Rheumatoid factor interference in the determination of carbohydrate antigen 19-9 (CA 19-9)

Berth, Mario; Bosmans, Eugène; Everaert, Jacques; Dierick, Jan; Schiettecatte, Johan; Anckaert, Ellen; Delanghe, Joris

doi:10.1515/cclm.2006.205

Cited by 40 publications

(16 citation statements)

References 11 publications

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“…RFs can also interfere with other laboratory tests, including those designed to detect anticardiolipin antibodies (especially if IgM levels are in the low positive range) [16], anti- β 2GPI antibodies [17], anti-HCV antibodies [18], antirubella antibodies [19], thyroid assays [20, 21], and tests for carbohydrate antigen 19–9 [22] and various cytokines [23]. …”

Section: Methods Of Detectionmentioning

confidence: 99%

Rheumatoid Factors: Clinical Applications

2013

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Rheumatoid factors are antibodies directed against the Fc region of immunoglobulin G. First detected in patients with rheumatoid arthritis 70 years ago, they can also be found in patients with other autoimmune and nonautoimmune conditions, as well as in healthy subjects. Rheumatoid factors form part of the workup for the differential diagnosis of arthropathies. In clinical practice, it is recommended to measure anti-cyclic citrullinated peptide antibodies and rheumatoid factors together because anti-cyclic citrullinated peptide antibodies alone are only moderately sensitive, and the combination of the two markers improves diagnostic accuracy, especially in the case of early rheumatoid arthritis. Furthermore, different rheumatoid factor isotypes alone or in combination can be helpful when managing rheumatoid arthritis patients, from the time of diagnosis until deciding on the choice of therapeutic strategy.

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Section: Methods Of Detectionmentioning

confidence: 99%

Rheumatoid Factors: Clinical Applications

2013

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“…Both situations have been reported in the literature: Berth et al [ 15 ] have reported a case of high level positivity for high RF (900 kU/L) associated with a very high positivity (80,000 U/L) with an assay for CA 19-9 (Centaur, Siemens Healthcare) but not with three other assays (ARCHITECT and AxSYM, Abbott, and Vidas, Biomerieux). In the divergent data reported by Liang et al [ 16 ], a patient with a history of biliary polyps and a single result for CA 19-9 of 395 U/L 7 years before showed very different levels of CA 19-9 in 2008 with AxSYM (1,047 U/L) and Elecsys (12 U/L) and was positive for also for RF (122 IU/mL).…”

Section: Introductionmentioning

confidence: 92%

CA 19-9: handle with care

Galli¹,

Basso

Plebani

2013

Clinical Chemistry and Laboratory Medicine

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Since its inception in the mid-1980s of the 20th century testing for carbohydrate antigen 19-9 (CA 19-9) has raised expectation for an earlier diagnosis and accurate monitoring of several malignant diseases. After almost 30 years, the available evidences have confirmed the appropriateness and usefulness of determining CA 19-9 levels as a prognostic indicator and as a reliable tool for monitoring pancreatic and gastrointestinal cancer, but concerns have been raised about its applications in screening, which is actually not recommended, and in the diagnosis of malignancies, due to several interferences that limit the specificity and to the insufficient sensitivity of this marker. In this paper we aimed to review the basic concepts of CA 19-9 testing and its current applications, with a major focus on the most recent evidences dealing with assay interference, methods comparison and monitoring of malignant diseases. The prognostic value and monitoring recommendations for pancreatic, gastric and colorectal cancers are described in depth.

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“…Immunoassay interference through endogenous antibodies, such as rheumatoid factor or heterophilic antibodies, remains a continuing challenge (2,3,7). The interference we described here was apparently caused by the direct binding of IgM antibodies to surface-modified polystyrene microparticles.…”

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confidence: 78%

Prevention of Assay Interference in Infectious-Disease Serology Tests Done on the Liaison Platform

Berth

Bosmans

2008

Clin Vaccine Immunol

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Immunoassay interference causing unexpected reactive results in magnetic-microparticle-based assays was detected. A systematic evaluation of Liaison Epstein-Barr virus immunoglobulin M showed that 5% of the positive results (0.4% of tested samples) could be explained by such interference. Adding chemical blocking reagents (polyvinylpyrrolidone and polyvinyl alcohol) to the assay buffers partially prevented this phenomenon.The Liaison diagnostic system (DiaSorin, Saluggia, Italy) is a convenient, automated immunoassay platform based on chemiluminescence and antigen/antibody-coated magnetic microparticles (4, 8). Immunoassay interference was suspected when, in a patient suffering from chronic fatigue, positive results were found for Borrelia burgdorferi sensu lato immunoglobulin M (IgM) (index, 7.0; cutoff, 1.1), cytomegalovirus IgM (70 mU/liter; cutoff, 30 mU/liter), Epstein-Barr virus (EBV) IgM (1,620 mU/liter; cutoff, 40 mU/liter), and herpes simplex virus IgM (index, 32; cutoff, 1.1). None of these positive results could be confirmed, either with other immunoassays or with immunoblotting. The patient serum contained neither rheumatoid factor nor paraprotein. We further thoroughly investigated the serum from this patient; we estimated the frequency of this type of interference, and we demonstrated a simple and inexpensive solution to partially prevent the problem.In the experimental methods described below, appropriate positive and negative control samples were used to detect any undesirable effects of the procedures.The index sample was pretreated with RF-Absorbent (Dade Behring, Marburg, Germany), which contains sheep IgM antibodies targeted against human IgG Fc fragments: 250 l of RF-Absorbent was added to 250 l of serum, and the mixture was briefly vortexed and incubated for 1 h at room temperature. This procedure, which precipitates IgG along with rheumatoid factor, did not affect the results and excluded insufficient sample pretreatment in the Liaison assays.Heterophilic antibody interference was excluded by treating the sample, according to the manufacturer's instructions, with a nonspecific antibody-blocking tube (Scantibodies Laboratory, Santee, CA). We also treated the sample by adding 40 g of PolyMAK-33 (MAK33-IgG1/IgG1 Poly; Roche Diagnostics, Mannheim, Germany) to 250 l of serum and incubated this mixture for 1 h at room temperature. PolyMAK-33 is a polymerized murine IgG1 preparation, superior to polyclonal mouse immunoglobulins in blocking heterophilic antibody activity (9). This procedure did not affect the results.However, incubating 250 l of sample with 75 l unlabeled beads (kindly provided by DiaSorin) at room temperature for 15 min and centrifuging this mixture for 5 min at 2,000 ϫ g completely eliminated the interference. Apparently, IgM antibodies from the patient reacted with the solid phase in the assays. To test whether this reactivity was restricted to one specific type of microparticle, we evaluated seven different types of microparticles (Dynabeads; Dynal Biotech, Oslo, Norway): M-27...

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Rheumatoid factor interference in the determination of carbohydrate antigen 19-9 (CA 19-9)

Cited by 40 publications

References 11 publications

Rheumatoid Factors: Clinical Applications

Rheumatoid Factors: Clinical Applications

CA 19-9: handle with care

Prevention of Assay Interference in Infectious-Disease Serology Tests Done on the Liaison Platform

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