Key result
Falsely elevated high-sensitivity troponin T results in a 12-year-old boy were caused by an interfering high molecular weight compound, presumably an IgG antibody.
Why the study?
Certain compounds in serum may interfere with hs-TnT measurement, causing falsely elevated results that do not match clinical signs and symptoms.
What causes falsely elevated high-sensitivity troponin T in a patient without clinical evidence of myocardial injury?
Case Report (n=1)
No
What causes falsely elevated high-sensitivity troponin T in a patient without clinical evidence of myocardial injury?
Falsely elevated high-sensitivity troponin T can occur due to interference from high molecular weight compounds like IgG, highlighting the importance of investigating discordant clinical and laboratory findings.
Alerts clinicians to assay interference in discordant pediatric hs-TnT results; leaves open prevalence and standardized detection methods.
INTRODUCTION: Measurement of high-sensitivity troponin T (hs-TnT) has become an essential step in the diagnosis of acute myocardial infarction. This high-sensitivity method allows quantifying the concentration of troponin T in blood of healthy subjects with a lower inaccuracy compared to previous reagent generations. However, the presence of certain compounds in the sample may interfere with the result. We present a patient who had repeatedly high concentrations of hs-TnT in the serum sample that did not agreed with the signs and symptoms. In addition, ultrasensitive troponin I concentration was undetectable. MATERIALS AND METHODS: To investigate the presence of an interfering compound, different analysis were carried out. In order to discard macro complexes in the sample, the serum was precipitated with polyethylene glycol. In addition, the serum was incubated with Scantibodies Heterophilic Blocking Tube, which can block heterophilic antibodies. Finally, a size exclusion chromatography of the sample was performed by the manufacturer. WHAT HAPPENED: The interfering substance was allocated into fractions with proteins of 150kDa, corresponding to high molecular weight proteins like immunoglobulin G (IgG). This compound was responsible for the falsely elevated hs-TnT results and it affected only the high-sensitivity methods. MAIN LESSON: The detected interfering compound was probably an IgG. This type of interference must be kept in mind in front of discordant results, even if they are extremely rare. Therefore, interdisciplinary cooperation between clinicians, laboratory and manufacturer is essential.
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Aliste-Fernández et al. (2019) conducted a case report in Falsely elevated high-sensitivity troponin T (n=1). High-sensitivity troponin T assay was evaluated on Identification of assay interference. Falsely elevated high-sensitivity troponin T results in a 12-year-old boy were caused by an interfering high molecular weight compound, presumably an IgG antibody.
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