A Case of Elevated Troponin I Level After Packed Red Blood Cell Transfusion With Normal Coronary Angiography

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2022 Jul 27

PMID 35891818

Authors

Sherif Roman

Manpreet Sran

Amgad N Makaryus

Affiliations

Soon will be listed here.

Abstract

Other than acute coronary syndrome (ACS), many clinical conditions are associated with increased cardiac troponin I (cTnI) levels. Conditions such as pulmonary embolism, acute heart failure, myocarditis, sepsis, and renal failure are commonly reported as underlying causes. Analytical interference with the cTnI assay can also lead to falsely elevated troponin I levels. That can happen due to multiple causes such as fibrin clots, heterophile antibodies, microparticles contained in the sample, rheumatoid factor, interference by bilirubin, hemolysis, and elevated alkaline phosphatase activity. Herein, we present the case of a 66-year-old female who presented with pleuritic chest pain and had a cTnI of 35.5 ng/mL post-transfusion of three units of packed red blood cells. The patient had a complete ischemic workup for ACS, including coronary angiography, which was negative for coronary artery disease.

References

Makaryus A, Makaryus M, Hassid B . Falsely elevated cardiac troponin I levels. Clin Cardiol. 2007; 30(2):92-4. PMC: 6653083. DOI: 10.1002/clc.20006. View

Roongsritong C, Warraich I, Bradley C . Common causes of troponin elevations in the absence of acute myocardial infarction: incidence and clinical significance. Chest. 2004; 125(5):1877-84. DOI: 10.1378/chest.125.5.1877. View

Mueller M, Biener M, Vafaie M, Doerr S, Keller T, Blankenberg S . Absolute and relative kinetic changes of high-sensitivity cardiac troponin T in acute coronary syndrome and in patients with increased troponin in the absence of acute coronary syndrome. Clin Chem. 2011; 58(1):209-18. DOI: 10.1373/clinchem.2011.171827. View

Smith S, Ladenson J, Mason J, Jaffe A . Elevations of cardiac troponin I associated with myocarditis. Experimental and clinical correlates. Circulation. 1997; 95(1):163-8. View

Anand A, Lee K, Chapman A, Ferry A, Adamson P, Strachan F . High-Sensitivity Cardiac Troponin on Presentation to Rule Out Myocardial Infarction: A Stepped-Wedge Cluster Randomized Controlled Trial. Circulation. 2021; 143(23):2214-2224. PMC: 8177493. DOI: 10.1161/CIRCULATIONAHA.120.052380. View

Hamwi S, Sharma A, Weissman N, Goldstein S, Apple S, Canos D . Troponin-I elevation in patients with increased left ventricular mass. Am J Cardiol. 2003; 92(1):88-90. DOI: 10.1016/s0002-9149(03)00477-6. View

Dasgupta A, BANERJEE S, Datta P . False-positive troponin I in the MEIA due to the presence of rheumatoid factors in serum. Elimination of this interference by using a polyclonal antisera against rheumatoid factors. Am J Clin Pathol. 1999; 112(6):753-6. DOI: 10.1093/ajcp/112.6.753. View

Collet J, Thiele H, Barbato E, Barthelemy O, Bauersachs J, Bhatt D . 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2020; 42(14):1289-1367. DOI: 10.1093/eurheartj/ehaa575. View

Dasgupta A, Chow L, Nazareno L, Tso G, Datta P . Performance evaluation of a new chemiluminescent cardiac troponin I assay. J Clin Lab Anal. 2000; 14(5):224-9. PMC: 6807918. View

10.

Brandt R, Filzmaier K, Hanrath P . Circulating cardiac troponin I in acute pericarditis. Am J Cardiol. 2001; 87(11):1326-8. DOI: 10.1016/s0002-9149(01)01536-3. View

11.

Sandeman D, Syed M, Kimenai D, Lee K, Anand A, Joshi S . Implementation of an early rule-out pathway for myocardial infarction using a high-sensitivity cardiac troponin T assay. Open Heart. 2021; 8(2). PMC: 8627412. DOI: 10.1136/openhrt-2021-001769. View

12.

Arrebola M, Lillo J, Diez de los Rios M, Rodriguez M, Dayaldasani A, Yahyaoui R . Analytical performance of a sensitive assay for cardiac troponin I with loci technology. Clin Biochem. 2010; 43(12):998-1002. DOI: 10.1016/j.clinbiochem.2010.04.073. View

13.

Hollander J, Than M, Mueller C . State-of-the-Art Evaluation of Emergency Department Patients Presenting With Potential Acute Coronary Syndromes. Circulation. 2016; 134(7):547-64. DOI: 10.1161/CIRCULATIONAHA.116.021886. View

14.

Dasgupta A, Chow L, Wells A, Datta P . Effect of elevated concentration of alkaline phosphatase on cardiac troponin I assays. J Clin Lab Anal. 2001; 15(4):175-7. PMC: 6807912. DOI: 10.1002/jcla.1023. View

15.

Radha R, Shahzadi S, Al-Sayah M . Fluorescent Immunoassays for Detection and Quantification of Cardiac Troponin I: A Short Review. Molecules. 2021; 26(16). PMC: 8399166. DOI: 10.3390/molecules26164812. View

16.

Wang C, Kuo L, Hung M, Cherng W . Coronary vasospasm as a possible cause of elevated cardiac troponin I in patients with acute coronary syndrome and insignificant coronary artery disease. Am Heart J. 2002; 144(2):275-81. DOI: 10.1067/mhj.2002.123843. View

17.

Reichlin T, Irfan A, Twerenbold R, Reiter M, Hochholzer W, Burkhalter H . Utility of absolute and relative changes in cardiac troponin concentrations in the early diagnosis of acute myocardial infarction. Circulation. 2011; 124(2):136-45. DOI: 10.1161/CIRCULATIONAHA.111.023937. View

18.

Ghosh S, Batta A, Sharma Y, Panda P . Very severe aortic stenosis masquerading as acute coronary syndrome. BMJ Case Rep. 2021; 14(12). PMC: 8704975. DOI: 10.1136/bcr-2021-244627. View

19.

Jaffe A, Ravkilde J, Roberts R, Naslund U, Apple F, Galvani M . It's time for a change to a troponin standard. Circulation. 2000; 102(11):1216-20. DOI: 10.1161/01.cir.102.11.1216. View