This specimen was also analyzed by alternate hCG assay.What is the expected time course of decline in serum hCG values after surgical removal of an ectopic growth via an operation or medical treatment using MTX?What are possible causes, including false-positive results, of persistently elevated serum hCG levels paired with negative urine-based pregnancy tests?Is it possible that the actual serum hCG levels in the patient are much higher (eg, due to gestational trophoblastic disease) and that the measured results are lower than actual hCG concentrations due to an interference?What analyses can the clinical laboratory perform to ascertain whether the serum hCG levels are reliable?1. Decreasing beta-hCG levels is highly predictive of treatment success.
Arch Gynecol Obstet. 2014 Aug;8(8):OC04-8. The beta-hCG difference variable is a reliable predictor of success in cases with rising beta-hCG levels after … Epub 2008 Feb 15.Gabbur N, Sherer DM, Hellmann M, Abdelmalek E, Phillip P, Abulafia O.Am J Perinatol. Her only previous pregnancy had also been ectopic. Analysis using a different serum hCG method (Abbott Architect i2000 [Architect Total β-HCG Abbott Laboratories, Abbott Park, IL]; recognizes intact hCG and free β subunits) by a commercial reference laboratory (ARUP Laboratories, Salt Lake City, UT) yielded a very similar result of 92 IU/L. Epub 2014 Mar 14.Celik E, Türkçüoğlu I, Karaer A, Kırıcı P, Eraslan S.J Turk Ger Gynecol Assoc. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2013 Sep 1;14(3):125-9. doi: 10.5152/jtgga.2013.50133. The laboratory was consulted 3.5 months after the surgery, because serum hCG levels had stopped declining and had leveled off to around 80 to 90 IU/L but with negative urine pregnancy tests. Diagnosis of ectopic pregnancy uses serial hCG levels (eg, demonstrating lack of expected rise in early pregnancy), ultrasonographic examinations, and sometimes uterine curettage.Treatment of ectopic pregnancy can be medical or surgical, with medical approaches generally favored if there is early recognition.Surgery is indicated when there is suspected Fallopian-tube rupture or if medical therapy is contraindicated. 2017 Jan-Feb;33(1):13-17. doi: 10.12669/pjms.331.11238.J Clin Diagn Res. Epub 2014 Aug 20.Kim K, Suh DH, Cheong HH, Yoon SH, Lee TS, No JH, Kim YB.Clin Exp Reprod Med. Incubation of the specimen with a heterophilic blocking reagent did not result in a lowering of the measured hCG value. COVID-19 is an emerging, rapidly evolving situation. This case illustrates challenges that may arise with serum hCG measurements in management of ectopic pregnancies. This can occur with conditions such as hydatidiform mole or choriocarcinoma that can produce extremely high serum hCG values (eg, exceeding 1,000,000 IU/L in some choriocarinomas) that generate a hook effect.4. An alternative hypothesis in this case is that the serum hCG level is actually much larger than measured and that some interference is producing a falsely lower value. There was a 7.93-fold increase in the need for an additional methotrexate dose, with 82.61% sensitivity and 75.81% specificity when the increase in β-hCG levels from Day 1 to Day 4 predicting the need for additional methotrexate dose was 8.25%. Van Voorhis, MD, Matthew D. Krasowski, MD, PhD, Persistent Human Chorionic Gonadotropin After Methotrexate Treatment and an Emergency Surgical Procedure for Ectopic Pregnancy, The case study is a 33-year-old white female with persistently elevated serum human chorionic gonadotropin (hCG) levels following methotrexate treatment and emergency surgery for ectopic pregnancy.
When it is an antibody against a specific immunogenStudies of the ‘hook’ effect in the one-step sandwich immunoassayElimination of “hook-effect” in two-site immunoradiometric assays by kinetic rate analysisLimitations in qualitative point of care hCG tests for detecting early pregnancy The Gyno is confused he says as my hemoglobin has gone up which means no internal bleeding, my pain is gone, and i have stopped bleeding. She had 2 L of hemoperitoneum at the time; her hemoglobin level dropped to 5.1 g/dL afterward.Pathology analysis of the surgical specimens showed the presence of chorionic villi with no evidence of gestational trophoblastic disease, consistent with the diagnosis of ectopic pregnancy. The success rates for MTX therapy are similar to those from a randomized controlled studyOxford University Press is a department of the University of Oxford. At the time of the first MTX dose, the serum hCG concentration was 27,995 IU/L. A possible explanation for the findings in this case is that urine hCG was present but at concentrations below the positive cutoff; nevertheless, we did not perform quantitative urine hCG analysis to test this hypothesis. The serum hCG level declined to 16,170 IU/L by the time of the emergency surgery. The current ectopic pregnancy, with estimated gestational age of 7 weeks, was treated initially with 2 doses of MTX, with declining human chorionic gonadotropin (hCG) levels after the second dose. Elsevier Science The specimen was also analyzed by the Elecsys HCG+β assay (F. Hoffman-La Roche Ltd, Basel, Switzerland; recognizes intact hCG, nicked forms of hCG, the β-core fragment, and the free β subunit), which produced a result of 84 IU/L. He said that he will know more on Friday and I may need another shot.
