Are troponin assays occasionally deceiving us?

Area of Science:

• Cardiology
• Clinical Chemistry
• Immunology

Background:

• Troponin (I or T) is the primary biomarker for detecting myocardial injury.
• Immune-based assays are standard for measuring troponin I levels in clinical settings.

Observation:

• A patient presented with misleadingly elevated troponin I levels.
• The elevation was attributed to a high rheumatoid factor titer.

Findings:

• Human antibodies, specifically rheumatoid factor, can interfere with troponin I immunoassay components.
• This interference leads to inaccurate quantification of troponin I, mimicking myocardial injury.

Implications:

• Clinicians must be aware of potential interferences in troponin testing.
• Understanding molecular mechanisms of interference is crucial for accurate diagnosis and patient management.
• Consideration of rheumatoid factor levels may be necessary in specific clinical scenarios.