False-positive troponin I measured with the Abbott AxSYM attributed to fibrin interference

Serum is often used for the measurement of cardiac troponin I (cTnI). Previous reports suggest that fibrin present in serum samples collected for cTnI analysis may interfere with measurement of this marker. We investigated the incidence and magnitude of fibrin interference in serum specimens submitted for cTnI measurement using the AxSYM analyzer by performing duplicate analysis of all specimens with increased cTnI results.

Over a 4-month period, we analyzed 3692 specimens for cTnI with the Abbott AxSYM. Of these, 307 (8.3%) showed increased cTnI. A threshold of three times the precision of the method (15%) was used to judge discrepancies between duplicate analyses of specimens; all specimens being recentrifuged between the initial and repeat cTnI analyses.

Of 307 patient specimens with elevated cTnI concentrations, 24 (7.8%) demonstrated differences of greater than 45% between duplicate analyses. Concentrations of cTnI obtained on initial analysis of these 24 specimens ranged from 2.4 to 24.0 microg/l. Repeat analysis showed the repeat values for 20 (83%) to be within the normal reference interval, with 16 (67%) showing concentrations of less than 0.3 microg/l.

Our finding indicates that interference should be highly suspected in serum specimens where the initially measured cTnI concentrations is in the range of 2.0-25.0 microg/l when using the Abbott AxSYM. The finding of no interference in specimens with measured troponin concentration greater than 25.0 microg/l suggests that the interference effect of fibrin is generally not sufficient to cause spurious elevations of cTnI into this range. In addition, since switching to plasma as the specimen of choice for the AxSYM, we have not observed any discrepant cTnI results following duplicate analysis of over 200 patient samples with initial measured cTnI concentrations of 2.0 microg/l or greater.