A new interference in some digoxin assays: anti-murine heterophilic antibodies

Clinical Pharmacology and Therapeutics
C LiendoS W Graves

Abstract

We describe a patient with cirrhotic liver disease and atrial fibrillation who was treated with spironolactone and digoxin. He was hospitalized because of an incidental finding of a high serum digoxin level (4.2 micrograms/L), but he remained asymptomatic without emerging arrhythmias. Despite discontinuation of both drugs, his serum digoxin level persisted at or above 3.0 micrograms/L for approximately 5 weeks, drawing into question the accuracy of the digoxin assay. Additional digoxin methods gave lower, discrepant results, providing evidence of an assay interference, and several possible sources of digoxin false positivity were evaluated. This included assessment of the contribution of digoxin-like immunoreactive factor (DLIF), digoxin metabolites, and spironolactone. Because the routine digoxin assay used a monoclonal antibody, we also tested for another hypothetical interference: human heterophilic ("anti-mouse") antibodies. We found no contribution from DLIF, digoxin antibodies, or spironolactone to the apparent digoxin results. However, the use of protein A to complex and selectively remove immunoglobulin G molecules markedly lowered the apparent digoxin value, as did the less specific process of ultrafiltration. These re...Continue Reading

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Citations

Mar 2, 2010·Clinical Chemistry and Laboratory Medicine : CCLM·Elena Llorente FernándezJordi To-Figueras
Feb 21, 2006·Clinical Endocrinology·Alison M Jones, John W Honour
Jun 24, 2000·Journal of Toxicology. Clinical Toxicology·M IngelsR F Clark
Nov 27, 2008·The Annals of Pharmacotherapy·Terry E Jones, Raymond G Morris
Jun 16, 2001·Journal of Endocrinological Investigation·M TommasiM Mannelli
Oct 9, 2002·Clinica Chimica Acta; International Journal of Clinical Chemistry·Stanley S Levinson, James J Miller
Dec 10, 1999·Annals of Clinical Biochemistry·C Selby

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