Causes, consequences, and recognition of false-positive reactions for ketones.
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Acetaminophen↗
Biomedical subjects
G Csako
Publications and source records attributed to G Csako.
Direct and indirect techniques for free thyroxin compared in patients with nonthyroidal illness. III. Analysis of interference variables by stepwise regression.
We applied stepwise regression for multivariate analysis of data for free thyroxin (FT4) in serum and for other laboratory tests of thyroid function in patients with nonthyroidal illness. Using the maximum R2 improvement and backward elimination methods to test five variables [prealbumin, albumin, T4-binding globulin (TBG), free fatty acids (FFA), and FFA/albumin molar ratio], we found that the variables with the greatest predictive power clustered according to the methodology of FT4 measurement. Thus, we best predicted the FT4 results obtained by 16 techniques as follows: FT4 measured by one-step (analog) RIAs, with albumin; FT4 determined by two-step (sequential) RIAs, with FFA or FFA/albumin molar ratio; FT4 estimated by a binding-rate-based RIA or conceptually related FT4 indices [based on triiodothyronine (T3) uptake], with TBG; FT4 measured by equilibrium dialysis, with TBG and FFA/albumin molar ratio; and T4/TBG ratios, with either none or prealbumin and albumin. We could very highly (P less than 0.001) predict total T4 and T3 by considering TBG, and total T3 also by considering prealbumin and albumin, whereas reverse T3 was predictable with prealbumin only (negative relationship). We found comparatively weak associations between thyrotropin (TSH) and albumin or TBG. In clinical practice, abnormalities in key variables should call attention to possible effects of these variables on FT4 and other thyroid-test results and thus to the need for appropriate correction or alternative testing.
Carrier Proteins↗
Direct and indirect techniques for free thyroxin compared in patients with nonthyroidal illness. I. Effect of free fatty acids.
We examined the effect of endogenous free fatty acids (FFA) on the measurement of free thyroxin (FT4) by five different methodologies represented in 16 different assays in a large number of patients with nonthyroidal illness (NTI). Some, but not all, one-step (analog) FT4 RIAs negatively correlated with FFA concentration. All two-step FT4 RIAs, equilibrium dialysis FT4, and the dialyzable (free) fraction of T4 positively correlated. In contrast, a binding-rate-based FT4 RIA, FT4 indices based on T3 macroaggregated albumin uptake, and T4/TBG ratios did not correlate. We also analyzed the FT4-FFA relationship with a second, more sensitive approach by correlating test results with FFA/albumin molar ratio as an estimate of the "excess" (nonalbumin bound) FFA. We found that all FT4 RIAs, equilibrium dialysis FT4, FT4 indices based on T3 uptake, the dialyzable fraction of labeled T4 in equilibrium dialysis, the fraction of labeled T4 bound to solid phase antibody in the binding-rate-based RIA, and T3 uptake correlated with the FFA/albumin molar ratio. This FFA dependency was comparable among all the various techniques and was relatively small. Thus, increases or decreases in FT4 results due to varying FFA (and albumin) concentrations are highly likely with most currently available methods (only the T4/TBG ratio did not reveal FFA-dependency), but the magnitude of changes varies with the "excess" FFA.
Dialysis↗
Direct and indirect techniques for free thyroxin compared in patients with nonthyroidal illness. II. Effect of prealbumin, albumin, and thyroxin-binding globulin.
