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Hager HB, Bolstad N, Warren DJ, et al. Falsely markedly elevated 25-hydroxyvitamin D in patients with monoclonal gammopathies. Clin Chem Lab Med. 2020;59(4):663-669doi: 10.1515/cclm-2020-1411.
Hager, H. B., Bolstad, N., Warren, D. J., Ness, M. V., Seierstad, B., & Lindberg, M. (2021). Falsely markedly elevated 25-hydroxyvitamin D in patients with monoclonal gammopathies. Clinical chemistry and laboratory medicine, 59(4), 663-669. https://doi.org/10.1515/cclm-2020-1411
Hager, Helle Borgstrøm, et al. "Falsely markedly elevated 25-hydroxyvitamin D in patients with monoclonal gammopathies." Clinical chemistry and laboratory medicine vol. 59,4 (2021): 663-669. doi: https://doi.org/10.1515/cclm-2020-1411
Hager HB, Bolstad N, Warren DJ, Ness MV, Seierstad B, Lindberg M. Falsely markedly elevated 25-hydroxyvitamin D in patients with monoclonal gammopathies. Clin Chem Lab Med. 2020 Oct 30;59(4):663-669. doi: 10.1515/cclm-2020-1411. Print 2021 Mar 26. PMID: 33119540.
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Clin Chem Lab Med. 2020 Oct 30;59(4):663-669. doi: 10.1515/cclm-2020-1411. Print 2021 Mar 26.

Falsely markedly elevated 25-hydroxyvitamin D in patients with monoclonal gammopathies.

Clinical chemistry and laboratory medicine

Helle Borgstrøm Hager, Nils Bolstad, David J Warren, Marianne Vindal Ness, Birgitte Seierstad, Morten Lindberg

Affiliations

  1. Department of Medical Biochemistry, Vestfold Hospital Trust, Tønsberg, Norway.
  2. Department of Medical Biochemistry, Oslo University Hospital - Radiumhospitalet, Oslo, Norway.
  3. Department of Laboratory Diagnostics, Vestre Viken Hospital Trust, Drammen, Norway.

PMID: 33119540 DOI: 10.1515/cclm-2020-1411

Abstract

OBJECTIVES: Monoclonal immunoglobulins can cause interference in many laboratory analyses. During a 4 month period we observed seven patients with monoclonal disease and falsely extremely elevated 25-hydroxyvitamin D (25(OH)D) results above 160 ng/mL (>400 nmol/L) measured using an immunoassay from Abbott Diagnostics. Based on these findings, we studied the occurrence of falsely elevated 25(OH)D in samples with paraproteins and investigated possible mechanisms of the observed interference.

METHODS: 25(OH)D was analyzed using the Architect i2000 platform from Abbott Diagnostics and a higher order method, liquid chromatography-mass spectrometry (LC-MS/MS), in serum samples from 50 patients with known monoclonal disease. Patients with falsely elevated 25(OH)D were included in further studies to elucidate the cause of interference. Spuriously elevated results were in addition analyzed on two alternative platforms (Siemens and Roche).

RESULTS: Falsely elevated 25(OH)D levels were present in eight patients on the Abbott analyzer and one on the Siemens platform. Results from Roche were comparable with LC-MS/MS. Additional investigations excluded elevated concentrations of rheumatoid factor and heterophilic antibodies as the cause of interference in the Abbott assay.

CONCLUSIONS: Laboratories should be aware of the risk of falsely elevated 25(OH)D in samples run on the Architect analyzer from patients with monoclonal disease. Highly elevated vitamin D results should be diluted and if the dilution is non-linear, rerun by a different method, preferably LC-MS/MS. In patients with spuriously elevated 25(OH)D without known monoclonal disease, the laboratory should consider requesting protein electrophoresis to exclude paraprotein interference.

© 2020 Helle Borgstrøm Hager et al., published by De Gruyter, Berlin/Boston.

Keywords: 25-hydroxyvitamin D2; analytical interference; artefact; humans; immunoassay; monoclonal protein; paraproteins

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