Automated alarm to detect antigen excess in serum free immunoglobulin light chain kappa and lambda assays

Abstract

Background. Antigen excess causing a falsely low concentration result may occur when measuring serum free immunoglobulin light chains (SFLC). Automated antigen excess detection methods are available only with some analyzers. We have now developed and verified such a method. Methods. Residuals of sera with known SFLC-κ and -λ concentrations were analyzed using Binding Site reagents and methods adapted to the Roche Cobas^® c.501 analyzer. Results. We analyzed 117 sera for SFLC-κ and -λ and examined how the absorbance increased with time during the 7 minutes of reaction (absorbance reading points 12–70). From this an antigen excess alarm factor (ratio of absorbance increases between reading points 68–60 and 20–12, multiplied by 100) was defined. Upon our request, Roche added to our two SFLC assays a program which calculated this antigen excess alarm factor and triggered an alarm when the factor was below a defined value. We verified this antigen excess alarm function by analyzing serum from 325 persons of whom 143 were multiple myeloma patients. All samples with a known concentration above 30 mg/L triggered either an antigen excess alarm, an ‘above test’ alarm or both. Also, all samples above 200 mg/L (SFLC-λ) and 300 mg/L (SFLC-κ) triggered the antigen excess alarm and all but one triggered the above test alarm. Conclusions. The antigen excess alarm function presented here detected all known antigen excess samples at no increased time of analysis, a reduced workload and reduced reagent cost.

Key Words::

• Multiple myeloma
• turbidimetry
• nephelometry
• antigen excess
• free light chains

Acknowledgements

We thank Mohammed Jasim and Tore Øie, Roche Norway, for applying the automated antigen excess detection methods to the Roche Cobas^® c.501 analyzer. We thank the medical technologists at the Department of Medical Biochemistry, Oslo University Hospital, Ullevål and Rikshospitalet, for their kind help during the project.

Declaration of interest: The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.