Limitations of the human Chorionic Gonadotropin (hCG) assay in the diagnosis of gestational trophoblastic disease
A 31-year-old lady presented with abnormal vaginal bleeding during her first trimester of pregnancy. Based on the ultrasound findings and the decreasing hCG trend (from 1040 mIU/mL to 759 mIU/mL), a diagnosis of missed miscarriage was made. A week later, the patient presented with heavy vaginal blee...
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| Format: | Article |
| Language: | English |
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Faculty of Medicine and Health Sciences, Universiti Putra Malaysia
2022
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| Online Access: | http://psasir.upm.edu.my/id/eprint/99322/ http://psasir.upm.edu.my/id/eprint/99322/1/2022121912535821_MJMHS_0791.pdf |
| _version_ | 1848863101489774592 |
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| author | Rusman, Zety Wizana Thambiah, Subashini C. Samsudin, Intan Nureslyna Anas, Siti Sharina Sthaneshwar, Pavai |
| author_facet | Rusman, Zety Wizana Thambiah, Subashini C. Samsudin, Intan Nureslyna Anas, Siti Sharina Sthaneshwar, Pavai |
| author_sort | Rusman, Zety Wizana |
| building | UPM Institutional Repository |
| collection | Online Access |
| description | A 31-year-old lady presented with abnormal vaginal bleeding during her first trimester of pregnancy. Based on the ultrasound findings and the decreasing hCG trend (from 1040 mIU/mL to 759 mIU/mL), a diagnosis of missed miscarriage was made. A week later, the patient presented with heavy vaginal bleeding. Ultrasound findings showed classic snowstorm appearance suggestive of complete hydatidiform mole. The serum hCG level however, was 357 mIU/mL. In a case of hydatiform mole with inappropriately low hCG, analytical interference was suspected. Post- dilution serum hCG of 5,775,000 mIU/mL confirmed the presence of hook effect in a two-site hCG immunoassay. Discordance between serum hCG and clinical findings should be actively investigated by the laboratory to prevent delay in diagnosis and treatment. This case also highlights the need for clinicians to be aware of the hCG assay used in their hospital’s laboratory so that they may recognise false negative hCG results. |
| first_indexed | 2025-11-15T13:27:34Z |
| format | Article |
| id | upm-99322 |
| institution | Universiti Putra Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-15T13:27:34Z |
| publishDate | 2022 |
| publisher | Faculty of Medicine and Health Sciences, Universiti Putra Malaysia |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | upm-993222023-03-09T07:11:12Z http://psasir.upm.edu.my/id/eprint/99322/ Limitations of the human Chorionic Gonadotropin (hCG) assay in the diagnosis of gestational trophoblastic disease Rusman, Zety Wizana Thambiah, Subashini C. Samsudin, Intan Nureslyna Anas, Siti Sharina Sthaneshwar, Pavai A 31-year-old lady presented with abnormal vaginal bleeding during her first trimester of pregnancy. Based on the ultrasound findings and the decreasing hCG trend (from 1040 mIU/mL to 759 mIU/mL), a diagnosis of missed miscarriage was made. A week later, the patient presented with heavy vaginal bleeding. Ultrasound findings showed classic snowstorm appearance suggestive of complete hydatidiform mole. The serum hCG level however, was 357 mIU/mL. In a case of hydatiform mole with inappropriately low hCG, analytical interference was suspected. Post- dilution serum hCG of 5,775,000 mIU/mL confirmed the presence of hook effect in a two-site hCG immunoassay. Discordance between serum hCG and clinical findings should be actively investigated by the laboratory to prevent delay in diagnosis and treatment. This case also highlights the need for clinicians to be aware of the hCG assay used in their hospital’s laboratory so that they may recognise false negative hCG results. Faculty of Medicine and Health Sciences, Universiti Putra Malaysia 2022-12 Article PeerReviewed text en http://psasir.upm.edu.my/id/eprint/99322/1/2022121912535821_MJMHS_0791.pdf Rusman, Zety Wizana and Thambiah, Subashini C. and Samsudin, Intan Nureslyna and Anas, Siti Sharina and Sthaneshwar, Pavai (2022) Limitations of the human Chorionic Gonadotropin (hCG) assay in the diagnosis of gestational trophoblastic disease. Malaysian Journal of Medicine and Health Sciences, 18 (supp.21). pp. 134-136. ISSN 2636-9346 https://medic.upm.edu.my/upload/dokumen/2022121912535821_MJMHS_0791.pdf 10.47836/mjmhs18.s21.22 |
| spellingShingle | Rusman, Zety Wizana Thambiah, Subashini C. Samsudin, Intan Nureslyna Anas, Siti Sharina Sthaneshwar, Pavai Limitations of the human Chorionic Gonadotropin (hCG) assay in the diagnosis of gestational trophoblastic disease |
| title | Limitations of the human Chorionic Gonadotropin (hCG) assay in the diagnosis of gestational trophoblastic disease |
| title_full | Limitations of the human Chorionic Gonadotropin (hCG) assay in the diagnosis of gestational trophoblastic disease |
| title_fullStr | Limitations of the human Chorionic Gonadotropin (hCG) assay in the diagnosis of gestational trophoblastic disease |
| title_full_unstemmed | Limitations of the human Chorionic Gonadotropin (hCG) assay in the diagnosis of gestational trophoblastic disease |
| title_short | Limitations of the human Chorionic Gonadotropin (hCG) assay in the diagnosis of gestational trophoblastic disease |
| title_sort | limitations of the human chorionic gonadotropin (hcg) assay in the diagnosis of gestational trophoblastic disease |
| url | http://psasir.upm.edu.my/id/eprint/99322/ http://psasir.upm.edu.my/id/eprint/99322/ http://psasir.upm.edu.my/id/eprint/99322/ http://psasir.upm.edu.my/id/eprint/99322/1/2022121912535821_MJMHS_0791.pdf |