Unusually high concentrations of cTnI and cTnT in a patient with catastrophic antiphospholipid antibody syndrome.
BACKGROUND
We present a case of a patient with catastrophic antiphospholipid antibody syndrome with unusually high concentrations of cardiac Troponin I (cTnI) and cardiac Troponin T (cTnT). Troponins are sensitive and specific markers of myocardial injury. The degree of their elevation, in the context of the chronic autoimmune condition of the patient, elicited a thorough investigation for the presence of interfering antibodies.


METHODS
Cardiac markers, including total CK, CK-MB, cTnI, and cTnT, were measured in this patient over a period of 14 days after the onset of symptoms. In order to rule out a possible interference, serum samples were subjected to serial dilutions and were incubated with a blocking reagent (HBR) prior to analysis.


RESULTS
The time release of the cardiac markers into the systemic circulation of this patient followed the typical pattern after a myocardial infraction. Serial dilutions of the samples, and incubation with the blocking reagent revealed no indication of the presence of interfering antibodies.


CONCLUSIONS
The results strongly suggest that the extremely high concentrations of cTnT and cTnI in this patient were real and indicative of a massive myocardial infarction (MI). These may be the highest concentrations of cTnI and cTnT reported in the systemic circulation of a single patient.
Department of Pathology, The Johns Hopkins University School of Medicine, 600 N Wolfe St, Meyer B125, Baltimore, MD 21287, USA. olaterzl@jhmi.edu
Omar F
OF
Laterza
Hassan
H
Nayer
Mary
M
Jo Bill
Lori J
LJ
Sokoll
D000328:Adult; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000150:complications* / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D005260:Female; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000378:metabolism; D012770:Shock, Cardiogenic / Q000097:blood; D019210:Troponin I / Q000097:blood* / Q000378:metabolism; D020107:Troponin T / Q000097:blood* / Q000378:metabolism
D015415:Biomarkers; D007527:Isoenzymes; D019210:Troponin I; D020107:Troponin T; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form