{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,11]],"date-time":"2026-01-11T08:14:25Z","timestamp":1768119265165,"version":"3.49.0"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Proficiency testing, a cornerstone of external quality assessment, benchmarks laboratory performance and detects systematic errors. Although extremely rare, matrix-related interference in proficiency testing samples can produce misleading results across platforms, highlighting the importance of sample commutability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>During a proficiency testing cycle for transfusion-transmitted infections, a blood center observed uniform low hepatitis B surface antigen reactivity in 5 blinded samples on the Alinity i chemiluminescent microparticle immunoassay (CMIA) platform (Abbott). This consistent yet unusual reactivity prompted further investigation. Cross-validation using the Roche Elecsys-e411 analyzer, Abbott ARCHITECT i1000SR analyzer, and the bioM\u00e9rieux VIDAS enzyme-linked fluorescent assay (ELFA) showed similar results, whereas the QuidelOrtho VITROS 3600 chemiluminescence immunoassay reported 4 nonreactive results and 1 invalid result. Reflex testing on rapid immunochromatographic tests, nucleic acid testing (NAT), and neutralization assays was performed. A reflex testing protocol that integrated orthogonal methodologies, root cause analysis, and corrective maintenance were employed to systematically investigate discordance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The CMIA consistently showed low reactivity; the ELFA was borderline; and the VITROS 3600, rapid tests, and NAT were nonreactive. Neutralization assays confirmed nonspecific signals. Instrument issues were excluded. The external quality assessment provider attributed these findings to matrix interference, likely from stabilizers. Performance assessment used a peer group methodology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Matrix interference in proficiency testing, although rare, can compromise interpretation. Reflex testing, structured root cause analysis, robust standard operating procedures, staff training, and attention to sample commutability are essential to strengthen quality assurance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/labmed\/lmaf090","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T13:29:15Z","timestamp":1764941355000},"source":"Crossref","is-referenced-by-count":0,"title":["False positives in transfusion-transmitted infection proficiency testing due to matrix effects in external quality assessment samples: lessons for clinical laboratories"],"prefix":"10.1093","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1187-6871","authenticated-orcid":false,"given":"Rasika Dhawan","family":"Setia","sequence":"first","affiliation":[{"name":"BLK-Max Super Speciality Hospital Department of Transfusion Medicine, , New Delhi,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1277-4869","authenticated-orcid":false,"given":"Mitu","family":"Dogra","sequence":"additional","affiliation":[{"name":"BLK-Max Super Speciality Hospital Department of Transfusion Medicine, , New Delhi,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gajendra","family":"Gupta","sequence":"additional","affiliation":[{"name":"Institute of Healthcare Quality and Accreditation Blood Bank External Quality Assessment Scheme, , Jaipur, Rajasthan,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sadhana","family":"Mangwana","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine and Immunohematology, Sri Balaji Action Medical Institute , New Delhi,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepti","family":"Sachan","sequence":"additional","affiliation":[{"name":"Department of Transfusion Medicine, Dr Rela Institute & Medical Centre , Chennai,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4571-802X","authenticated-orcid":false,"given":"Amena Ebadur","family":"Rahman","sequence":"additional","affiliation":[{"name":"BLK-Max Super Speciality Hospital Department of Transfusion Medicine, , New Delhi,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anil","family":"Handoo","sequence":"additional","affiliation":[{"name":"Department of Laboratory Services, BLK-Max Super Speciality Hospital , New Delhi,","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"2026011021370659700_lmaf090-B1","volume-title":"Overview of External Quality Assessment (EQA): Module 10, Content Sheet 10-1","author":"World Health Organization","year":"2011"},{"key":"2026011021370659700_lmaf090-B2","doi-asserted-by":"publisher","first-page":"3686","DOI":"10.3390\/cancers14153686","article-title":"The significance of external quality assessment schemes for molecular testing in clinical laboratories","volume":"14","author":"Laudus","year":"2022","journal-title":"Cancers (Basel)"},{"key":"2026011021370659700_lmaf090-B3","doi-asserted-by":"publisher","first-page":"497","DOI":"10.2147\/RMHP.S453020","article-title":"Navigating quality assessment hurdles in clinical laboratory services: a comprehensive review in resource-limited settings","volume":"17","author":"Cherie","year":"2024","journal-title":"Risk Manag Healthc Policy"},{"key":"2026011021370659700_lmaf090-B4","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/s0009-8981(01)00518-6","article-title":"Role of external quality assurance schemes in assessing and improving quality in medical laboratories","volume":"309","author":"Libeer","year":"2001","journal-title":"Clin Chim Acta"},{"key":"2026011021370659700_lmaf090-B5","author":"Westgard","year":"2023"},{"key":"2026011021370659700_lmaf090-B6","doi-asserted-by":"publisher","first-page":"255","DOI":"10.4103\/IJPM.IJPM_404_19","article-title":"Utility of grey zone testing strategy in transfusion transmissible infection testing in blood bank is of limited value!","volume":"63","author":"Bhardwaj","year":"2020","journal-title":"Indian J Pathol Microbiol"},{"key":"2026011021370659700_lmaf090-B7"},{"key":"2026011021370659700_lmaf090-B8","doi-asserted-by":"publisher","first-page":"6","DOI":"10.26463\/rjahs.3_1_3","article-title":"Are peer comparison statistics obtained from internal quality control and external quality assurance programs comparable? 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