We studied the correlation of thyroxin (T4)-binding proteins with the apparent free T4 (FT4) in 101 patients with nonthyroidal illness (NTI). Most patients (95%) were seriously ill at the time of blood collection. Concentrations of T4-binding prealbumin (transthyretin), albumin, and T4-binding globulin (TBG) often were low in the sera of these patients. Albumin was the most frequently subnormal, TBG the least. FT4 in serum was determined by five methods represented in 16 different assays. With few exceptions, analog (one-step) FT4 RIAs--both the binding-rate-based RIA and the related FT4 indices (calculated from triiodothyronine-macroaggregated albumin uptake and total T4)--and T4/TBG ratios correlated positively and usually highly significantly (P less than 0.01) with concentrations of prealbumin, albumin, and TBG. Equilibrium dialysis values for FT4 did not correlate with prealbumin concentrations but showed a weakly (P less than 0.03) positive association with albumin and a highly significant (P less than 0.002) positive correlation with TBG. Of the three two-step FT4 RIAs tested, the only statistically significant but weakly (P less than 0.02) positive correlation with T4-binding proteins was between Spiria FT4 and TBG. Thus, in these NTI patients, FT4 estimates vary with methodology and, to a lesser extent, with the particular assay used. The results from two-step FT4 RIAs are least associated with binding protein concentrations.
Humans↗
Response of humans to gamma-irradiated reference Escherichia coli endotoxin.
This study assesses the effect of gamma-irradiation of endotoxin given intravenously to healthy human volunteers. The national reference standard endotoxin derived from E. coli was placed in aqueous medium in sterile-sealed ampoules and divided into four groups. One group received endotoxin with no radiation while the other three received endotoxin with gamma-irradiation at doses of 0.18, 0.36, or 1.08 Mrad. These doses of radiation cause characteristic alterations to the endotoxin molecule, primarily to the O-polysaccharide moiety. Each of the four different preparations of endotoxin was given intravenously to four volunteers at a concentration of 4 ng/kg. The responses for clinical symptoms, cortisol, and growth hormone were significantly and progressively reduced by increasing the irradiation to the endotoxin. Most strikingly, no clinical symptoms were noted with the endotoxin exposed to the highest dose of radiation (1.08 Mrad). Fever, vital signs, white blood cell count, and differential exhibited no statistically significant differences among the groups, but the kinetics of change were altered by increasing doses of gamma-irradiation. Irradiated endotoxin was significantly more effective in decreasing the platelet count than untreated endotoxin. The fever index correlated significantly with maximum temperature, change in temperature, white blood cell count index, mature neutrophil count index, and the cortisol index. Thus, there is dissociation of biological activities for endotoxin in humans due to molecular changes primarily in the O-polysaccharide moiety from exposure to gamma-irradiation.
Adult↗
Endotoxin-induced platelet activation in human whole blood in vitro.
The effect of purified bacterial endotoxin was studied on human platelets in vitro. In adding up to 1 microgram/mL of a highly purified endotoxin, we found neither aggregation nor ATP release in heparinized or citrated human platelet-rich plasma. On the other hand; endotoxin at concentrations as low as a few ng/mL (as may be found in septic patients) caused platelet aggregation in both heparinized and citrated human whole blood, as monitored by change in impedance, free platelet count, and size. Unlike collagen, the platelet aggregation with endotoxin occurred after a long lag phase, developed slowly, and was rarely coupled with measurable release of ATP. The platelet aggregating effect of endotoxin was dose-dependent and modified by exposure of the endotoxin to ionizing radiation. Thus, the activation of human platelets by "solubilized" endotoxin in plasma requires the presence of other blood cells. We propose that the platelet effect is mediated by monocytes and/or neutrophils stimulated by endotoxin.
Adenosine Triphosphate↗
Factitious elevation of thyrotropin in a new ultrasensitive assay: implications for the use of monoclonal antibodies in "sandwich" immunoassay.
