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Clinical Chemistry 44: 1584-1595, 1998;
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(Clinical Chemistry. 1998;44:1584-1595.)
© 1998 American Association for Clinical Chemistry, Inc.

Letters

Interference with Nephelometric Assay of C-Reactive Protein by Monoclonal Immunoglobulin

Manfred Lammers

Dade Behring Marburg GmbH, Product Line Plasma Proteins, P.O. Box 1149, D-35001 Marburg, Germany, E-mail lammers{at}msmbwma.hoechst.com


To the Editor:

Various chemical laboratory methods are subject to interference by monoclonal immunoglobulins (paraproteins, e.g., those cited in references 1 and 2). This phenomenon does not depend on antibody specificity of the monoclonal immunoglobulins but on peculiarities of their physico-chemical behavior. Occasionally, similar interference has been reported with homogeneous immunoassays for C-reactive protein (CRP) determination (3)(4)(5). Yamada et al. (6) add to this list a case report of a patient with monoclonal IgM, type {kappa}, exhibiting erroneously high results in our particle-enhanced immuno-nephelometric assays for determination of CRP and antistreptolysin O (ASO) (N Latex CRP and N Latex ASL, respectively, of Dade Behring). The mechanism of interference by monoclonal IgM with the N Latex CRP assay (product code OUSV) has been investigated in more detail by Le Carrer et al. (7). That study showed that an unspecific reaction of certain monoclonal proteins (mostly of {kappa}-type) depended on the presence of latex particles and was further affected by coating of the particles with antibody (rabbit anti-human CRP) and by reaction enhancers (polyethylene glycol, PEG).

Behring Diagnostics in 1996 launched a new generation of immunonephelometric CRP assay, N Latex CRP mono (product code OQIY, available in most parts of the world). This assay utilizes modified latex particles with optimized surface characteristics, mouse monoclonal antibodies, and no reaction enhancer. In our evaluation, we were unable to detect unspecific reactions with IgM paraproteins (8). Nevertheless, users should remain aware of potential interferences and should check the clinical plausibility of their results.


References

  1. Zaman Z, Sneyers L, Van Orshoven A, Blanckaert N, Marien G. Elimination of paraprotein interference in determination of plasma inorganic phosphate by ammonium molybdate method. Clin Chem 1994;41:609-614. [Abstract/Free Full Text]
  2. Bakker AJ. Influence of monoclonal immunoglobulins in direct determinations of iron in serum. Clin Chem 1991;37:690-694. [Abstract/Free Full Text]
  3. Gallou G, Legras B, Ruelland A, Grosbois B, Cloarec L. Problems of C-reactive protein determination in patients with monoclonal immunoglobulins [Letter]. Clin Chem 1993;39:918.[Free Full Text]
  4. Ponge TD, Le Carrer DL, Sagniez MM, Pontet M, Cottin SL. False rise in C-reactive protein in a patient with monoclonal IgM immunoglobulin. Clin Chim Acta 1993;220:101-106. [ISI][Medline] [Order article via Infotrieve]
  5. Borque de Larrea L, Rus A, Carlström A, Pira U, Delobbes E, Thiry P, et al. Determination of C-reactive protein by an improved turbidimetric assay on Boehringer Mannheim/Hitachi analysis systems. Klin Lab 1993;39:55-62.
  6. Yamada K, Yagihashi A, Ishii S, Tanemura K, Kida T, Watanabe N, et al. Interference with nephelometric assay of C-reactive protein and antistreptolysin-O by monoclonal IgM-{kappa} from a myeloma patient [Letter]. Clin Chem 1997;43:2435-2437. [Free Full Text]
  7. Le Carrer D, Audrain M, Grivard P, Richard C. Protéine C-réactive: Réactions non spécifiques dans le dosage néphélémétrique avec immunolatex. Feuillets de Biologie 1995;36:203-207.
  8. Lammers M, Harthus HP, Walter G. A liquid particle-enhanced reagent for the immunonephelometric determination of C-reactive protein using monoclonal antibodies [Abstract]. Proc XIV Int Congr Clin Chem, London 1996;:473.



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This Article
Right arrow Extract Freely available
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Right arrow Articles by Lammers, M.
Related Collections
Right arrow Clinical Immunology
Right arrow Proteomics and Protein Markers
Right arrow Automation and Analytical Techniques

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