Impact of fibrin in high sensitivity cardiac troponin (Hs-cTn) detection: Implications for quality control

Abstract

High-sensitivity troponin (hs-cTn) assays are crucial in the timely diagnosis of acute myocardial infarction (AMI). However, the presence of fibrin clots, among other interfering factors, can lead to false-positive results, undermining diagnostic accuracy. This critical literature review evaluates the implications of fibrin clot detection in hs-cTn testing, emphasising the need for robust quality control measures in emergency cardiac testing. Through this review, it was shown that biomedical scientists must prevent activities during the pre-analysis stage that may lead to fibrin formation. When such situations become inevitable due to various reasons, including patients’ predispositions, several steps were outlined to confirm the diagnostic accuracy of hs-cTn in myocardial infarction. The importance of technological advancements in detecting fibrin and other potential sources of cross-reactivity or interference was also identified through a comparative analysis of some auto-analysers, proposing possible solutions to address these pitfalls as a means of promoting efficiency and quality assurance in the diagnosis of myocardial infarction through high-sensitivity troponin assays. It further exposed the limitations of these digital analysers and how they cannot independently determine the procedural and outcome quality of diagnostic medicine.