Antibody-mediated interferences affecting cardiac troponin assays: recommendations from the IFCC Committee on Clinical Applications of Cardiac Biomarkers

Author:

Hammarsten Ola1,Warner Janet V.2,Lam Leo34,Kavsak Peter5,Lindahl Bertil6,Aakre Kristin M.78ORCID,Collinson Paul910ORCID,Jaffe Allan S.11,Saenger Amy K.1213,Body Richard141516,Mills Nicholas L.17,Omland Torbjørn1819,Ordonez-Llanos Jordi2021,Apple Fred S.1213

Affiliation:

1. Department of Clinical Chemistry and Transfusion Medicine , University of Gothenburg , Gothenburg , Sweden

2. Faculty of Medicine , The University of Queensland , Saint Lucia , Australia

3. Chemical Pathology, LabPlus , Auckland City Hospital , Auckland , New Zealand

4. Biochemistry , Middlemore Hospital Laboratories , Auckland , New Zealand

5. Department of Pathology and Molecular Medicine , McMaster University , Hamilton , ON , Canada

6. Department of Medical Sciences , Uppsala University and Uppsala Clinical Research Center, Uppsala University , Uppsala , Sweden

7. Department of Medical Biochemistry and Pharmacology and Department of Heart Disease , Haukeland University Hospital , Bergen , Norway

8. Department of Clinical Science , University of Bergen , Bergen , Norway

9. Departments of Clinical Blood Sciences and Cardiology , St George’s University Hospitals NHS Foundation Trust , London , UK

10. St George’s University of London , London , UK

11. Departments of Laboratory Medicine and Pathology and Cardiology , Mayo Clinic , Rochester , MN , USA

12. Department of Laboratory Medicine and Pathology , Hennepin Healthcare/HCMC , Minneapolis , MN , USA

13. Department of Laboratory Medicine and Pathology , University of Minnesota , Minneapolis , MN , USA

14. Emergency Department , Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester , UK

15. Division of Cardiovascular Sciences , The University of Manchester , Manchester , UK

16. Healthcare Sciences Department , Manchester Metropolitan University , Manchester , UK

17. BHF/University Centre for Cardiovascular Science and Usher Institute, University of Edinburgh , Edinburgh , UK

18. Department of Cardiology , Akershus University Hospital , Lørenskog , Norway

19. Institute of Clinical Medicine, University of Oslo , Oslo , Norway

20. Servicio de Bioquímica Clínica , Hospital de Sant Pau , Barcelona , Spain

21. Foundation for the Biochemistry and Molecular Pathology , Barcelona , Spain

Abstract

Abstract The International Federation of Clinical Chemistry Committee on Clinical Applications of Cardiac Biomarkers (IFCC C-CB) provides educational documents to facilitate the interpretation and use of cardiac biomarkers in clinical laboratories and practice. Our aim is to improve the understanding of certain key analytical and clinical aspects of cardiac biomarkers and how these may interplay. Measurements of cardiac troponin (cTn) have a prominent place in the clinical work-up of patients with suspected acute coronary syndrome. It is therefore important that clinical laboratories know how to recognize and assess analytical issues. Two emerging analytical issues resulting in falsely high cTn concentrations, often several fold higher than the upper reference limit (URL), are antibody-mediated assay interference due to long-lived cTn-antibody complexes, called macrotroponin, and crosslinking antibodies that are frequently referred to as heterophilic antibodies. We provide an overview of antibody-mediated cTn assay interference and provide recommendations on how to confirm the interference and interpret the results.

Funder

The Swedish Heart and Lung Foundation

The Swedish Cancer Society

British Heart Foundation.

Publisher

Walter de Gruyter GmbH

Subject

Biochemistry (medical),Clinical Biochemistry,General Medicine

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