Cardiac troponin and natriuretic peptide analytical interferences from hemolysis and biotin: Educational aids from the IFCC Committee on Cardiac Biomarkers (IFCC C-CB)

Abstract

Two interferences recently brought to the forefront as patient safety issues include hemolysis (hemoglobin) and biotin (vitamin B7). The International Federation for Clinical Chemistry Committee on Cardiac Biomarkers (IFCC-CB) obtained input from a majority of cTn and NP assay manufacturers to collate information related to high-sensitivity (hs)-cTnI, hs-cTnT, contemporary, and POC cTn assays, and NP assays interferences due to hemolysis and biotin. The information contained in these tables was designed as educational tools to aid laboratory professionals and clinicians in troubleshooting cardiac biomarker analytical results that are discordant with the clinical situation.

Keywords: biotin; hemolysis; interferences; natriuretic peptide; troponin

Cardiac troponin I and T (cTnI, cTnT) and the natriuretic peptides (NP; B-type natriuretic peptide, BNP; N Terminal-proBNP; NT-proBNP) are the primary cardiac biomarkers utilized in the diagnosis of myocardial injury and infarction (MI) and heart failure (HF), respectively. As with any clinical laboratory test, there are exogenous and endogenous factors that adversely interfere with the analytical performance of the cTn and NP assays, potentially resulting in inappropriate clinical interpretation of the results if the interferences are not identified. Analytical interferences are particularly concerning when dealing with cardiac biomarker assays, which are utilized to make time sensitive critical clinical decisions. Two interferences recently brought to the forefront as patient safety issues include hemolysis (hemoglobin) and biotin (vitamin B7, vitamin H, coenzyme R). The International Federation for Clinical Chemistry Committee on Cardiac Biomarkers (IFCC-CB) obtained input from a majority of cTn and NP assay manufacturers to collate information related to high-sensitivity (hs)-cTnI, hs-cTnT, contemporary, and POC cTn assays (Table 1) [1], and NP assays (Table 2) [2] interferences due to hemolysis and biotin. The information contained in these tables was designed as educational tools to aid laboratory professionals and clinicians in troubleshooting cardiac biomarker analytical results that are discordant with the clinical situation.