Key result
Removal of immunoglobulin G from the patient's serum reversed the cardiac troponin T assay failure, suggesting interference by a circulating autoantibody to cardiac troponin T.
Case Report (n=1)
No
Circulating autoantibodies to cardiac troponin T can cause false-negative assay failures on the CARDIAC Troponin T Quantitative reader, highlighting the need for clinical vigilance when laboratory results do not match the clinical picture.
Autoantibody interference may explain false-negative troponin T results when mismatched with clinical findings; this single case leaves open assay prevalence and generalizability.
BACKGROUND: Immunoassays are prone to interference by various substances which may cause inaccurate results. This type of interference is difficult to detect analytically. OBJECTIVE: A case of CARDIAC Troponin T Quantitative reader (Roche Diagnostics) assay failure was detected and investigated in order to ascertain the likely cause. METHOD: Patient whole blood was mixed with cardiac troponin T-positive blood, patient and control sera were denuded of immunoglobulin G by protein A-affinity chromatography and patient sera were mixed with mouse serum. Samples were analysed on a CARDIAC Troponin T Quantitative reader. RESULTS: A mixture of patient whole blood and cardiac troponin T-positive blood resulted in assay failure; removal of immunoglobulin G from patient sera reversed the cardiac troponin T assay failure; the addition of mouse serum as a heterophile antibody blocking agent had no effect. CONCLUSION: It is proposed that the interference resulting in assay failure may not be because of a heterophile antibody, but rather a result of a circulating autoantibody to cardiac troponin T, which may compete with antibody assay reagents for binding sites.
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Fortgens et al. (2013) conducted a case report in Cardiac troponin T assay failure (n=1). Immunoglobulin G (IgG) depletion via protein A-affinity chromatography vs. Untreated patient plasma/whole blood was evaluated on Formation of control line on cTnT reagent strip. Removal of immunoglobulin G from the patient's serum reversed the cardiac troponin T assay failure, suggesting interference by a circulating autoantibody to cardiac troponin T.
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