Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States of America.
Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States of America.
Clin Chim Acta. 2019 Oct;497:125-129. doi: 10.1016/j.cca.2019.07.010. Epub 2019 Jul 17.
Analysis of many clinically important analytes is dependent on antibody-based assays. However, depending on the design, these assays are vulnerable to interference from endogenous molecules including circulating antibodies and free biotin. In this case report, we describe a patient whose laboratory findings from immunoassay based methodologies, are inconsistent with the clinical presentation.
A 14-year-old male was referred to Pediatric Endocrinology for suspected hyperthyroidism based on critically elevated free thyroxine (fT4) levels although clinical assessment was inconsistent with hyperthyroidism. Because repeat testing was discrepant, Endocrinology questioned the validity of the results prompting consultation with the laboratory to investigate the source of the inconsistent findings. Review of discordant results revealed that fT4 levels measured in laboratories utilizing Roche instrumentation were critically high, while results from laboratories using alternative platforms (i.e. Siemens Centaur) were within normal limits.
After a comprehensive evaluation which included testing of paired specimens on multiple platforms, measurement of serially diluted specimens and a formal evaluation for the presence of heterophile antibodies, it was determined that a heterophile antibody interference was the most likely cause of the aberrant results in this patient.
许多临床重要分析物的分析依赖于基于抗体的检测方法。然而，根据设计，这些检测方法容易受到内源性分子的干扰，包括循环抗体和游离生物素。在本病例报告中，我们描述了一名患者，其免疫检测方法的实验室检测结果与临床表现不一致。
一名 14 岁男性因游离甲状腺素 (fT4) 水平严重升高而被转介至儿科内分泌科，怀疑患有甲状腺功能亢进症，但临床评估与甲状腺功能亢进症不一致。由于重复检测结果不一致，内分泌科对检测结果的有效性提出质疑，促使与实验室进行咨询以调查不一致结果的来源。对不一致结果的回顾显示，罗氏仪器检测的 fT4 水平极高，而使用替代平台（即西门子 Centaur）的实验室结果在正常范围内。
经过全面评估，包括在多个平台上检测配对标本、检测连续稀释标本以及对存在异嗜性抗体的正式评估，确定该患者异常结果最有可能是由于异嗜性抗体干扰所致。
