A Case of Pseudoreduction of IgA

BACKGROUND: Immunoglobulin A (IgA) is an important biomarker for clinical evaluation of immune system function and multiple myeloma. The hook effect may lead to a false decrease in IgA test results, especially at extremely high IgA concentrations, which may mask the true disease state and result in misdiagnosis or missed diagnosis. METHODS: We report a case of false decrease in IgA due to the hook effect. RESULTS: The detection values of IgA (6.89 g/L), IgM (0.33 g/L), and IgG (2.72 g/L) in the patient were significantly different from the serum globulin level (52.5 g/L). After dilution, the true value of IgA was retested to be 37.25 g/L. The original value of IgA was falsely reduced due to the hook effect. CONCLUSIONS: When the IgA test results contradict the serum globulin levels, attention should be paid to the hook effect. Laboratory personnel should obtain the true level of IgA through sample dilution retesting to avoid misdiagnosis and missed diagnosis of multiple myeloma.