Three patients who had falsely elevated serum TSH concentrations (initial values, 30.5, 74, and greater than 50 mU/L) in a mouse monoclonal immunoradiometric assay are reported. Two patients were treated for hypothyroidism inappropriately, and one underwent unnecessary diagnostic testing. Immunoaffinity chromatography of serum from one patient indicated that the serum TSH level was truly low. Addition of mouse serum or immunoglobulin G (IgG) or absorption of patient serum with solid phase-bound mouse IgG-1 reduced the TSH content in the serum of the three patients to undetectable levels. Blocking studies revealed that all patients had antibodies directed at mouse IgG-1, the subclass of mouse antibody present in the assay kit. The serum of one patient who had autoimmune disease with elevated serum Igs had much broader species cross-reactivity than that of another patient who had known exposure to rats and mice. We hypothesize that such antimouse antibodies can arise either from endogenous autoimmunity or exogenous animal exposure. Serum TSH elevations also were found when the serum samples were tested in other mouse monoclonal immunoassays, underscoring the fact that antibody interference can potentially affect many assays used in endocrinology and other areas of medicine to make major diagnostic and therapeutic decisions. Clinicians must be aware of such interactions; relatively simple laboratory maneuvers can differentiate true from false results in assays of this type.
Adult↗
Escape from blockade of interfering heterophile antibodies in a two-site immunoradiometric assay for thyrotropin.
Sandwich-type immunoassays in which mouse monoclonal antibodies are used are subject to positive interference by heterophile antibodies present in human serum. Manufacturers now customarily add nonspecific mouse immunoglobulins to absorb the heterophile antibodies and eliminate such interference. We describe the case of a patient who had spurious increases in thyrotropin concentration in serum despite use of the mouse immunoglobulins included in the assay kit. This resulted in a puzzling clinical picture, a workup, and treatment. We demonstrate that the observed increases in thyrotropin were markedly reduced by including additional amounts of mouse immunoglobulins of the appropriate class, subclass, and fragment type in the assay mixture.
Adolescent↗
The potency of immunoglobulin G fragments for inhibition of interference caused by anti-immunoglobulin antibodies in a monoclonal immunoradiometric assay for thyrotropin.
Heterophile antibodies in patients' serum may produce false increases in apparent analyte concentrations in "sandwich"-type immunoassays. Using three patients with endogenous anti-mouse IgG antibodies and a two-site mouse monoclonal assay for thyrotropin, we studied the ability of IgG fragments to block this positive interference. Mouse whole IgG and IgG Fc fragment blocked the interference virtually completely; IgG F(ab')2 and Fab fragments did not. Rat and horse immunoglobulin fragments gave variable results. We suggest that sandwich assays formulated with IgG Fab or F(ab')2 fragments may be less susceptible to positive interference by heterophile antibodies. Unlike sera from the three patients, simulated human specimens containing heterologous anti-IgG antibodies showed little or no selectivity in inhibition by IgG fragments, and therefore are not useful to study this phenomenon.
Animals↗
Free platelet count and size distribution during C1q inhibition of collagen-induced platelet aggregation.
Electronic free platelet counting was more sensitive than turbidimetry to detect collagen-induced platelet activation in human platelet-rich plasma. Purified human C1q exhibited a greater inhibitory effect on collagen-induced platelet aggregation in turbidimetry than free platelet counting. Because the change from small to large platelet aggregates is responsible for the continuing increase in light transmission, C1q was likely more capable of blocking the formation of large platelet aggregates than the formation of small aggregates from single platelets. The rate of change by collagen in light transmission and free platelet count was reduced in the presence of C1q but the timing of the peak response remained the same. Electronic platelet sizing revealed that the volume of single platelets transiently increased during the turbidimetric "lag phase". The mean, mode and median volume of the remaining free platelets then decreased, suggesting a selective loss of large, functionally more active platelets and/or platelet degranulation. C1q had no effect on the volume increment during the "lag phase", but reduced the subsequent fall in the volume of free platelets.
Adult↗
Dose-dependent changes in the antigenicity of bacterial endotoxin exposed to ionizing radiation.
