Falsely elevated serum estradiol due to heterophile antibody interference: a case report

Atkins, Paul; Mattman, André; Thompson, David M.

doi:10.20945/2359-3997000000324

Cited by 2 publications

(1 citation statement)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One perimenopausal (41-year-old) woman with a false high level of estradiol was found to contain an IgA lambda heterophile antibody that could bind the 125 I-labelled tracer of a competitive radioimmunoassay [10]. One postmenopausal woman with heterophile antibody interference that caused false estradiol elevation was in the setting of a competitive CLIA (Siemens ADVIA CENTAUR ® ) [11]. In another postmenopausal (62-year-old) woman with multiple steroid hormone elevations, (estradiol, progesterone, testosterone, cortisol) the false estradiol levels were due to laboratory interference of electro-CLIA (Roche Cobas e602) but not by the heterophile antibody [12].…”

Section: Discussionmentioning

confidence: 99%

Falsely elevated serum estradiol in woman of reproductive age led to unnecessary intervention and delayed fertility opportunity: a case report and literature review

2022

BMC Women's Health

View full text Add to dashboard Cite

Background The optimal management of patients in reproductive endocrinology relies on the accuracy and validity of sex hormone assays. Endogenous or exogenous substances can compete with the analyte. This competition can result in interfering errors and falsely indicate elevated serum levels. Obvious interference in estradiol assays appears to occur rarely. Consequently, clinicians who are not familiar with the potential of interference could be misled. In addition to unnecessary investigations and interventions and severe mental stress, falsely elevated estradiol results can result in missed or delayed fertility opportunities. Case A 28-year-old female with pregnancy demand was diagnosed with polycystic ovary syndrome, Hashimoto’s thyroiditis and subclinical hypothyroidism. She was found to have persistently elevated levels of serum estradiol in the early follicular phase (between 527 and 642 pg/mL). Screening workup was performed for nearly 11 months to find the causes. Serum tumor biomarkers were normal. Abdominal and pelvic computed tomography were negative for adrenal or adnexal masses. A left mesosalpinx cyst and benign pathological results were achieved by laparoscopic surgery. Hormonal substances and dietary supplements were absent, as determined by dietary records. Ultrasound confirmed follicles could grow slowly and eventually ovulate. Falsely elevated estradiol levels were suspected due to the discrepancy among high estradiol levels, follicle growth and normal gonadotropin levels. Immunological interference by heterophile antibody was finally verified by two competitive chemiluminescent immunoassay platforms (estradiol levels in the early follicle phase: 619 pg/mL, Siemens ADVIA CENTAUR and 60 pg/mL, Beckman, DxI 800). Successful clinical pregnancy was eventually achieved by combining induced ovulation, ultrasound monitoring and intercourse guidance. Conclusions Analytical interference and laboratory error should be suspicious at first when the clinical characteristics contradict the laboratory results of serum hormones. Measuring serum estradiol with another immunoassay platform is an easy and non-time-consuming method to exclude the heterophile interfering.

show abstract

Section: Discussionmentioning

confidence: 99%

Falsely elevated serum estradiol in woman of reproductive age led to unnecessary intervention and delayed fertility opportunity: a case report and literature review

2022

BMC Women's Health

View full text Add to dashboard Cite

show abstract

Falsely Elevated Estradiol Results in a 62-Year-Old Male Patient

Talaber

Meisel

Rosén

2022

Laboratory Medicine

View full text Add to dashboard Cite

Falsely increased estradiol levels can lead to unnecessary tests and therapeutic interventions. Here, we present a case of a 62-year-old man with falsely elevated estradiol, which led to subsequent follow-up testing and prescriptions. Alternative immunoassay testing, in conjunction with Scantibodies’ blocking reagents, polyethylene glycol precipitation, and liquid chromatography-tandem mass spectrometry confirmation demonstrated that the falsely elevated estradiol was due to the presence of macro-estradiol. This report emphasizes the importance of recognizing analytical interferences in immunoassays to appropriately manage subsequent testing and patient care.

show abstract

Falsely elevated serum estradiol due to heterophile antibody interference: a case report

Cited by 2 publications

References 18 publications

Falsely elevated serum estradiol in woman of reproductive age led to unnecessary intervention and delayed fertility opportunity: a case report and literature review

Falsely elevated serum estradiol in woman of reproductive age led to unnecessary intervention and delayed fertility opportunity: a case report and literature review

Falsely Elevated Estradiol Results in a 62-Year-Old Male Patient

Contact Info

Product

Resources

About