The pH of chemistry assays plays an important role in monoclonal immunoglobulin interferences

• Investigation of the cause of IgM paraprotein interference with creatinine assay.
• Paraprotein precipitation under assay conditions caused the interference.
• Identified The pH of chemistry assays is a key factor causing paraprotein precipitation.
• Results showed that not all paraproteins precipitate under the same assay conditions.
• Different paraproteins react differently to changes in pH and ionic strength.

ObjectivesImmunoglobulin paraproteins can interfere with multiple chemistry assays. We want to investigate the mechanisms of immunoglobulin interference.Design and methodsSerum samples containing paraproteins from the index patient and eight additional patients were used to investigate the interference with the creatinine and total protein assays on the Beckman Coulter AU5400/2700 analyzer, and to determine the effects of pH and ionic strength on the precipitation of different immunoglobulins in these patient samples.ResultsThe paraprotein interference with the creatinine and total protein assays was caused by the precipitation of IgM paraprotein in the index patient's samples under alkaline assay conditions. At extremely high pH (12–13) and extremely low pH (1–2) and low ionic strength, paraprotein formed large aggregates in samples from the index patient but not from other patients.ConclusionsThe pH and ionic strength are the key factors that contribute to protein aggregation and precipitation which interfere with the creatinine and total protein measurements on AU5400/2700. The different amino acid sequence of each monoclonal paraprotein will determine the pH and ionic strength at which the paraprotein will precipitate.