Carbohydrate deficient transferrin and forensic medicine

In forensic medicine, diagnosing chronic alcohol abuse is a difficult task. Carbohydrate deficient transferrin (CDT) is one of the most common diagnostic markers for detecting chronic alcohol abuse. However, its diagnostic value is not 100% sensitive and specific. A number of caveats are known (e.g. pre-analytical issues, mutant transferrins, some metabolic diseases, body composition, arterial hypertension, drug treatment, exposure to organic solvents). In view of the numerous caveats, a careful interpretation of CDT analysis is needed. For forensic and occupational medicine applications, such as delegation to working sites where alcoholism may have fatal consequences or to obtain a driver's license, a well-balanced interpretation is needed. For these purposes, high performance liquid chromatography or capillary zone electrophoresis are to be preferred for CDT analysis as their main advantage is the separation of different CDT isoforms. In problem cases, the use of additional alternative tests (e.g. ethyl glucuronide and fatty acid ethyl esters in hair) can be considered.