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Anti-ruthenium antibodies mimic macro-TSH in electrochemiluminescent immunoassay

  • Alois Gessl EMAIL logo , Stefan Blueml , Christian Bieglmayer and Rodrig Marculescu EMAIL logo
Published/Copyright: May 15, 2014
Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 52 Issue 11

Abstract

Background: Macro-hormones are circulating conjugates of hormones with immunoglobulins, which often artefactually elevate biochemical test results. Particularly when causing only moderate elevation no suspicion will be raised. By far the most frequently encountered macro-hormone is macro-prolactin. Here we report a female patient with rheumatoid arthritis who had persistently and grossly elevated thyroid stimulating hormone (TSH) but normal free thyroxine in electrochemiluminescent assays. Although clinically euthyroid, she was put on thyroxine therapy which caused hyperthyroid symptoms.

Methods: An analytic interference by macro-TSH was assumed by dilution experiments, polyethylene-glycol-precipitation, the addition of a heterophilic antibody blocking reagent and size exclusion chromatography.

Results: Further workup, however, revealed the presence of anti-ruthenium antibodies.

Conclusions: 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.

Keywords: electrochemiluminescent immunoassay; interference; macro-thyroid stimulating hormone (TSH); ruthenium-complex; thyroid stimulating hormone
Corresponding authors: Alois Gessl, Medical University of Vienna, Department of Medicine III, Division of Endocrinology and Metabolism, Waehringer Guertel 18-20, 1090 Vienna, Austria, Phone: +43 1 40400 4310, Fax: +43 1 40400 4309; E-mail: ; and Rodrig Marculescu, Medical University of Vienna, Department of Laboratory Medicine, Waehringer Guertel 18-20, 1090 Vienna, Austria, Phone: +43 1 40400 5355, Fax: +43 1 40400 5389, E-mail:

Acknowledgments

The authors thank Dr. Christina Porzig, Roche Diagnostics GmbH, Penzberg, Germany for her help with elucidating this case.

Conflict of interest statement

Authors’ conflict of interest disclosure: The authors stated that there are no conflicts of interest regarding the publication of this article

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

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Received: 2014-1-19
Accepted: 2014-4-16
Published Online: 2014-5-15
Published in Print: 2014-11-19

©2014 by De Gruyter

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https://doi.org/10.1515/cclm-2014-0067
Keywords for this article
electrochemiluminescent immunoassay; interference; macro-thyroid stimulating hormone (TSH); ruthenium-complex; thyroid stimulating hormone

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. From symptoms to biomarkers: a change of paradigm
  4. Reviews
  5. Biochemical markers in early diagnosis and management of systemic amyloidoses
  6. The accuracy of the anti-mitochondrial antibody and the M2 subtype test for diagnosis of primary biliary cirrhosis: a meta-analysis
  7. Genetics and Molecular Diagnostics
  8. Selection of an optimal method for co-isolation of circulating DNA and miRNA from the plasma of pregnant women
  9. General Clinical Chemistry and Laboratory Medicine
  10. Harmonisation of seven common enzyme results through EQA
  11. Harmonization in hemolysis detection and prevention. A working group of the Catalonian Health Institute (ICS) experience
  12. Adopting European Network for Health Technology Assessments (EunetHTA) core model for diagnostic technologies for improving the accuracy and appropriateness of blood gas analyzers’ assessment
  13. Impact of assay design on test performance: lessons learned from 25-hydroxyvitamin D
  14. Anti-ruthenium antibodies mimic macro-TSH in electrochemiluminescent immunoassay
  15. The relationship between the Spine Deformity Index, biochemical parameters of bone metabolism and vascular calcifications: results from the Epidemiological VERtebral FRACtures iTalian Study (EVERFRACT) in dialysis patients
  16. Quantification of polyclonal free light chains in clinical samples using a single turbidimetric immunoassay
  17. Global coagulation tests: their applicability for measuring direct factor Xa- and thrombin inhibition and reversal of anticoagulation by prothrombin complex concentrate
  18. Reference Values and Biological Variations
  19. The importance of individual biology in the clinical use of serum biomarkers for ovarian cancer
  20. The quality of diagnostic testing may be impaired during shipment of lithium-heparin gel tubes
  21. Cancer Diagnostics
  22. Serum human epididymis protein 4 (HE4) as a tumor marker in men with lung cancer
  23. Intestinal permeability in patients with metastatic colon cancer treated with patupilone
  24. Cardiovascular Diseases
  25. European multicenter analytical evaluation of the Abbott ARCHITECT STAT high sensitive troponin I immunoassay
  26. Infectious Diseases
  27. Early indicators of severity and construction of a risk model for prognosis based upon laboratory parameters in patients with hemorrhagic fever with renal syndrome
  28. Corrigendum
  29. Automated indirect immunofluorescence antinuclear antibody analysis is a standardized alternative for visual microscope interpretation
  30. Letters to the Editor
  31. The future of the laboratory information system – what are the requirements for a powerful system for a laboratory data management?
  32. Hypernatraemia in disguise
  33. Interference of therapeutic monoclonal immunoglobulins in the investigation of M-proteins
  34. The impact of exercise on the variation of serum free light chains
  35. Response to Jacobs: N Latex FLC serum free light-chain assays in patients with renal impairment
  36. Reply to Berlanga et al. (DOI 10.1515/cclm-2014-0420)
  37. Mean platelet volume in patients with non-alcoholic fatty liver disease: is mean platelet volume ready as a surrogate marker?
  38. False-positive D-dimer result in a latex-enhanced immunoassay caused by interfering human anti-mouse antibodies
  39. D-Dimer in normal pregnancy: determination of reference values for three commercially available assays
  40. Paraoxonase 2 sequence variation (c.311 C>G) is associated with a modest decrease in circulating LDL size in children and adolescents
  41. The effect of volume of hydrochloric acid preservation on 24-hour urinary catecholamine test
  42. Congress Abstracts
  43. Congress of Clinical Chemistry and Laboratory Medicine
  44. The 3rd EFLM-UEMS Congress
  45. 46th National Congress of the Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC – Laboratory Medicine)
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