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Related Experiment Videos

Artifactual hyperbilirubinemia due to paraprotein interference.

Liron Pantanowitz1, Gary L Horowitz, Jan N Upalakalin

  • 1Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass 02215, USA. lpantano@caregroup.harvard.edu

Archives of Pathology & Laboratory Medicine
|January 11, 2003
PubMed
Summary

Paraproteinemia can cause falsely high total bilirubin readings on the Roche assay due to precipitate formation. This rare interference highlights the need for laboratory vigilance when interpreting bilirubin results in affected patients.

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Area of Science:

  • Clinical Chemistry
  • Laboratory Medicine
  • Immunology

Background:

  • Automated chemistry assays can be subject to interference, though paraprotein interference is uncommon.
  • Two patients with paraproteinemia presented with erroneously elevated total bilirubin levels when analyzed using the Roche total bilirubin assay.

Purpose of the Study:

  • To elucidate the mechanism behind artifactual hyperbilirubinemia caused by paraproteins.
  • To determine the frequency of this interference in patients with monoclonal or increased immunoglobulins.

Main Methods:

  • Manual assay performance and analysis with an alternative manufacturer's assay for index patients.
  • Prospective study of 113 patients with monoclonal gammopathies or polyclonal hypergammaglobulinemia, measuring immunoglobulins, bilirubin, creatinine, and icterus spectrophotometrically.

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Main Results:

  • Precipitate formation observed in reaction mixtures with index patient serum, leading to turbidity and falsely elevated total bilirubin.
  • Index patients had normal direct bilirubin and normal total bilirubin by an alternate assay; no additional spurious results were found in the 113 patients.
  • The interference was attributed to turbidity rather than a true colorimetric change.

Conclusions:

  • Paraprotein interference in the Roche automated total bilirubin assay is caused by precipitate formation, resulting in spurious hyperbilirubinemia.
  • This interference is rare, likely idiosyncratic, and can lead to clinical confusion.
  • Laboratories should consider manual specimen examination or alternative assays if artifactual total bilirubin elevation is suspected.