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Carbohydrate deficient transferrin and forensic medicine
Joris R Delanghe1, Marc L De Buyzere
1Department of Clinical Chemistry, Ghent University Hospital, De Pintelaan 185, B 9000 Gent, Belgium. joris.delanghe@ugent.be
Summary
Diagnosing chronic alcohol abuse is challenging. Carbohydrate deficient transferrin (CDT) is a common marker, but its interpretation requires care due to numerous caveats, necessitating advanced methods and alternative tests for accuracy.
Area of Science:
- Forensic Medicine
- Clinical Chemistry
- Toxicology
Background:
- Diagnosing chronic alcohol abuse presents significant challenges in forensic medicine.
- Carbohydrate deficient transferrin (CDT) is a widely used biomarker for chronic alcohol consumption.
- The diagnostic utility of CDT is limited by incomplete sensitivity and specificity, with numerous known confounding factors.
Purpose of the Study:
- To highlight the limitations of Carbohydrate deficient transferrin (CDT) in diagnosing chronic alcohol abuse.
- To emphasize the need for careful interpretation of CDT results in forensic and occupational medicine.
- To recommend advanced analytical techniques and complementary tests for improved diagnostic accuracy.
Main Methods:
- Review of known caveats affecting Carbohydrate deficient transferrin (CDT) diagnostic value.
- Discussion of advanced analytical methods like high-performance liquid chromatography (HPLC) and capillary zone electrophoresis (CZE) for CDT isoform separation.
- Consideration of alternative biomarkers such as ethyl glucuronide and fatty acid ethyl esters in hair.
Main Results:
- Carbohydrate deficient transferrin (CDT) analysis is subject to various pre-analytical and biological interferences.
- High-performance liquid chromatography and capillary zone electrophoresis offer superior separation of CDT isoforms, enhancing diagnostic precision.
- Alternative tests provide valuable supplementary data in complex cases.
Conclusions:
- Accurate diagnosis of chronic alcohol abuse requires a nuanced interpretation of Carbohydrate deficient transferrin (CDT) results.
- Advanced analytical techniques and judicious use of alternative biomarkers are crucial for reliable forensic and occupational assessments.
- Careful consideration of individual patient factors and potential interferences is essential for clinical decision-making.
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