dc.contributor.author |
Lam, L |
en |
dc.contributor.author |
Bagg, Warwick |
en |
dc.contributor.author |
Smith, G |
en |
dc.contributor.author |
Chiu, WW |
en |
dc.contributor.author |
Middleditch, Martin |
en |
dc.contributor.author |
Lim, Julie |
en |
dc.contributor.author |
Kyle, Campbell |
en |
dc.date.accessioned |
2018-12-03T03:27:06Z |
en |
dc.date.issued |
2018-08 |
en |
dc.identifier.citation |
New Zealand Sociology 32(2):5-27 30 Nov 2017 |
en |
dc.identifier.issn |
1050-7256 |
en |
dc.identifier.uri |
http://hdl.handle.net/2292/44794 |
en |
dc.description.abstract |
Background: Exclusion of analytical interference is important when there is discrepancy between clinical and laboratory findings. However, interferences on immunoassays are often mistaken as isolated laboratory artefacts. The mechanism of a rare cause of interference in two patients that caused erroneous thyroid function tests, and also affects many other biotin dependent immunoassays, was characterized and reported. Patient findings: Patient 1 was a 77-year-old female with worsening fatigue while taking carbimazole over several years. Her thyroid function tests, however, were not suggestive of hypothyroidism. Patient 2 was a 25-year-old female also prescribed carbimazole for apparent primary hyperthyroidism. Despite an elevated free thyroxine, the lowest thyrotropin on record was 0.17 mIU/L. In both cases, thyroid function tests performed by an alternative method were markedly different. Further characterization of both patients' serum demonstrated analytical interference on many immunoassays using the biotin-streptavidin interaction. Sandwich assays (e.g., thyrotropin, follicle-stimulating hormone, troponin T, beta-human chorionic gonadotropin) were falsely low, while competitive assays (e.g., free thyroxine, free triiodothyronine, TSH binding inhibitory immunoglobulin) were falsely high. Pre-incubation of serum with streptavidin microparticles removed the analytical interference, initially suggesting the cause of interference was biotin. However, neither patient had been taking biotin. Instead, a ∼100 kDa immunoglobulin M (IgM) immunoglobulin with high affinity to streptavidin was isolated from each patient's serum. The findings confirm IgM anti-streptavidin antibodies as the cause of analytical interference. Summary: Two patients with apparent hyperthyroidism as a result of analytical interference caused by IgM anti-streptavidin antibodies are described. Conclusion: Analytical interference identified on one immunoassay should raise the possibility of other affected results. Characterization of interference may help to identify other potentially affected immunoassays. In the case of anti-streptavidin antibodies, the pattern of interference mimics that due to biotin ingestion. However, the degree of interference varies between individual assays and between patients. |
en |
dc.publisher |
Mary Ann Liebert |
en |
dc.relation.ispartofseries |
Thyroid |
en |
dc.rights |
Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. |
en |
dc.rights |
Final publication is available from Mary Ann Liebert, Inc., publishers http://dx.doi.org/10.1089/thy.2017.0673 |
en |
dc.rights.uri |
https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm |
en |
dc.rights.uri |
https://home.liebertpub.com/page/self-archiving/51 |
en |
dc.title |
Apparent hyperthyroidism caused by biotin-like interference from IgM anti-streptavidin antibodies |
en |
dc.type |
Journal Article |
en |
dc.identifier.doi |
10.1089/thy.2017.0673 |
en |
pubs.issue |
8 |
en |
pubs.begin-page |
1063 |
en |
pubs.volume |
28 |
en |
dc.rights.holder |
Copyright: Mary Ann Liebert, Inc. |
en |
pubs.end-page |
1067 |
en |
dc.rights.accessrights |
http://purl.org/eprint/accessRights/OpenAccess |
en |
pubs.subtype |
Article |
en |
pubs.elements-id |
743998 |
en |
pubs.org-id |
Medical and Health Sciences |
en |
pubs.org-id |
Medical Sciences |
en |
pubs.org-id |
School of Medicine |
en |
pubs.org-id |
Medicine Department |
en |
pubs.record-created-at-source-date |
2018-06-07 |
en |
pubs.online-publication-date |
2018-05-29 |
en |
pubs.dimensions-id |
29808739 |
en |