Sense and nonsense concerning biotin interference in laboratory tests.
Level 5 - mechanism / opinion, no new human data
Narrative review of laboratory mechanisms and clinical interference without systematic review methodology
PubMed 32567529 · doi:10.1080/17843286.2020.1780770
What was done
This narrative review evaluated the mechanisms, vulnerable laboratory tests, and mitigation strategies regarding exogenous biotin interference in streptavidin-biotin-based immunoassays, particularly in users of over-the-counter supplements and patients receiving high-dose biotin therapy for multiple sclerosis.
What was found
No numerical data, patient counts, or effect estimates are reported in the abstract. Analytically, assay design dictates the error: sandwich immunoassays yield falsely low results, whereas competitive immunoassays yield falsely elevated results. Susceptible analytes include TSH (falsely lowered) and FT3/FT4 (falsely elevated), thyroglobulin, DHEA-S, estradiol, testosterone, ferritin, progesterone, vitamin D, vitamin B12, PSA, PTH, LH, FSH, troponins I and T, and Pro-BNP, with potential effects on digoxin and serological markers (HIV, hepatitis B/C). Tumor markers and beta-hCG were noted to be robust. Countermeasures include patient pre-sampling scheduling, using unaffected assay platforms, or pre-analytical biotin neutralization steps.
Why it matters
Awareness of biotin interference prevents catastrophic clinical misdiagnoses, such as spurious thyrotoxicosis or missed myocardial infarction, in patients consuming high-dose biotin.
Limits
This is a narrative review without systematic search protocols, meta-analytic data, or quality grading. The abstract provides no specific quantitative interference thresholds, assay-specific analytical limits, or incidence rates of clinical misdiagnosis.
Cited by
- context Biotin supplements can interfere with laboratory hormone immunoassay testing.