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Impact of fibrin in high sensitivity cardiac troponin (Hs-cTn) detection: Implications for quality control
1Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria.
Insights
Fibrin clots can cause false positives in high-sensitivity troponin (hs-cTn) tests for acute myocardial infarction (AMI). This review highlights quality control needs and technological solutions to ensure accurate cardiac diagnosis.
Area of Science:
- Clinical Chemistry
- Cardiology
- Biomedical Science
Background:
- High-sensitivity troponin (hs-cTn) assays are vital for diagnosing acute myocardial infarction (AMI).
- Fibrin clots and other factors can interfere with hs-cTn assays, leading to inaccurate results.
- Accurate diagnosis is critical in emergency cardiac care.
Purpose of the Study:
- To review the impact of fibrin clot detection on hs-cTn testing accuracy.
- To emphasize the need for quality control in emergency cardiac testing.
- To identify technological solutions for improving diagnostic accuracy.
Main Methods:
- Critical literature review.
- Evaluation of fibrin clot implications in hs-cTn testing.
- Comparative analysis of auto-analysers for interference detection.
Main Results:
- Biomedical scientists must prevent pre-analytical fibrin formation.
- Steps are outlined to confirm hs-cTn diagnostic accuracy when fibrin is present.
- Technological advancements can help detect fibrin and other interferences.
- Limitations of current digital analysers in assessing procedural and outcome quality were identified.
Conclusions:
- Robust quality control is essential to prevent false-positive hs-cTn results due to fibrin.
- Technological solutions and careful pre-analytical procedures are key to accurate myocardial infarction diagnosis.
- Further advancements are needed to overcome analyser limitations in diagnostic quality assurance.
Abstract:
High-sensitivity troponin (hs-cTn) assays are crucial in the timely diagnosis of acute myocardial infarction (AMI). However, the presence of fibrin clots, among other interfering factors, can lead to false-positive results, undermining diagnostic accuracy. This critical literature review evaluates the implications of fibrin clot detection in hs-cTn testing, emphasising the need for robust quality control measures in emergency cardiac testing. Through this review, it was shown that biomedical scientists must prevent activities during the pre-analysis stage that may lead to fibrin formation. When such situations become inevitable due to various reasons, including patients' predispositions, several steps were outlined to confirm the diagnostic accuracy of hs-cTn in myocardial infarction. The importance of technological advancements in detecting fibrin and other potential sources of cross-reactivity or interference was also identified through a comparative analysis of some auto-analysers, proposing possible solutions to address these pitfalls as a means of promoting efficiency and quality assurance in the diagnosis of myocardial infarction through high-sensitivity troponin assays. It further exposed the limitations of these digital analysers and how they cannot independently determine the procedural and outcome quality of diagnostic medicine.
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