True and false syphilis bewilderment, almost cast into a big mistake!

After the case went to work on July 9th, everyone was busy with their work as usual.
Today is our immunization group Of Jiang teacher responsible for TRUST and TPPA trial, in the dermatology of a patient's TRUST test results, Mr. Jiang asked us all to see how the results are more appropriate (usually in the REPORT TRUST test results, are at least two people on the results of unified opinion before reporting), we all feel that this result is weak positive.
Jiang did not immediately report, can see the doubts in her eyes, she immediately inquired about the patient's historical results, did not find.
also asked whether the patient had been tested for syphilis-specific antibodies (chemical luminescence), the results showed 209.1.
this number once again confirms her doubts, as the patient's TPPA results are also positive.
Mr. Jiang then gave the patient a 1:2 dilution of the TRUST test, the results came out after everyone curiously came to see, the results are indeed somewhat strange - the original TIMES TRUST test results are weak positive, dilution multiplier 1:2 results are positive.
see Figure 1.
Figure 1, "What's going on here?" ""That's weird!" ...... There was a lot of talk.
I asked, "Will it be a fore-belt phenomenon?" " (I remember seeing similar reports in the literature before) Mr. Jiang went on to do it, and everyone was looking forward to what the outcome would be." Eight minutes later, the results shown in the image below were a surprise! The patient's final result is not previously judged to be a weak positive, actually 1:64 positive (TRUST titrity)! See Figure 2.
2 when you see the final test results, it really makes people a little worried! If the results were not further considered at the time, and no other test results were queried and analysed, the results would most likely be reported as "weak positives".
If the patient gets a completely inconsistent result with his or her true situation, it is likely that the doctor's diagnosis and treatment of him will be completely different, ultimately delaying the patient's diagnosis and treatment, delaying the condition!" What is the foreband phenomenon? Hook effect (HOOK effect): refers to the phenomenon of false negative due to the inappropriate proportion of antigen antibody, in which antibody overdose is called the pre-band effect;
antigen antibody-specific reaction, the amount of binding produced is related to the concentration of the reactant.
whether different amounts of antigens are added to a certain amount of antibodies or different amounts of antibodies are added to a certain amount of antigens, the strongest antigen-antibody reaction can only be found when the molecular ratio of the two is appropriate.
see Figure 3.
Figure 3 Laboratory to prevent hook effect leading to false negative improvement measures: if the first time to understand the clinical symptoms of patients, can also prompt us to pay special attention to the possible hook effect in the trial, but the actual situation is and clinical communication is often not so timely, so we learn from this experience, for Trust trials, we carried out the following improvement process: 1. clinical presentation, recommended that patients suspected that they may be infected with syphilis, syphilis-specific antibodies (chemical luminescence), syphilis nonsealitant antibodies (TRUST trials) and TPPA trials should be carried out at the same time.
testing methods can be used to help clinical diagnosis and treatment in a timely and accurate manner.
2. Laboratory improved the testing process: TRUST test results must be combined with the results of TPPA and syphilis-specific antibodies (chemical luminescence) for analysis, judgment and final results reporting.
we have to dilute the serum before we have a TURST test if we suspect that there may be a pre-band phenomenon.
this can be very good to prevent false negative due to hook effect, better for the clinical issue of a practical and accurate report.
1. Using a single method to detect syphilis helix antibodies is prone to misdiagnosis and omission.
the accuracy of antibody test results of syphilis helix is closely related to the interests of patients, so the joint detection of a variety of syphilis detection methods is very necessary.
2. As a tester, usually pay attention to the accumulation and supplement of professional knowledge, in the daily work we treat every specimen, every test should adhere to a serious and rigorous attitude, diligent thinking, do not let go of any questionable specimens and results, to dig deep into the end, really do a good job of clinical "eyes"! Source: Test Medicine Network !-- end of the content presentation -- !-- determine whether the login ends.