The key laboratory studies are as follows: analysis by alternative serum hCG assay(s) with different methodology, dilution studies, and incubation with heterophilic blocking agents.After discussion between the laboratory director and obstetric team, multiple studies were performed on a specimen from the patient that had yielded a serum hCG value of 83 IU/L via the Roche Diagnostics HCG STAT assay (which recognizes intact hCG).
Arch Gynecol Obstet. 2014 Aug;8(8):OC04-8. The beta-hCG difference variable is a reliable predictor of success in cases with rising beta-hCG levels after … Epub 2008 Feb 15.Gabbur N, Sherer DM, Hellmann M, Abdelmalek E, Phillip P, Abulafia O.Am J Perinatol. Her only previous pregnancy had also been ectopic. Analysis using a different serum hCG method (Abbott Architect i2000 [Architect Total β-HCG Abbott Laboratories, Abbott Park, IL]; recognizes intact hCG and free β subunits) by a commercial reference laboratory (ARUP Laboratories, Salt Lake City, UT) yielded a very similar result of 92 IU/L. Epub 2014 Mar 14.Celik E, Türkçüoğlu I, Karaer A, Kırıcı P, Eraslan S.J Turk Ger Gynecol Assoc. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2013 Sep 1;14(3):125-9. doi: 10.5152/jtgga.2013.50133. The laboratory was consulted 3.5 months after the surgery, because serum hCG levels had stopped declining and had leveled off to around 80 to 90 IU/L but with negative urine pregnancy tests. Diagnosis of ectopic pregnancy uses serial hCG levels (eg, demonstrating lack of expected rise in early pregnancy), ultrasonographic examinations, and sometimes uterine curettage.Treatment of ectopic pregnancy can be medical or surgical, with medical approaches generally favored if there is early recognition.Surgery is indicated when there is suspected Fallopian-tube rupture or if medical therapy is contraindicated. 2017 Jan-Feb;33(1):13-17. doi: 10.12669/pjms.331.11238.J Clin Diagn Res. Epub 2014 Aug 20.Kim K, Suh DH, Cheong HH, Yoon SH, Lee TS, No JH, Kim YB.Clin Exp Reprod Med. Incubation of the specimen with a heterophilic blocking reagent did not result in a lowering of the measured hCG value. COVID-19 is an emerging, rapidly evolving situation. This case illustrates challenges that may arise with serum hCG measurements in management of ectopic pregnancies. This can occur with conditions such as hydatidiform mole or choriocarcinoma that can produce extremely high serum hCG values (eg, exceeding 1,000,000 IU/L in some choriocarinomas) that generate a hook effect.4. An alternative hypothesis in this case is that the serum hCG level is actually much larger than measured and that some interference is producing a falsely lower value. There was a 7.93-fold increase in the need for an additional methotrexate dose, with 82.61% sensitivity and 75.81% specificity when the increase in β-hCG levels from Day 1 to Day 4 predicting the need for additional methotrexate dose was 8.25%. Van Voorhis, MD, Matthew D. Krasowski, MD, PhD, Persistent Human Chorionic Gonadotropin After Methotrexate Treatment and an Emergency Surgical Procedure for Ectopic Pregnancy, The case study is a 33-year-old white female with persistently elevated serum human chorionic gonadotropin (hCG) levels following methotrexate treatment and emergency surgery for ectopic pregnancy.
When it is an antibody against a specific immunogenStudies of the ‘hook’ effect in the one-step sandwich immunoassayElimination of “hook-effect” in two-site immunoradiometric assays by kinetic rate analysisLimitations in qualitative point of care hCG tests for detecting early pregnancy The Gyno is confused he says as my hemoglobin has gone up which means no internal bleeding, my pain is gone, and i have stopped bleeding. She had 2 L of hemoperitoneum at the time; her hemoglobin level dropped to 5.1 g/dL afterward.Pathology analysis of the surgical specimens showed the presence of chorionic villi with no evidence of gestational trophoblastic disease, consistent with the diagnosis of ectopic pregnancy. The success rates for MTX therapy are similar to those from a randomized controlled studyOxford University Press is a department of the University of Oxford. At the time of the first MTX dose, the serum hCG concentration was 27,995 IU/L. A possible explanation for the findings in this case is that urine hCG was present but at concentrations below the positive cutoff; nevertheless, we did not perform quantitative urine hCG analysis to test this hypothesis. The serum hCG level declined to 16,170 IU/L by the time of the emergency surgery. The current ectopic pregnancy, with estimated gestational age of 7 weeks, was treated initially with 2 doses of MTX, with declining human chorionic gonadotropin (hCG) levels after the second dose. Elsevier Science The specimen was also analyzed by the Elecsys HCG+β assay (F. Hoffman-La Roche Ltd, Basel, Switzerland; recognizes intact hCG, nicked forms of hCG, the β-core fragment, and the free β subunit), which produced a result of 84 IU/L. He said that he will know more on Friday and I may need another shot.
The key laboratory studies are as follows: analysis by alternative serum hCG assay(s) with different methodology, dilution studies, and incubation with heterophilic blocking agents.After discussion between the laboratory director and obstetric team, multiple studies were performed on a specimen from the patient that had yielded a serum hCG value of 83 IU/L via the Roche Diagnostics HCG STAT assay (which recognizes intact hCG).