Elevated troponin levels associated with hemolysis

A 75-year-old African American man with a history of gastroesophageal reflux reported chest pain during an episode of intravascular hemolysis. Although the electrocardiogram and echocardiogram were unchanged from baseline, cardiac troponin I was persistently elevated. Cardiac catheterization showed no critical disease, and the elevated troponin was attributed to interference by free hemoglobin and/or bilirubin. Hemoglobinemia and hyperbilirubinemia may produce either false-positive or false-negative troponin levels, depending on the assay used and the form or subunit of troponin measured. In the presence of hemolysis, troponin levels must be interpreted with caution.