The antigenic properties of the highly purified US reference standard endotoxin (RSE) exposed to varying doses of ionizing radiation were studied with double immunodiffusion, immunoelectrophoresis and immunoblotting. Rabbit RSE antisera identified 2 distinct major antigenic components for untreated RSE: one related to the O-polysaccharide side chain ("O-antigenic specificity"), the other to the R-core. Based on a serologic cross-reactivity of R-core of RSE (Escherichia coli 0113) with the R-core of the lipopolysaccharide from E. coli 0111, the core type of E. coli 0113 was identified as coli R3. Increasing exposure of RSE to ionizing radiation progressively destroyed all antigenic reactivities: at lower doses of radiation the rate of elimination differed for the 2 antigen classes. The O-polysaccharide was more sensitive to gamma-radiation than the R-core and the O-antigenicity was lost before that of the R-core. Endotoxin molecules containing incomplete R-core (radiation-induced or mutant) did not react with the RSE antiserum.
Animals↗
On the albumin-dependence of measurements of free thyroxin. II. Patients with non-thyroidal illness.
We studied the relation between thyroxin-binding proteins and free thyroxin (FT4) measurements by five radioimmunoassays (RIA) and an FT4 index (FT4I) in patients with non-thyroidal illness (NTI). The one-step FT4 RIAs and the FT4I frequently failed to identify the true FT4 status (as determined by equilibrium dialysis) of NTI patients. In these patients, falsely low FT4 results with one-step RIAs and FT4I were associated with decreasing total T3 and T4 concentrations, which, furthermore, paralleled decreasing serum albumin concentrations. All NTI patients with "low T3, low T4 syndrome" had subnormal albumin concentration. The two-step RIAs and equilibrium dialysis showed normal FT4 concentrations in most patients with NTI. However, sera from a subset of NTI patients with "low T3 syndrome" gave above-normal FT4 results with these methods. From their predictably poor performance in the presence of a subnormal albumin concentration, we conclude that the one-step FT4 RIAs and FT4I are inappropriate for testing the thyrometabolic status of NTI patients.
Diagnostic Errors↗
False-positive results for ketone with the drug mesna and other free-sulfhydryl compounds.
All free-sulfhydryl compounds tested produced false-positive reactions in the Legal test for ketones. The color developed in the ketone pad of urine dipsticks [N-Multistix SG, Multistix 10 SG (Ames), and Chemstrip 9 (Boehringer-Mannheim)] was misinterpreted for ketone bodies, both by visual and automated reading. In contrast to the reaction with true ketones, a drop of glacial acetic acid added onto the ketone pad of dipsticks discharged the false-positive red color. A red-violet also developed instantly with free -SH compounds in the Acetest tablet assay (Ames), but quickly faded. In general, the presence of acidic groups such as -COOH and -SO3H in the structure appeared to increase the nitroprusside reactivity of free -SH compounds, whereas the presence of a -NH2 group appeared to decrease it. Currently, false-positive ketone reactions ascribable to a free -SH group are most likely to be seen for urine containing mesna. The false-positive test for ketones caused by free -SH compounds can be recognized and ruled out by proper procedures. On the other hand, this chromogenic reaction with free thiols might be used for monitoring urinary excretion of mesna.
False Positive Reactions↗
Interference by anti-immunoglobulin G antibodies in immunoradiometric assays of thyrotropin involving mouse monoclonal antibodies.
"Sandwich"-type assays are subject to positive interference by the patient's "heterophile" antibodies. If present, these bind to the animal immunoglobulins in the assay reagents, forming artefactual sandwiches indistinguishable from those formed with the analyte itself. Immunoglobulins from non-immunized animals, added to the assay reagents, can diminish this effect by blocking the patient's antibodies. Elsewhere, we studied several patients with anti-mouse immunoglobulin activity, whose serum gave spuriously high results for thyrotropin (TSH) concentrations. Here we have studied this phenomenon by adding, to pooled zero-TSH serum, antibodies to mouse, goat, and horse immunoglobulins and then assaying TSH by several other sandwich-type assays involving mouse monoclonal antibodies. Assays not supplemented with blocking immunoglobulins from mice or other animals were more susceptible to this effect. When large amounts of antibody were added, the antibody excess diminished the interference. However, the presence of blocking immunoglobulins could reverse such antibody excess, actually enhancing, instead of diminishing, the positive interference. Users should be aware that blocking immunoglobulins may diminish but not necessarily eliminate this problem with such assays.
