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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

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Volume 42, Issue 8


Plasma or serum samples: measurements of cardiac troponin T and of other analytes compared

Roberto Dominici / Ilenia Infusino
  • Scuola di Specializzazione in Biochimica Clinica, Università degli Studi di Milano, Milano, Italy
  • Other articles by this author:
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/ Cristina Valente / Irene Moraschinelli
  • Corso di Laurea in Tecniche di Laboratorio Biomedico, Università degli Studi dell’Insubria, Varese, Italy
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Carlo Franzini
Published Online: 2011-09-21 | DOI: https://doi.org/10.1515/CCLM.2004.154


Conflicting data in the literature concern possible differences in the immunochemical measurement of cardiac troponins, either in plasma or in serum. In order to address this specific point, 96 serum and heparin-plasma pairs were obtained for cardiac marker measurement [cardiac troponin T (cTnT); myoglobin (Myo) and creatine kinase-MB isoenzyme (CK-MB)]; 29 additional “common” analytes were measured in 77 such samples. The cardiac markers were measured by electrochemiluminescence (Elecsys 2010, Roche); the other analytes by established automated methods (Modular, Roche). Mean plasma/serum ratios for cTnT (0.95), creatine kinase-MB (1.01) and myoglobin (0.99) were comparable with those of the 29 common analytes (interval of means 0.83–1.05). The distribution of the plasma-serum differences also showed similarities between cardiac markers and other analytes. A few outlier plasma-serum differences (3–5%) were measured for both categories of analytes. Addition of heparin to serum (51 samples) caused decreased cTnT (mean ratio 0.92). In 3 of 51 such samples the cTnT decrease was more marked, but in a second sample from the same subjects (1 week later) such a prominent, heparin-induced loss of cTnT no longer appeared. In conclusion, plasma-serum differences in immuno-reactive cTnT compare with those observed for other analytes. In occasional heparin-plasma samples immunochemical measurement of cTnT may give exceptionally low values. However, in our sample group of 96 patients (cTnT lower or higher than the cut-off in, respectively, 24 and 72 patients), no misclassification occurred if plasma instead of serum cTnT values were considered.

Keywords: cardiac markers; heparin; plasma; serum; troponins


  • 1

    Panteghini M. IFCC Committee on Standardization of Markers of Cardiac Damage: premises and project presentation. Clin Chem Lab Med 1998; 36:887–93.CrossrefGoogle Scholar

  • 2

    Panteghini M, Apple FS, Christenson RH, Dati F, Mair J, Wu AH. Use of biochemical markers in acute coronary syndromes. Clin Chem Lab Med 1999; 37:687–93.CrossrefGoogle Scholar

  • 3

    Nosanchuk JS. False increase of troponin I attributable to incomplete separation of serum [letter]. Clin Chem 1999; 45:714.Google Scholar

  • 4

    Wu AHB, Apple FS, Gibler WB, Jesse RL, Warshaw MM, Valdes R Jr. National Academy of Clinical Biochemistry Standards of Laboratory Practice: recommendations for the use of cardiac markers in coronary artery diseases. Clin Chem 1999; 45:1104–21.Google Scholar

  • 5

    Gerhardt W, Nordin G, Herbert A-K, Burzell BL, Isaksson A, Gustavsson E, et al. Troponin T and I assays show decreased concentrations in heparin plasma compared with serum: lower recoveries in early than in late phases of myocardial injury. Clin Chem 2000; 46:817–21.Google Scholar

  • 6

    Stiegler H, Fischer Y, Vazquez-Jimenez JF, Graf J, Filzmaier K, Fausten B, et al. Lower cardiac troponin T and I results in heparin-plasma than in serum. Clin Chem 2000; 46:1338–44.Google Scholar

  • 7

    Panteghini M. Present issues in the determination of troponins and other cardiac markers of cardiac damage. Clin Biochem 2000; 33:161–6.CrossrefGoogle Scholar

  • 8

    Pagani F, Bonetti G, Stefini F, Ciccia C, Panteghini M. Serum and plasma samples for ACS:systems cardiac markers [letter]. Clin Chem 2000; 46:1020–2.Google Scholar

  • 9

    Hedberg P, Melkko T, Valkama J, Puukka M. Higher CK-MB mass values in heparin plasma than in serum measured with the Abbott AxSYM system [letter]. Clin Chem Lab Med 2001; 39:872–4.CrossrefGoogle Scholar

  • 10

    Buechler KF, Nakamura KK. More on troponin assays and heparin [letter]. Clin Chem 2001; 47:144–7.Google Scholar

  • 11

    Gerhardt W, Nordin G, Isaksson A, Haglund S, Gustavsson S, Muller-Bardof M, et al. More on troponin assays and heparin [reply letter]. Clin Chem 2001; 47:145–7.Google Scholar

  • 12

    Cerutti A, Corsini L, Finotto R, Perazzi C. Comparison of cardiac troponin I in serum and heparin plasma with the dimension RxL assay. Clin Chem 2002; 48:790–1.Google Scholar

  • 13

    Penttila K, Koukkunen H, Halinen M, Punnonen K, Pyirala K, Rantanen T, et al. Serum and plasma as alternative sample types in analysis of cardiac markers in the clinical routine. Scand J Clin Lab Invest 2002; 62:553–60.CrossrefGoogle Scholar

