The customer stated that they received erroneous results for five samples from the same patient tested for multiple assays on a cobas 6000 e 601 module (e601) analyzer.Affected assays include the elecsys ft4 ii assay (ft4ii), the elecsys ft4 iii assay (ft4iii), elecsys ft3 iii (ft3), the elecsys tsh assay (tsh), elecsys ferritin (ferr), roche diagnostics elecsys anti-tg (anti-tg), roche diagnostics cobas elecsys anti-tpo (anti-tpo), and the elecsys anti-tshr immunoassay (anti-tshr).Refer to the medwatches with the following patient identifiers for information related to each affected assay: (b)(6) = ft4ii , (b)(6) = ft4iii, (b)(6) = ft3 , (b)(6) = tsh , (b)(6) = ferr , (b)(6) = anti-tg , (b)(6) = anti-tpo , (b)(6) = anti-tshr.The patient had "perfect" thyroid values in (b)(6) 2018.On (b)(6) 2018, the patient was hospitalized due to recurrent falling and general malaise.The 5 samples were collected from the patient and based on vastly increased ft4, ft3, and anti-tshr results, it was concluded that an initial attack of graves' disease occurred.The results for all thyroid assays did not fit the clinical picture of the patient, however, treatment for hyperthyroidism (strumasol) was started.Samples dated (b)(6) 2018 (sample 2), (b)(6) 2018 (sample 4), and (b)(6) 2018 (sample 5) were also tested on an abbott architect analyzer.In addition, the customer ran a comparison of the ft4ii and ft4iii assays on (b)(6) 2018 using samples dated (b)(6) 2018 (sample 1), (b)(6) 2018 (sample 2), and (b)(6) 2018 (sample 3).Unless otherwise indicated, the erroneous test results were reported outside of the laboratory.No adverse events were alleged to have occurred with the patient.The lot numbers and expiration dates of all involved reagents were asked for, but not provided.
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The customer has confirmed that tsi testing took place on a siemens immulite analyzer, not an abbott architect.Three samples from the patient were provided for investigation.Investigations of the samples determined that they contain an interfering factor which interferes with a component of the ft3, ft4ii, tsh, and ferr assays.The effect of this interfering factor is reduced with the ft4iii assay.Ft4 results measured by assays from different vendors can generate different values.This is related to the overall setups of the assays, the antibodies used, differences in reference materials, and differences in the standardization methodology used.The ft4iii results generated with the roche and abbott assays for the sample dated (b)(6) 2018 were both comparable in relation to the normal reference range of the respective assays.The investigation was unable to find a definitive root cause.For diagnostic purposes, the results should always be assessed in conjunction with the patient¿s medical history, clinical examination and other findings.
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