Analytical Interference Leading to a Diagnosis of Lymphoproliferative Disorder


Klin Onkol 2017; 30(1): 55-57. DOI: 10.14735/amko201755.

Background: Monoclonal immunoglobulins (paraproteins) are produced by B lymphocytes in lymphoproliferative disorders. A single monoclonal immunoglobulin is homogeneous in terms of its structure, and it can occur in human serum at high concentration and cause significant interference in laboratory assays. Case: We present a case of an 84-year-old man who was admitted to the hospital for progression of dyspnea. Basic laboratory tests showed a serum concentration of conjugated bilirubin, measured using the diazo spectrophotometric method, which was much higher than that of total bilirubin. The cause of the discrepancy was attributed to analytical interference by monoclonal immunoglobulins, which helped establish a diagnosis of lymphoproliferative disorder. Conclusion: Monoclonal immunoglobulins are relatively rare in serum but are an important cause of analytical interference. Monoclonal immunoglobulins should always be considered a source of interference when unexpectedly high, low, or contradictory data are encountered, and appropriate confirmatory tests (electrophoresis, imunofixation) should be performed in such circumstances. Failure to do so can result in errors in diagnosis and inadequate treatment. Conversely, when samples contain abnormal and especially high monoclonal immunoglobulin levels, the biochemical data should be carefully examined for any discrepancies, such as paraprotein interference, and the results should be taken into consideration in patient management.

Full text in PDF