Anti-ruthenium antibodies mimic macro-TSH in electrochemiluminescent immunoassay

Gessl, Alois; Blueml, Stefan; Bieglmayer, Christian; Marculescu, Rodrig

doi:10.1515/cclm-2014-0067

Cited by 22 publications

(16 citation statements)

References 38 publications

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“…This elevated immunoglobulin may be a marker, if not the source, of an interfering antibody responsible for the multiple analytic interferences. More specifically, we assume that because Roche electro-chemiluminescence immunoassays use ruthenium labeling and separation is done by streptavidin-coated microparticles, antibodies to either of those agents could explain the interference [ 8 , 9 ]. High-dose biotin supplements have been shown to interfere with streptavidin conjugates [ 10 ], but our patient did not use biotin at the time of testing.…”

Section: Discussionmentioning

confidence: 99%

Falsely Elevated Steroid Hormones in a Postmenopausal Woman Due to Laboratory Interference

Langlois

Moramarco

et al. 2017

Journal of the Endocrine Society

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Laboratory interference is a drawback in hormonal testing, and clinicians should have a high index of suspicion when faced with biochemical results discordant with the patient's clinical manifestations. A 62-year-old postmenopausal woman initially consulted her primary care physician for mood lability; laboratory workup showed markedly elevated levels of total serum estradiol, progesterone, testosterone, and cortisol as measured by immunoassay. Further investigation demonstrated no evidence of estrogen effect on uterus, no adrenal or adnexal mass, and no evidence of Cushing syndrome. Conventional techniques to unmask laboratory interference, such as dilution, antigen precipitation, and using a different immunoassay did not unveil a potential laboratory interference. The patient had no apparent risk factor for analytic interference, such as absent rheumatoid factor and heterophilic antibodies, but had only mild monoclonal IgG hypergammaglobulinemia. In this case, mass spectrometry unmasked the false elevation in steroid hormones. Interference of gammaglobulins or antibodies with the labeling and separation process of the assay could be the culprits. In conclusion, we report a unique case of multiple steroid hormones elevations due to laboratory interference unmasked by mass spectrometry.

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Section: Discussionmentioning

confidence: 99%

Falsely Elevated Steroid Hormones in a Postmenopausal Woman Due to Laboratory Interference

Langlois

Moramarco

et al. 2017

Journal of the Endocrine Society

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“…Since patients did not use heparin it was postulated that an antibody caused the grossly elevated FT4 results on the Immulite 2500 in comparison with other analyzers and equilibrium dialysis. Several different immunoassay tests have been reported to give aberrant results when interfering antibodies are present ( 14 - 17 ). Antibody interference was eliminated by treatment with protein A/G sepharose but not with HBT.…”

Section: Discussionmentioning

confidence: 99%

“…When FT4 immunoassay interference is suspected, retesting with a different commercial assay is a useful strategy ( 17 , 18 ). However, comparison of FT4 results between different methods can be challenging ( 19 , 20 ).…”

Section: Discussionmentioning

confidence: 99%

Misleading FT4 measurement: Assay-dependent antibody interference

et al. 2016

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IntroductionCommonly used free thyroxine (FT4) immunoassays can be falsely elevated due to interference causing misinterpreted thyroid function. We present two cases with high FT4 concentrations due to antibody interference. This study’s aim was to investigate the source of the FT4 immunoassay interference and possibility of its removal by two different techniques in order to correct the discrepancy between obtained FT4 values and the patient’s clinical status.Materials and methodsTwo patients presented at their general practitioners’ with elevated FT4 concentrations in combination with a normal and increased thyroid stimulating hormone (TSH) concentrations. Clinical symptoms differed between patients but did not correspond with the hyperthyroid status suggested by the laboratory results. FT4 concentrations from both patients were measured on four common commercial immunoassays and the dialysis method before and after treatment with heterophilic blocking tubes and protein A/G.ResultsRemoval of interfering antibodies using protein A/G resulted in normal FT4 concentrations.ConclusionThis report illustrates falsely elevated FT4 concentrations due to assay interference on the Immulite immunoassay analyser caused by heterophilic antibodies, which were eliminated by protein A/G treatment. We point out the importance of a close collaboration between doctors and the laboratory to avoid unnecessary clinical intervention.

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“…Some use biotin-streptavidin as the separation tool [40] and ruthenium [41] for an electrochemiluminescent signal. Antibodies to ruthenium have been reported [42] and also biotin [43]. Further, the therapeutic use of biotin [44] has caused false results on immunoassay utilising biotin-streptavidin [45,46].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

The investigation of interferences in immunoassay

Ward

Simpson

Boscato³

et al. 2017

Clinical Biochemistry

118

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Immunoassay procedures have a wide application in clinical medicine and as such are used throughout clinical biochemistry laboratories both for urgent and routine testing. Clinicians and laboratory personnel are often presented with immunoassay results which are inconsistent with clinical findings. Without a high index of suspicion interferences will often not be suspected. Artifactual results can be due to a range of interferences in immunoassays which can include cross reacting substances, heterophile antibodies, autoantibodies and the high dose hook effect. Further, pre-analytical aspects and certain disease states can influence the potential for interference in immunoassays. Practical solutions for investigation of artifactual results in the setting of the routine clinical laboratory are provided.

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Anti-ruthenium antibodies mimic macro-TSH in electrochemiluminescent immunoassay

Abstract: To our knowledge this is the first report of anti-ruthenium antibodies selectively interfering with a TSH assay and causing erratic gross elevation of TSH mimicking macro-TSH.

Cited by 22 publications

References 38 publications

Falsely Elevated Steroid Hormones in a Postmenopausal Woman Due to Laboratory Interference

Falsely Elevated Steroid Hormones in a Postmenopausal Woman Due to Laboratory Interference

Misleading FT4 measurement: Assay-dependent antibody interference

The investigation of interferences in immunoassay

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