02 Jan How Biotin Can Skew Lab Results
A water-soluble vitamin in the Vitamin B family, biotin (B7) plays an integral role in the conversion of food into energy as well as promoting healthy hair and nails. While available in small doses from foods like eggs, bananas, and milk, biotin is often included in multivitamins and specialty supplements designed to encourage strong nails and rapid hair growth. Some recent studies even suggest that regular use of biotin may play a supporting role in the treatment of neurodegenerative disorders, like multiple sclerosis.
Due to its prevalence, taking biotin may seem harmless, and in many ways, it is not a threat. However, the FDA has recently made one potentially dangerous side effect known: the ability to skew important laboratory test results.
Biotin and Bloodwork
Testing the levels of substances within the blood is an integral part of medical care in both inpatient and outpatient settings. This kind of lab work is often a first line of defense against disease, alerting doctors and technicians as to both present medical conditions as well as potential signs of developing problems.
The efficacy of bloodwork can vary based on the particular testing method being used to evaluate patient samples. A common form of test is an immunoassay panel, a variation that analyzes the levels of specific substances in the blood based on their properties as antigens or antibodies. However, many forms of immunoassays utilize biotin as a part of this process. Biotins is frequently used to bind to chemicals within the blood for the purpose of measurement.
In the average patient, immunoassays can be highly effective, but the presence of excess biotin in the blood from supplements can create significant issues in evaluation. Biotin use can block the binding mechanisms that are used to accurately measure substances, leading to misleading results. In some cases, results from testing are negligible, but in others, the issues created through inaccurate testing can be extremely dangerous.
Despite serving as an essential B vitamin, biotin is not required in the body in substantial doses; only 30 micrograms are necessary on a daily basis. Most supplements provide excessive amounts, anywhere from 166 times to 333 times the average required quantities. Consuming a standard amount of biotin isn’t problematic, but the rise of biotin in multivitamins and popular beauty products can have devastating consequences. Conservative estimates place the number of men and women taking products high in biotin to be in the multimillions.
Affected Tests and Patient Outcomes
The FDA has been aware of the effects of biotin on test results for some time, and subsequently issued a statement related to the laboratory challenges in November 2017. In the memo, the FDA stated that “biotin can significantly interfere with certain lab tests and cause incorrect test results which may go undetected.”
More alarmingly, the FDA admitted to noting at least one death associated with false results from testing due to biotin’s obfuscation of accurate substance levels. In the known case of death, biotin obscured levels in a troponin test. A biomarker used to help diagnose heart attacks, troponin can appear in artificially low levels in those taking supplementary biotin and lead to the misdiagnosis of potentially-fatal heart diseases.
Most studies related to biotin’s effects have involved hormone testing, including tests for parathyroid hormones (PTH), thyroid stimulating hormones (THS), triiodothyronine, and thyroxine. However, biotin is used in many other immunoassays, creating potential conflicts in screening panels that may occur in yet-untested ways. While no additional mortalities are known, the use of immunoassays in applications like cancer detection and treatment planning raise unsettling possibilities.
Addressing the Dangers of Biotin
Many researchers, physicians, and laboratory technicians are aware of the consequences of supplemental biotin in testing, but addressing this can be a challenge. As many patients who require testing are unaware of their biotin use, particularly those who ingest biotin as a part of a multivitamin or more general supplement, it may not be possible to determine who takes biotin and who does not in a time-efficient manner. We instruct our clients to notate any potential prescriptions and vitamins such as biotin that can interfere with testing results.
Unfortunately, many labs do not have the capacity to handle testing in an alternative environment, leading to potential unknowns in testing levels. Without an in-depth way to survey each patient regarding both vitamin use and individual beauty routines prior to testing coupled with careful evaluation of unusually low levels of substances noted by immunoassay panels, it may be nearly impossible for standard testing facilities to properly detect illness. Many physicians now know to instruct their patients not to take products with biotin in the days before a blood test, but patient compliance is never guaranteed.
Recent technological innovation may have identified a solution that protects patients from false negatives that can be detrimental to health and mortality. The Abbott Architect ci8200 is the only platform on the market today that is completely free from biotin interference. When blood tests are processed using the Abbott Architect ci8200, the patient’s use of biotin becomes irrelevant, ensuring a more accurate and safer screening environment, regardless of the purpose for testing.
Testing at Captiva Lab
At Captiva Lab, we are well aware of the shortcomings in immunoassay testing due to the use of supplemental biotin and are prepared to address this in our testing methods. Through the use of the Abbott Architect ci8200, we are able to provide testing to partners and patients without the risk of misdiagnosis or false negatives due to the use of biotin in supplementation.
Roadblocks that may impede testing arise frequently in medicine but we believe in finding alternate ways forward. At Captiva Lab, we work consistently to stay at the forefront of our field to ensure that our testing procedures are both comprehensive and cutting-edge. This allows us to provide more reliable, effective, and precise results than the competition, offering highly dependable testing resources for corporations, medical centers, rehabilitation facilities, and others in need.