False increase in serum C-reactive protein caused by monoclonal IgM-lambda: a case report

Interference caused by human anti-animal antibodies has been described in many laboratory assays. Usually the antigen giving rise to these antibodies is not known. When present in sufficiently high titer, these antibodies may have a significant effect on laboratory assays, causing falsely increased or decreased values, to the detriment of patient care and laboratory diagnosis. We report a case of an 86-year old man who had greatly increased C-reactive protein (CRP) levels in serum (>500 mg/l), suggestive of an unusually strong inflammatory response such as seen in septicemia. Because this diagnosis was not consistent with his symptoms, CRP measurements were repeated using alternative methods, none of which gave CRP results higher than 12 mg/l. Protein electrophoresis followed by immunofixation showed a monoclonal IgM-lambda paraprotein (7 g/l), which bound the goat anti-CRP antibodies used in the first CRP assay. Precipitation of the IgM-lambda paraprotein eliminated the interference. Subsequent bone marrow tests did not reveal any blood malignancy, and the monoclonal IgM component was attributed to monoclonal gammopathy of unknown significance. In conclusion, an IgM-lambda paraprotein was shown to cause falsely elevated CRP values in an automated immunometric assay using goat anti-CRP antibodies.