Immunoassay interference secondary to therapeutic high-dose biotin: A paediatric case report

Abstract

High-dose biotin therapy is used in a diverse range of conditions ranging from multiple sclerosis and inborn errors of metabolism, such as holocarboxylase synthase deficiency, mitochondrial disorders, biotin responsive basal ganglia disease and biotinidase deficiency. The streptavidin–biotin complex is one of the strongest non-covalent bonds in nature – a characteristic that is exploited in immunoassays used in the clinical laboratory for the quantitation of a wide range of analytes. These streptavidin–biotin-based immunoassays are susceptible to interference in patients treated with high-dose biotin; results may be falsely high or low depending on the design of the assay.