Antibody-mediated interferences affecting cardiac troponin assays: recommendations from the IFCC Committee on Clinical Applications of Cardiac Biomarkers

The International Federation of Clinical Chemistry Committee on Clinical Applications of Cardiac Biomarkers (IFCC C-CB) provides educational documents to facilitate the interpretation and use of cardiac biomarkers in clinical laboratories and practice. Our aim is to improve the understanding of certain key analytical and clinical aspects of cardiac biomarkers and how these may interplay. Measurements of cardiac troponin (cTn) have a prominent place in the clinical work-up of patients with suspected acute coronary syndrome. It is therefore important that clinical laboratories know how to recognize and assess analytical issues. Two emerging analytical issues resulting in falsely high cTn concentrations, often several fold higher than the upper reference limit (URL), are antibody-mediated assay interference due to long-lived cTn-antibody complexes, called macrotroponin, and crosslinking antibodies that are frequently referred to as heterophilic antibodies. We provide an overview of antibody-mediated cTn assay interference and provide recommendations on how to confirm the interference and interpret the results.

Automated summary

The IFCC C-CB provides educational materials to help interpret and use cardiac biomarkers in clinical laboratories and practice. Their aim is to improve understanding of key analytical and clinical aspects of cardiac biomarkers and their interplay. Two emerging analytical issues causing falsely high cTn concentrations are antibody-mediated assay interference (macrotroponin) and crosslinking antibodies (heterophilic antibodies). They provide an overview of these interference issues and recommendations on confirmation and interpretation of results.