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Persistent Troponin Elevation in the Setting of an Elevated Rheumatoid Factor: When It Pays to Double Check
Alexandra Saunders1, Albert K Y Tsui2, Naji Alhulaimi3
1Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
CJC Open
|August 17, 2021
Summary
Elevated cardiac troponin levels may not always indicate heart attack. Assay interference, caused by factors like rheumatoid factor, can lead to false positives, necessitating further investigation.
Area of Science:
- Cardiology
- Clinical Chemistry
- Laboratory Medicine
Background:
- High-sensitivity troponin I (hs-TnI) is a key biomarker for diagnosing acute myocardial infarction.
- Elevated hs-TnI levels in the absence of clinical evidence of ischemia pose a diagnostic challenge.
Observation:
- The patient presented with persistently elevated hs-TnI levels that were inconsistent with normal cardiac imaging findings.
- Initial investigations were inconclusive in determining the cause of the elevated hs-TnI.
Findings:
- Subsequent analysis of alternate troponin samples revealed low levels, suggesting potential assay interference.
- Elevated rheumatoid factor was identified as a possible interfering factor.
- Reanalysis using heterophile antibody blocking tubes confirmed lower hs-TnI levels, resolving the discrepancy.
Implications:
- Assay interference should be considered in cases of unexplained hs-TnI elevation, especially when clinical presentation is discordant with cardiac ischemia.
- This case underscores the need for careful interpretation of troponin results and consideration of interfering factors.
- Laboratory reevaluation with specific blocking agents can resolve diagnostic dilemmas caused by immunoassay interference.
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