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Intermethod discordance for alpha-fetoprotein measurements in Fanconi anemia
B Cassinat1, D Darsin, P Guardiola
1Nuclear Medicine Department, Assistance Publique-Hôpitaux de Paris, Saint-Louis Hospital, 75010 Paris, France. cassinat@chu-stlouis.fr
Background:
The significantly higher serum alpha-fetoprotein (AFP) in patients with Fanconi anemia (FA) than in non-FA aplastic patients has potential diagnostic utility, but the increase is method-dependent. The aim of this study was to compare five AFP assays on FA and non-FA samples and to investigate possible explanations for FA-specific discrepancies.
Methods:
Two methods available in our laboratory (Kryptor and IMx) were compared on 59 FA and 27 non-FA patient samples. Kryptor, Immulite, Elecsys, Immuno-I, and Elsa-2 methods were then compared on 14 FA and 14 non-FA patient samples. The AFP glycosylation profile was analyzed by electrophoretic separation in a lectin-containing gel.
Results:
With all six methods, AFP values were significantly higher in FA than in non-FA patients, but the diagnostic precision and optimal cutoff values varied. Indeed, two methods reached 100% sensitivity and specificity, but in other methods, one or both of these parameters were significantly <100%. Neither heterophilic antibodies nor a specific glycosylation profile was detected in FA samples.
Conclusions:
AFP results are method-dependent in FA. New methods must be evaluated before use in differential diagnosis of aplastic patients.