Unexpected discovery of CRP analytical interference: A case report

Objectives: Immunoturbidimetric assays are sensitive techniques in clinical biology that may be subjected to matrix effects, hook effects or aspecific reactions. Among these, large quantities of immunoglobulins can distort the intensity of the detected signal. This study illustrates the deleterious effect of analytical interference on clinical patient management, and assesses the practical relevance of a recently proposed algorithm for interference investigation.

Methods: Determination of C-Reactive Protein (CRP) concentration by liquid immunoprecipitation on latex particles coated with mouse anti-CRP monoclonal antibodies, rabbit anti-CRP polyclonal antibodies, by solid phase immunochemistry or by enzymatic assay.

Results: During the follow-up of a 75-year-old patient suffering from multiple chronic diseases in the Internal Medicine Department of Toulouse University Hospital, a severe infection was suspected facing a CRP plasma value over 700 mg/L while he was in remission of an indolent marginal zone lymphoma. Because of the absence of clinical signs of infection, an interference in the liquid immunoprecipitation CRP assay was suspected. The hypothesis of an interference due to anti-mouse autoantibodies was ruled out because of normal results for other immunoassays using different types of antibodies. Moreover, no interference was observed using solid phase immunochemistry assay. Protein electrophoresis and immunofixation documented a relapse of lymphoma along with the presence of abnormal monoclonal immunoglobulins interfering with CRP measurement.

Conclusion: The interpretation of common clinical biochemistry parameters such as CRP can be difficult owing to analytical interferences. Reviewing all the pharmaco-clinico-biological data and collaboration with clinicians is of critical importance for optimal patient management.