ikem.cz.
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$a Kotrbatá, Markéta $u Department of Laboratory Methods, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 140 21 Prague 4, Czech Republic. Electronic address: marketa.kotrbata@ikem.cz.
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$a Sečník, Peter $u Department of Laboratory Methods, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 140 21 Prague 4, Czech Republic. Electronic address: peter.secnik@ikem.cz.
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$a Kettner, Jiří $u Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 140 21 Prague 4, Czech Republic. Electronic address: jiri.kettner@ikem.cz.
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$a Jabor, Antonín $u Department of Laboratory Methods, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 140 21 Prague 4, Czech Republic; Charles University, 3rd Faculty of Medicine, Ruská 87, 100 00 Prague 10, Czech Republic. Electronic address: anja@medicon.cz.
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