Animals↗
False-positive urinalysis results with acidified urine.
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False Positive Reactions↗
Relation of structure to function for the U. S. reference standard endotoxin after exposure to 60Co radiation.
The structure and function of the highly purified U.S. reference standard endotoxin (RSE) were studied after exposure to ionizing radiation from a 60Co source. With increasing doses of radiation, the trilaminar ribbon-like structure of untreated endotoxin exhibited focal swelling, after which only spherical particles were seen by electron microscopy. These morphological changes were paralleled by the respective loss of O-side chain repeating units and pieces of the R-core from the lipopolysaccharide molecules, as demonstrated by electrophoresis. The biologic function of the irradiated endotoxin was assessed with a variety of tests. At higher doses of radiation, a direct relation was observed between the degradation of the molecular and supramolecular structure and the loss of biologic function. At lower doses of radiation, however, there was variability among the functional assays in their rate of change with progressive irradiation of the RSE. The results suggest that the carbohydrate moiety plays an important role both in determining the supramolecular structure and in modulating certain biologic activities of bacterial endotoxins.
Animals↗
On the albumin dependence of measurements of free thyroxin. I. Technical performance of seven methods.
We evaluated three one-step (analog) and two two-step radioimmunoassay for free thyroxin (FT4), and a FT4 index calculated from the total T4 (TT4) and thyroxin-binding globulin (TBG) ratio for technical performance, for correlation with the reference FT4 method (equilibrium dialysis), and for dependence on TBG and albumin concentrations. The one-step methods (Amerlex, Coat-A-Count, and GammaCoat) showed greater precision than the two-step procedures (GammaCoat and Spiria). Results by the latter two techniques, however, correlated better with those by equilibrium dialysis than did those by the analog methods or by TT4/TBG. Only the GammaCoat two-step method had a slight but statistically significant (inverse) correlation with TBG concentration. All three analog methods and TT4/TBG showed a marked dependence on albumin concentration, whereas the Spiria technique showed only a slight dependence. Only equilibrium dialysis was independent of both the TBG and albumin concentration. Thus, despite their good precision, the analog (one-step) FT4 methods and the TT4/TBG approach cannot be expected to produce valid results when the concentration of albumin in serum is abnormally low or high.
Dialysis↗
Modification of the chemical composition and structure of the U.S. Reference Standard Endotoxin (RSE) by 60Co radiation.
A highly purified bacterial lipopolysaccharide (LPS) preparation was exposed in water to megadoses of ionizing radiation from a 60Co source. As evidenced by electrophoresis, the radiation treatment progressively degraded the lipopolysaccharide molecules by removing first the O-side chain units and then components of the R-core. Chemical analysis of the irradiated (LPS) preparations showed that, in accord with the structural changes, the most profound effects of ionizing radiation occurred in the hydrophilic oligo/polysaccharide moieties (R-core and O-side chain). Progressively higher doses of radiation degraded the simple sugars in decreasing order of galactose, galactosamine, glucosamine, glucose, and heptose. The R-core component 2-keto-3-deoxyoctonate was the most "resistant" sugar derivative to ionizing radiation. Due to its central position in the LPS aggregates in water, even at comparatively high doses of radiation the hydrophobic lipid A moiety of endotoxin was less affected than the sugar components. Of the fatty acids of lipid A, however, either partial conversion of beta-hydroxymyristic acid into myristic acid or selective loss of the former occurred. The observed structural and chemical changes of LPS are consistent with the effect of active oxygen radicals of radiolysis. In addition, the extensive physicochemical changes explain the altered biological reactivity of radiation-treated endotoxins.
Cobalt Radioisotopes↗