  • 14

    Panteghini M. Performance of today’s cardiac troponin assays and tomorrow’s. Clin Chem 2002; 48:809–10.Google Scholar

  • 15

    Peetz D, Hafner G, Lackner KJ. Analytical characteristics of the AxSYM troponin I and creatine kinase MB assays. Clin Chem 2002; 48:1110–1.Google Scholar

  • 16

    Dorizzi RM, Caputo M, Ferrari A, Lippi L, Rizzotti P. Comparison of serum and heparin-plasma samples in different generations of dimension troponin I assays [letter]. Clin Chem 2003; 49:2294–5.Google Scholar

  • 17

    Panteghini M, Pagani F. On the comparison of serum and plasma samples in troponin assays [letter]. Clin Chem 2003; 49:835–6.CrossrefGoogle Scholar

  • 18

    Passing H, Bablok W. A new biometrical procedure for testing the equality of measurements from two different analytical methods. Applications of linear regression procedures for method comparison studies in clinical chemistry. Part I. J Clin Chem Clin Biochem 1983; 21:709–20.Google Scholar

  • 19

    Fraser CG, Hyltoft Petersen P. Analytical performance characteristics should be judged against objective quality specifications. Clin Chem 1999; 45:321–3.Google Scholar

  • 20

    Ciuti R, Rinaldi G. Serum and plasma compared for use in 19 common chemical tests performed in the Hitachi 737 analyzer [letter]. Clin Chem 1989; 35:1562–3.Google Scholar

  • 21

    Doumas BT, Hause LL, Simuncak DM, Breitenfeld D. Differences between values for plasma and serum in tests performed in the Ektachem 700 XR analyzer, and evaluation of ‘‘plasma separator tubes (PST)’’. Clin Chem 1989; 35:151–3.Google Scholar

  • 22

    Dupuy AM, Badiou S, Descomps B, Cristol JP. Immunoturbidimetric determination of C-reactive protein (CRP) on heparin plasma. Comparison with serum determination. Clin Chem Lab Med 2003; 41:948–9.CrossrefGoogle Scholar

  • 23

    Cloete H, Kleinhans W, Mansvelt EPG. Ferritin assay performed on the Technicon Immuno 1 analyser using serum and plasma samples. Clin Lab Haem 2002; 24:281–3.Google Scholar

  • 24

    Hartland AJ, Neary RH. Serum potassium is unreliable as an estimate of in vivo plasma potassium. Clin Chem 1999; 45:1091–2.Google Scholar

  • 25

    Bakker AJ, Mirchi B, Dijkstra JT, Reitsma F, Syperda H, Zijlstra A. IFCC method for lactate dehydrogenase measurement in heparin plasma is unreliable [technical briefs]. Clin Chem 2003; 49:662–4.CrossrefGoogle Scholar

  • 26

    Herzum I, Bander R, Renz H, Wahl HG. Reliability of IFCC method for lactate dehydrogenase measurement in lithium-heparin plasma samples. Clin Chem 2003; 49:2094–6.CrossrefGoogle Scholar

  • 27

    Panteghini M, Pagani F. Biological variation of myoglobin in serum [letter]. Clin Chem 1997; 43:2435.Google Scholar

  • 28

    Ross SM, Fraser CG. Biological variation of cardiac markers: analytical and clinical considerations. Ann Clin Biochem 1998; 35:80–4.CrossrefGoogle Scholar

  • 29

    Speth M, Seibold K, Katz N. Interaction between heparin and cardiac troponin T and troponin I from patients after coronary bypass surgery. Clin Biochem 2002; 35:355–62.CrossrefGoogle Scholar

  • 30

    Eriksson S, Junikka M, Laitinen P, Majamaa-Voltti K, Alfthan H, Pettersson K. Negative interference in cardiac troponin I immunoassays from a frequently occurring serum and plasma component. Clin Chem 2003; 49:1095–104.CrossrefGoogle Scholar

  • 31

    Bhagavan NV, Lai EM, Rios PA, Yang J, Ortega-Lopez AM, Shinoda H, et al. Evaluation of human serum albumin cobalt binding assay for the assessment of myocardial ischemia and myocardial infarction. Clin Chem 2003; 49:581–5.CrossrefGoogle Scholar

  • 32

    Apple FS, Quist HE, Doyle PJ, Otto AP, Murakami MM. Plasma 99th percentile reference limits for cardiac troponin and creatine kinase MB mass for use with European Society of Cardiology/American College of Cardiology consensus recommendations. Clin Chem 2003; 49:1331–6.CrossrefGoogle Scholar

About the article

Corresponding author: Prof. Carlo Franzini, Università degli Studi di Milano, Dipartimento di Scienze Cliniche L. Sacco, Via G. B. Grassi, 74, 20157 Milano, Italy. Phone: +02-3904 2806, Fax: +02-3564 016, E-mail:

Received: 2004-01-15

Accepted: 2004-06-10

Published Online: 2011-09-21

Published in Print: 2004-08-01

Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 42, Issue 8, Pages 945–951, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/CCLM.2004.154.

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