Pre-analytical interference in point-of-care troponin T testing: a case series
-
Lekha Priyadharshini Kamarajan
Abstract
Objectives
To examine the impact of haematological and biochemical abnormalities on the failure of point-of-care troponin T (POCT) testing in patients with suspected acute coronary syndrome (ACS).
Case presentation
Five patients underwent Roche Troponin T Card Test (lateral flow immunoassay) in an emergency setting. Despite correct sampling and procedural adherence, no valid results were obtained resulting in an aborted test. Laboratory analysis revealed severe anaemia, polycythaemia, leucocytosis, thrombocytopenia, and hepatic and renal dysfunction across cases. After stabilization, repeat POCT yielded valid results in all survivors, correlating with normalized haematological parameters.
Conclusions
Pre-analytical factors such as extreme haematocrit, leucocytosis, and biochemical derangements can cause POCT failure. Pre-testing screening and guideline updates are essential to optimize POCT reliability in acute care.
Acknowledgements
Patients, concerned relatives, hospital staff for their cooperation in this case.
-
Research ethics: Institute Ethical Committee, AIIMS Patna(IEC) waives off ethical clearance for case reports at our institute.
-
Informed consent: Informed consent was obtained from all individuals included in this study, or their legal guardians or wards.
-
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. LPK: collection of data, history and preparing first draft, MM: content, supervision, patient investigation, reviewing the first draft, editing, re-reviewing, SK: collection of data, supervison, reviewing final draft, AK: clinical workup, diagnosis, reviewing final draft.
-
Use of Large Language Models, AI and Machine Learning Tools: None declared.
-
Conflict of interest: The authors state no conflict of interest.
-
Research funding: None declared.
-
Data availability: All relevant data have been submitted with the manuscript.
References
1. Cemin, R, Daves, M. Pre-analytic variability in cardiovascular biomarker testing: the dark side of the moon. Eur Heart J Suppl 2015;17:A2–5.Search in Google Scholar
2. von Lode, P, Laurila, P, Pulkki, K, Vuorinen, K, Astedt, B. Point-of-care testing of cardiac markers. Scand J Clin Lab Invest Suppl 2005;240:27–35.Search in Google Scholar
3. Lippi, G, Cervellin, G, Plebani, M. Preanalytical variability in troponin testing: implications for clinical practice. Clin Biochem 2011;44:1289–94.Search in Google Scholar
4. Okyay, GU, Yıldırır, A. Preanalytical and analytical factors responsible for false-positive cardiac troponins. Turk Kardiyol Dernegi Arsivi 2015;43:725–9.10.5152/akd.2015.6006Search in Google Scholar PubMed PubMed Central
5. Krintus, M, Panteghini, M. Laboratory-related issues in high-sensitivity cardiac troponin measurement. Clin Chem Lab Med 2020;58:789–802.10.1515/cclm-2020-0017Search in Google Scholar PubMed
6. Lippi, G, Chance, JJ, Church, S, Grankvist, K, Huisman, W, Jansen, RTP, et al.. Preanalytical quality improvement: from dream to reality. Clin Chem Lab Med 2011;49:1113–26. https://doi.org/10.1515/cclm.2011.600.Search in Google Scholar PubMed
7. Plebani, M. The detection and prevention of errors in laboratory medicine. Ann Clin Biochem 2010;47:101–10. https://doi.org/10.1258/acb.2009.009222.Search in Google Scholar PubMed
8. Storrow, AB, Nowak, RM, Diercks, DB, Mihalik, G, Han, JH, McNaughton, CD, et al.. Absolute values of cardiac troponin predict adverse events in patients with chest pain and a non-diagnostic electrocardiogram: results from the EMCREG-international i*trACS study. Am J Emerg Med 2008;26:752–6.Search in Google Scholar
9. Collinson, PO, Gaze, DC, Bainbridge, K, Fry, CH, Flather, M, Goodacre, S, et al.. Utility of cardiac troponin measurement in hospital patients with chest pain and suspected acute coronary syndrome. Heart 2006;92:378–80.Search in Google Scholar
10. Goodacre, S, Cross, E, Arnold, J, Angelini, K, Capewell, S, Nicholl, J. The health care burden of acute chest pain. Heart 2005;91:229–30. https://doi.org/10.1136/hrt.2003.027599.Search in Google Scholar PubMed PubMed Central
© 2025 Walter de Gruyter GmbH, Berlin/Boston
