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Clinical Chemistry and Laboratory Medicine (CCLM)

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

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter

IMPACT FACTOR 2018: 3.638

CiteScore 2018: 2.44

SCImago Journal Rank (SJR) 2018: 1.191
Source Normalized Impact per Paper (SNIP) 2018: 1.205

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Volume 44, Issue 9


Rheumatoid factor interference in the determination of carbohydrate antigen 19-9 (CA 19-9)

Mario Berth / Eugene Bosmans / Jacques Everaert / Jan Dierick / Johan Schiettecatte
  • Radioimmunology Laboratory, Academisch Ziekenhuis – Vrije Universiteit Brussel, Brussels, Belgium
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Ellen Anckaert
  • Radioimmunology Laboratory, Academisch Ziekenhuis – Vrije Universiteit Brussel, Brussels, Belgium
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Joris Delanghe
Published Online: 2011-09-21 | DOI: https://doi.org/10.1515/CCLM.2006.205


Background: Investigation of a 61-year-old Caucasian male suffering from fatigue and weight loss led to the finding of a carbohydrate antigen 19-9 (CA 19-9) concentration of 80kU/L using an ADVIA Centaur analyser. Determination of CA 19-9 on Vidas, AxSYM and Architect i2000 systems gave normal results. His rheumatoid factor concentration was very high (900kIU/L) and assay interference was suspected.

Methods: Besides using several laboratory procedures to show the cause of the interference, we tried to estimate the frequency of the suspected interference. Therefore, two studies were performed. The first was carried out in a multicentre setting using four different CA 19-9 methods on 51 randomly selected samples with high rheumatoid factor concentrations and ten samples containing no or very low rheumatoid factor. In the second study we used heterophilic blocking tubes for 68 routinely analysed samples with CA 19-9 concentrations ranging between 37 and 250kU/L using an ADVIA Centaur analyser.

Results: In the multicentre study we found eight discrepant CA 19-9 results, but only one was clearly due to interference. We showed that the interference detected, just as in the index case, was caused by rheumatoid factor. The other discrepancies could not be explained, but are probably related to method-dependent differences. In the 68 routinely analysed samples, no interference could be shown using the heterophilic blocking tubes.

Conclusions: Although interferences in the CA 19-9 assay are not frequent, the ADVIA Centaur system appears to be more sensitive to rheumatoid factor interference. The lack of standardisation remains an important issue for this assay. The determination of CA 19-9 during the follow-up of patients should be performed using a single method. If, however, there is any clinical doubt about a result, CA 19-9 should be determined using another method to exclude possible interferences.

Clin Chem Lab Med 2006;44:1137–9.

Keywords: antibodies; artifacts; CA-19-9 antigen; diagnostic errors; false positive reactions; heterophile; rheumatoid factor


  • 1.

    Duffy MJ. CA 19-9 as a marker for gastrointestinal cancers: a review. Ann Clin Biochem 1998; 35:364–70.Google Scholar

  • 2.

    European Group on Tumour Markers. Tumour markers in gastrointestinal cancers – EGTM recommendations. Anticancer Res 1999;19:2811–5. Available from http://egtm.web.med.uni-muenchen.de/index2.html.Google Scholar

  • 3.

    Reinsberg J. Interferences with two-site immunoassays by human anti-mouse antibodies formed by patients treated with monoclonal antibodies: comparison of different blocking reagents. Clin Chem 1998; 44:1742–4.Google Scholar

  • 4.

    Preissner CM, O'Kane DJ, Singh RJ, Morris JC, Grebe SK. Phantoms in the assay tube: heterophile antibody interferences in serum thyroglobulin assays. J Clin Endocrinol Metab 2003; 88:3069–74.Google Scholar

  • 5.

    Biguet B, Habersetzer F, Beaudonnet A, Bizollon CA, Trepo C, Cohen R. Discordant CA 19.9 serum results by microparticle enzyme immunoassay and immunoradiometric assay. Clin Chem 1995; 41:1057–8.Google Scholar

  • 6.

    Bjerner J, Bormer OP, Nustad K. The war on heterophilic antibody interference. Clin Chem 2005; 51:9–11.Google Scholar

  • 7.

    Levinson SS, Miller JJ. Towards a better understanding of heterophile (and the like) antibody interference with modern immunoassays. Clin Chim Acta 2002; 325:1–15.Google Scholar

  • 8.

    Bjerner J. Human anti-immunoglobulin antibodies interfering in immunometric assays. Scand J Clin Lab Invest 2005; 65:349–64.Google Scholar

  • 9.

    Stern P, Friedecky B, Bartos V, Bezdickova D, Vavrova J, Uhrova J, et al. Comparison of different immunoassays for CA 19-9. Clin Chem Lab Med 2001; 39:1278–82.Google Scholar

  • 10.

    Bechtel B, Wand AJ, Wroblewski K, Koprowski H, Thurin J. Conformational analysis of the tumor-associated carbohydrate antigen 19-9 and its Lea blood group antigen component as related to the specificity of monoclonal antibody CO19-9. J Biol Chem 1990; 265:2028–37.Google Scholar

About the article

Corresponding author: Dr. Mario Berth, Immunology Department, Algemeen Medisch Laboratorium, Desguinlei 88, 2018 Antwerpen, Belgium Phone: +32-3-3030809, Fax: +32-3-2160603,

Received: 2006-03-25

Accepted: 2006-06-26

Published Online: 2011-09-21

Published in Print: 2006-09-01

Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 44, Issue 9, Pages 1137–1139, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/CCLM.2006.205.

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