Dear Graham
We had similar incidents on the Immulite 1000 and subsequently moved to a Roche platform.
Kind regards,
Madelene Jacobsz
Lancet Laboratories
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Graham Jones
Sent: 23 February 2017 01:46 PM
To: [log in to unmask]
Subject: ACTH question
Dear Colleagues,
We measure ACTH using a Siemens Immulite 1000 and have had about 8 samples were the result was elevated and on repeat testing on another method (Roche) the result was not elevated. We did the extra testing initially because of clinician feedback that the stable, elevated ACTH in some patients was not in keeping with the clinical picture. We subsequently tested other elevated samples and found this problem as well. The affected samples show non-linear dilution and PEG precipitation results are different from those see in other ACTH samples.
This has been described in a number of papers (Grasco J et al A diagnostic conundrum: heterophile antibody interference in an adrenocorticotrophic hormone immunoassay not detectable using a proprietary heterophile blocking agent. Ann Clin Biochem 2013: 50(5) 433-67) and Choy et al, Immunoassay interference complicating management of Cushing's disease: the onus is on the clinician and the laboratory. Ann Clin Biochem 2016).
We have informed Siemens and are awaiting feedback on occurrence of this issue in other labs.
I would be interested to hear if other labs have seen this phenomenon.
With thanks,
Graham
________________________________
From: Clinical biochemistry discussion list <[log in to unmask]<mailto:[log in to unmask]>> on behalf of Mohammad Al-Jubouri <[log in to unmask]<mailto:[log in to unmask]>>
Sent: Thursday, 23 February 2017 9:43 PM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: Odd Calcium Results
It seems that the initial hypercalcaemia was spurious (pseudohypercalcaemia), do you have ionised calcium result from blood gas analsysis. Have you done serum protein electrophoresis?
Regards
Mohammad
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Gee, Stephen
Sent: 23 February 2017 10:22
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Odd Calcium Results
Dear collective
We have an unusual calcium case and would welcome any thoughts:
37 year old Female with Crohn's disease, Hypothyroidism, Vitamin D deficiency and Hyperparathyroidism who takes Azathioprine, T4 and Vitamin D supplements.
The following results were obtained:
10/02/2017
18/02/2017
Calcium
3.18
3.69
Albumen
42
45
Corrected Calcium
3.18
3.65
PTH
9.0
-
Following the raised calcium on the 18/02/17 this patient was admitted to hospital and the admission bloods were:
21/02/2017
22/02/2017
Calcium
2.27
2.47
Albumen
42
45
Corrected Calcium
2.27
2.43
PTH
-
7.2
The Endocrinologist looking after this patient does not believe the calcium results from the 10th or 18th but these are technically correct as these results can be reproduced in the laboratory.
We would welcome any thoughts.
Stephen
Stephen Gee
Quality Co-Ordinator
Blood Sciences
The pathology partnership - Ipswich Hospital Hub Laboratory,
01473 703703
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