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Sense and nonsense concerning biotin interference in laboratory tests
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<blockquote data-quote="madman" data-source="post: 180692" data-attributes="member: 13851"><p><strong>Sense and nonsense concerning biotin interference in laboratory tests (2020)</strong></p><p><em>Alena Moerman & Joris R. Delanghe</em></p><p></p><p></p><p><strong>ABSTRACT</strong></p><p><strong></strong></p><p><strong>Introduction:</strong> <em>Biotin supplementation (mainly OTC preparations) has gained popularity. There are concerns about biotin interference in immunoassays and potential misdiagnosis, especially since the discovery of high-dose therapy in MS. <span style="color: rgb(184, 49, 47)"><em>This review summarizes the dangers of biotin usage and possible countermeasures. </em></span></em></p><p></p><p><strong>Methods:</strong> <em>Immunoassays design determines whether positive or negative analytical errors may occur. Techniques using biotinylated reagents and biotin-binding proteins may generate errors. In sandwich immunoassays, biotin causes lowered results. Competitive immunoassays are more vulnerable: biotin usage causes false increased results. <span style="color: rgb(184, 49, 47)">The interference is platform-dependent. Parameters vary in their susceptibility: a combination of false positives and negatives mimicking a coherent profile is dangerous, e.g. combining falsely lowered TSH with falsely elevated FT4/FT3 mimicking hyperthyreosis. Other susceptible parameters are thyroglobulin, DHEA-S, estradiol, testosterone, ferritin, progesterone, Vitamin D, Vitamin B12, PSA, PTH, LH, FSH, Troponins I and T, Pro-BNP. Digoxin and PSA may also be affected. Tumor markers and ßhCG are robust. Inserts of serological markers of HIV, hepatitis B, and C warn of biotin interference.</span> </em></p><p></p><p><strong>Results:</strong> <em>Manufacturers have made assays less vulnerable to biotin interference. In doubtful cases, it is helpful to determine testosterone in females and estrogen in males. Both are elevated if biotin interference is present. Biotin supplementation should be discontinued. However, this is impossible in MS patients needing biotin, as interrupting this medication is discouraged.</em></p><p></p><p><strong>Conclusions:</strong> <span style="color: rgb(0, 0, 0)"><em>Solutions to overcome this interference are: informing patients prior to analysis (avoiding peak biotin values when sampling), choice of appropriate immunoassays, and use of biotin removing steps prior to analysis. </em></span></p><p></p><p></p><p></p><p></p><p><strong>Conclusion </strong></p><p></p><p><em><strong><span style="color: rgb(184, 49, 47)">T</span></strong></em><strong><em><span style="color: rgb(184, 49, 47)">he problem concerning biotin and its interference in immunoassays is real and should not be minimized.</span></em></strong> <em><strong><span style="color: rgb(184, 49, 47)">It is expected that the magnitude of the issue will only increase since the OTC and mainly pharmacologic usage will continue to rise.</span></strong></em> <strong><em><span style="color: rgb(44, 130, 201)">Alertness and awareness are the keys to the solution.</span></em></strong> <em><strong><span style="color: rgb(44, 130, 201)">When the problem is noticed in time, there are a number of strategies to overcome this interference: informing the patient prior to analysis (avoiding peak biotin values at the moment of sampling), choice of appropriate immunoassays, and (in case of doubtful result), use of biotin removing steps prior to analysis). </span></strong></em></p></blockquote><p></p>
[QUOTE="madman, post: 180692, member: 13851"] [B]Sense and nonsense concerning biotin interference in laboratory tests (2020)[/B] [I]Alena Moerman & Joris R. Delanghe[/I] [B]ABSTRACT Introduction:[/B] [I]Biotin supplementation (mainly OTC preparations) has gained popularity. There are concerns about biotin interference in immunoassays and potential misdiagnosis, especially since the discovery of high-dose therapy in MS. [COLOR=rgb(184, 49, 47)][I]This review summarizes the dangers of biotin usage and possible countermeasures. [/I][/COLOR][/I] [B]Methods:[/B] [I]Immunoassays design determines whether positive or negative analytical errors may occur. Techniques using biotinylated reagents and biotin-binding proteins may generate errors. In sandwich immunoassays, biotin causes lowered results. Competitive immunoassays are more vulnerable: biotin usage causes false increased results. [COLOR=rgb(184, 49, 47)]The interference is platform-dependent. Parameters vary in their susceptibility: a combination of false positives and negatives mimicking a coherent profile is dangerous, e.g. combining falsely lowered TSH with falsely elevated FT4/FT3 mimicking hyperthyreosis. Other susceptible parameters are thyroglobulin, DHEA-S, estradiol, testosterone, ferritin, progesterone, Vitamin D, Vitamin B12, PSA, PTH, LH, FSH, Troponins I and T, Pro-BNP. Digoxin and PSA may also be affected. Tumor markers and ßhCG are robust. Inserts of serological markers of HIV, hepatitis B, and C warn of biotin interference.[/COLOR] [/I] [B]Results:[/B] [I]Manufacturers have made assays less vulnerable to biotin interference. In doubtful cases, it is helpful to determine testosterone in females and estrogen in males. Both are elevated if biotin interference is present. Biotin supplementation should be discontinued. However, this is impossible in MS patients needing biotin, as interrupting this medication is discouraged.[/I] [B]Conclusions:[/B] [COLOR=rgb(0, 0, 0)][I]Solutions to overcome this interference are: informing patients prior to analysis (avoiding peak biotin values when sampling), choice of appropriate immunoassays, and use of biotin removing steps prior to analysis. [/I][/COLOR] [B]Conclusion [/B] [I][B][COLOR=rgb(184, 49, 47)]T[/COLOR][/B][/I][B][I][COLOR=rgb(184, 49, 47)]he problem concerning biotin and its interference in immunoassays is real and should not be minimized.[/COLOR][/I][/B] [I][B][COLOR=rgb(184, 49, 47)]It is expected that the magnitude of the issue will only increase since the OTC and mainly pharmacologic usage will continue to rise.[/COLOR][/B][/I] [B][I][COLOR=rgb(44, 130, 201)]Alertness and awareness are the keys to the solution.[/COLOR][/I][/B] [I][B][COLOR=rgb(44, 130, 201)]When the problem is noticed in time, there are a number of strategies to overcome this interference: informing the patient prior to analysis (avoiding peak biotin values at the moment of sampling), choice of appropriate immunoassays, and (in case of doubtful result), use of biotin removing steps prior to analysis). [/COLOR][/B][/I] [/QUOTE]
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Sense and nonsense concerning biotin interference in laboratory tests
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