Detecting paraprotein interference on a direct bilirubin assay by reviewing the photometric reaction data

A case of atypical IgA paraprotein interference on multiple chemistry assays: How to deal with it

This case report discusses how paraproteins interfere with multiple chemistry analyses and protocols to overcome such obstacles. A serum specimen containing two monoclonal IgA (llight chain) paraproteins is subjected to a battery of tests on three wet chemistry platforms - AU5800, Cobas Pure, and Alinityci; the results were compared with those on a Vitros 350/ ECiQ dry chemistry platform. Paraprotein interference was found to affect the bilirubins, inorganic phosphate, and iron, whose repeat runs were also found to be irreproducible. Dilution with normal saline also failed to produce a satisfactory effect. Deproteinization by polyethylene glycol and dilution of the specimen with a normal serum specimen were observed to produce desirable results. Interference by IgA paraprotein on measurement of the bilirubin, phosphate, and iron in the wet chemistry system can be mitigated either by deproteinization or by dilution with normal serum.

A component could not be larger than the whole, polyclonal immunoglobulin interference in conjugated/direct bilirubin assay and elimination: A case report

Analytical interferences (hemolysis, icterus, paraproteinemia, and lipemia) are of great concern in laboratory tests. In our case report, the conjugated bilirubin result of a patient was significantly higher than the total bilirubin. We recommend being more cautious with samples that produce indistinguishable results and attempting to resolve the issues before releasing them.

Contribution of the laboratory to a diagnosis process by sequential reflective testing: Paraprotein interference on a direct bilirubin assay

Errors in laboratory medicine occur in the preanalytical, analytical, and postanalytical phases. The errors are mostly detected in the preanalytical period. However, analytical errors are still an important source of error, despite their frequency is reduced significantly in years thanks to developments in laboratories. In this case, an analytical error was noticed during the verification of a patient’s results. The direct bilirubin of a 66-year-old male patient admitted to the emergency department was higher than the total bilirubin. The patient’s symptoms were fatigue and dyspnoea. Albumin and haemoglobin (Hb) concentrations of the patient were significantly low. After considering the patient’s demographics and laboratory results, the laboratory specialist suspected a paraproteinemia interference. Total protein was performed as a reflective test. The albumin/globulin ratio was reversed. Thereafter, serum protein electrophoresis (SPEP) and immunofixation electrophoresis (IFE) were performed as another reflective tests, respectively. SPEP and IFE results were in favour of monoclonal gammopathy. The patient was directed to a haematologist, underwent a bone marrow biopsy, and the result was reported as Waldenstrom’s macroglobulinemia with plasma cell differentiation expressing IgM-Kappa. The patient went on a chemotherapy protocol, and his condition has been improved in subsequent months. Detection of analytical errors is of great importance, like in our case, and may be used as a tool to identify patients who have not yet been diagnosed. The laboratory specialist must dominate the entire process of each test in the laboratory, be aware of the limitations of tests, and turn these disadvantages into advantages when necessary.