{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T05:40:08Z","timestamp":1756532408505,"version":"3.44.0"},"reference-count":9,"publisher":"Walter de Gruyter GmbH","issue":"10","license":[{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_cclm-2025-0409_abs_001\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Antigen excess (AE) or high dose hook-effect can seriously affect the reported concentration of an analyte, which may impact clinical decisions. This study analyze to what extent the Roche Elecsys<jats:sup>\u00ae<\/jats:sup> Myoglobin assay is affected by antigen excess and how this can affect the reported myoglobin concentration.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2025-0409_abs_002\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A dilution series experiment was conducted on a patient sample with a very high myoglobin concentration (&gt;150,000\u202f\u03bcg\/L). Based on this, an AE mitigation procedure based on sample dilutions was developed and implemented. A retrospective analysis of reported patient results was performed to assess the potential frequency of samples that could be affected by\u00a0AE.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2025-0409_abs_003\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In the dilution experiment the Roche Elecsys<jats:sup>\u00ae<\/jats:sup> Myoglobin assay was susceptive to AE, where samples with concentrations\u00a0&gt;115,000\u202f\u03bcg\/L may be reported as\u00a0&lt;3,000\u202f\u03bcg\/L. Dilution series from patient samples (n=20) subjected to the AE mitigation procedure showed the same pattern as the dilution experiment. The percentage of samples\u00a0&gt;115,000\u00a0\u00b5\/L increased significantly after the AE mitigation procedure had been implemented. After implementation of the AE mitigation procedure, the maximum myoglobin concentration observed was 780,000\u202f\u03bcg\/L.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2025-0409_abs_004\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>If the Roche Elecsys<jats:sup>\u00ae<\/jats:sup> Myoglobin assay is used according to the manufacturer, extremely high myoglobin samples risk being reported as only mildly elevated or near normal. This may affect clinical decisions. Thus, we suggest an AE mitigation procedure with automatic dilution of samples where myoglobin concentrations exceed 500\u202f\u03bcg\/L to mitigate this risk. Roche needs to take further actions to eliminate the consequences of the AE interference.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/cclm-2025-0409","type":"journal-article","created":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T04:49:17Z","timestamp":1747889357000},"page":"2053-2058","source":"Crossref","is-referenced-by-count":0,"title":["High myoglobin plasma samples risk being reported as falsely low due to antigen excess\u00a0\u2013\u00a0follow up after a 2-year period of using a mitigating procedure"],"prefix":"10.1515","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0976-9057","authenticated-orcid":false,"given":"Anders O.","family":"Olsson","sequence":"first","affiliation":[{"name":"Department of Clinical Chemistry , 56749 Sahlgrenska University Hospital , Gothenburg , Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Lundberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry , 56749 Sahlgrenska University Hospital , Gothenburg , Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esmira","family":"Becirevic","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry , 56749 Sahlgrenska University Hospital , Gothenburg , Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malin","family":"Stenberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry , 56749 Sahlgrenska University Hospital , Gothenburg , Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joakim","family":"Sandstedt","sequence":"additional","affiliation":[{"name":"Department of Clinical Chemistry , 56749 Sahlgrenska University Hospital , Gothenburg , Sweden"},{"name":"Department of Laboratory Medicine , Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"key":"2025083005004182285_j_cclm-2025-0409_ref_001","doi-asserted-by":"crossref","unstructured":"Gr\u00e4fe, C, Liebchen, U, Greimel, A, Maciuga, N, Bruegel, M, Irlbeck, M, et al.. The effect of cytosorb\u00ae application on kidney recovery in critically ill patients with severe rhabdomyolysis: a propensity score matching analysis. Ren Fail 2023;45:2259231. https:\/\/doi.org\/10.1080\/0886022x.2023.2259231.","DOI":"10.1080\/0886022X.2023.2259231"},{"key":"2025083005004182285_j_cclm-2025-0409_ref_002","doi-asserted-by":"crossref","unstructured":"Forni, L, Aucella, F, Bottari, G, B\u00fcttner, S, Cantaluppi, V, Fries, D, et al.. Hemoadsorption therapy for myoglobin removal in rhabdomyolysis: consensus of the hemoadsorption in rhabdomyolysis task force. BMC Nephrol 2024;25:247. https:\/\/doi.org\/10.1186\/s12882-024-03679-8.","DOI":"10.1186\/s12882-024-03679-8"},{"key":"2025083005004182285_j_cclm-2025-0409_ref_003","unstructured":"Elecsys Myoglobin (07027583500) Package Insert, v.9.0, Roche Diagnostics; Mannheim G, Editor 2024-06-01."},{"key":"2025083005004182285_j_cclm-2025-0409_ref_004","unstructured":"Elecsys Myoglobin (12178214122) Package Insert, v.22.0, Roche Diagnostics; Mannheim G, Editor 2024-07-01."},{"key":"2025083005004182285_j_cclm-2025-0409_ref_005","doi-asserted-by":"crossref","unstructured":"Jacobs, JF, van der Molen, RG, Bossuyt, X, Damoiseaux, J. Antigen excess in modern immunoassays: to anticipate on the unexpected. Autoimmun Rev 2015;14:160\u20137. https:\/\/doi.org\/10.1016\/j.autrev.2014.10.018.","DOI":"10.1016\/j.autrev.2014.10.018"},{"key":"2025083005004182285_j_cclm-2025-0409_ref_006","doi-asserted-by":"crossref","unstructured":"Kurt-Mangold, M, Drees, D, Krasowski, MD. 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Clin Chem 1988;34:177. https:\/\/doi.org\/10.1093\/clinchem\/34.1.177.","DOI":"10.1093\/clinchem\/34.1.177"},{"key":"2025083005004182285_j_cclm-2025-0409_ref_009","doi-asserted-by":"crossref","unstructured":"Kikuchi, H, Ohta, A, Takahashi, Y, Shibata, A, Ohtake, T, Watanabe, K. High-dose hook effect in an immunochromatography-optical quantitative reader method for myoglobin. Clin Chem 2003;49:1709\u201310. https:\/\/doi.org\/10.1373\/49.10.1709.","DOI":"10.1373\/49.10.1709"}],"container-title":["Clinical Chemistry and Laboratory Medicine (CCLM)"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/cclm-2025-0409\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/cclm-2025-0409\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T05:03:50Z","timestamp":1756530230000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/cclm-2025-0409\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,22]]},"references-count":9,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,5,22]]},"published-print":{"date-parts":[[2025,9,25]]}},"alternative-id":["10.1515\/cclm-2025-0409"],"URL":"https:\/\/doi.org\/10.1515\/cclm-2025-0409","relation":{},"ISSN":["1434-6621","1437-4331"],"issn-type":[{"type":"print","value":"1434-6621"},{"type":"electronic","value":"1437-4331"}],"subject":[],"published":{"date-parts":[[2025,5,22]]}}}