A paraprotein interference and its management in clinical laboratory / Bir paraprotein interferansı vakasının klinik laboratuvarda yönetimi

Madenci, Özlem Çakır; Yücel, Nihal; Dağdelen, Lale Köroğlu; Temel, Yusuf; Bölük, Aycan; Orçun, Asuman

doi:10.1515/tjb-2016-0020

Cited by 4 publications

(1 citation statement)

References 8 publications

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“…2) interference in a sample on one platform is non-transferable to the other in the above instances corresponding measurements in the other wet chemistry platform correlated well with the dry chemistry results; 3) interference is not to the concentration of the measurand, in this case, bilirubin and 4) interference is not proportional to the amount of paraproteins present, as the absolute percentage variation of the wet chemistry vis-á-vis dry chemistry results does not correlate inversely with the A/G ratio (Table 3). As explained by King et al (30) and Madenci et al (31), such interferences in bilirubin measurement by diazotization are usually due to precipitation of proteins in the extremely acidic pH of the reaction mixture.…”

Section: Discussionmentioning

confidence: 99%

Paraprotein interferences: Insights from a short study involving multiple platforms and multiple measurands.

Sarkar

2023

Preprint

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Background: Though paraproteinaemic interferences is a well-known phenomenon in clinical chemistry, a large-scale evaluation study involving multiple paraproteinaemic specimens on multiple platforms including multiple measurands with an aim to provide a predictive analysis, is singularly lacking. The present study aims to fill this gap in research. Material & Methods: This cross-sectional non-interventional observational study involved thirteen paraproteinaemic subjects, determined their gamma globulin characterization and measured their total bilirubin, direct bilirubin, HDL-cholesterol, calcium, inorganic phosphate, iron and unsaturated iron binding capacity (UIBC) levels on a dry chemistry platform (Vitros 350) as the established method and two wet chemistry platforms (AU5800 and Cobas 6000) as the evaluation methods. Data thus generated was analyzed for any significant variation and tested if such variation increased with decreasing albumin/ globulin ratio. Results: Significant variation between dry chemistry and wet chemistry measurements were obtained for direct bilirubin, HDL and iron on AU5800 with p-values of 0.0009, <0.0001 and 0.0466 respectively. Similarly, discrepant results were obtained on Cobas 6000 for direct bilirubin and iron, with p-values of <0.0001 and 0.0002 respectively. Additionally, UIBC measurements on AU5800 varied significantly with increasing amounts of paraprotein present in the specimen (p-value = 0.0207). Conclusion: This study emphasizes on predictive analyses to show that paraprotein interferences are fairly common on wet chemistry platforms. Evolving algorithms for monitoring of reaction curves can minimize release of erroneous results due to such interferences.

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Section: Discussionmentioning

confidence: 99%

Paraprotein interferences: Insights from a short study involving multiple platforms and multiple measurands.

Sarkar

2023

Preprint

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A simple method to overcome paraproteinemic interferences in chemistry and immunoassays

Sarkar

2024

Laboratory Medicine

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Background Interferences on chemistry and immunoassay results due to paraproteinemia may lead to erroneous diagnoses and treatment. Such interferences are difficult to recognize and even more difficult to deal with. This report describes 1 such case where multiple measurands were affected and how the interferant was overcome. Case Report Paraproteins present in an immunoglobulin (Ig)G-lambda multiple myeloma specimen interfered with results of total bilirubin, direct bilirubin, inorganic phosphate, iron, ferritin, and total thyroxine measured on 3 platforms: AU5800, Alinity ci, and cobas pure. Repeat testing upon dilution with normal saline or deproteinization by polyethylene glycol precipitation gave unsatisfactory results on some or all the affected measurands. Repeat testing after dilution of the interferant serum with a healthy serum corrected the anomalous results for all the affected measurands. Conclusion Dilution of paraproteinemic serum with a healthy serum of known concentrations appears to be the most suitable method to negate the effects of paraproteinemic interferences.

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Contribution of the laboratory to a diagnosis process by sequential reflective testing: Paraprotein interference on a direct bilirubin assay

Yilmaz¹,

Şen

Gülbahar³

2021

Biochem. med. (Online)

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Errors in laboratory medicine occur in the preanalytical, analytical, and postanalytical phases. The errors are mostly detected in the preanalytical period. However, analytical errors are still an important source of error, despite their frequency is reduced significantly in years thanks to developments in laboratories. In this case, an analytical error was noticed during the verification of a patient’s results. The direct bilirubin of a 66-year-old male patient admitted to the emergency department was higher than the total bilirubin. The patient’s symptoms were fatigue and dyspnoea. Albumin and haemoglobin (Hb) concentrations of the patient were significantly low. After considering the patient’s demographics and laboratory results, the laboratory specialist suspected a paraproteinemia interference. Total protein was performed as a reflective test. The albumin/globulin ratio was reversed. Thereafter, serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE) were performed as another reflective tests, respectively. SPEP and IFE results were in favour of monoclonal gammopathy. The patient was directed to a haematologist, underwent a bone marrow biopsy, and the result was reported as Waldenstrom’s macroglobulinemia with plasma cell differentiation expressing IgM-Kappa. The patient went on a chemotherapy protocol, and his condition has been improved in subsequent months. Detection of analytical errors is of great importance, like in our case, and may be used as a tool to identify patients who have not yet been diagnosed. The laboratory specialist must dominate the entire process of each test in the laboratory, be aware of the limitations of tests, and turn these disadvantages into advantages when necessary.

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A paraprotein interference and its management in clinical laboratory / Bir paraprotein interferansı vakasının klinik laboratuvarda yönetimi

Cited by 4 publications

References 8 publications

Paraprotein interferences: Insights from a short study involving multiple platforms and multiple measurands.

Paraprotein interferences: Insights from a short study involving multiple platforms and multiple measurands.

A simple method to overcome paraproteinemic interferences in chemistry and immunoassays

Contribution of the laboratory to a diagnosis process by sequential reflective testing: Paraprotein interference on a direct bilirubin assay

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