Journal Information
Journal ID (publisher-id): BM
Journal ID (nlm-ta): Biochem Med (Zagreb)
Title: Biochemia Medica
Abbreviated Title: Biochem. Med. (Zagreb)
ISSN (print): 1330-0962
ISSN (electronic): 1846-7482
Publisher: Croatian Society of Medical Biochemistry and Laboratory Medicine
Article Information
Copyright statement: ©Croatian Society of Medical Biochemistry and Laboratory Medicine.
Copyright: 2021, Croatian Society of Medical Biochemistry
License (open-access):
This is an Open Access article distributed under the terms of the Creative Commons Attribution (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Date received: 11 November 2020
Date accepted: 04 February 2021
Publication date (electronic): 15 April 2021
Publication date (print): 15 June 2021
Volume: 31
Issue: 2
Electronic Location Identifier: 021002
Publisher ID: bm-31-2-021002
DOI: 10.11613/BM.2021.021002
Delayed diagnosis and treatment of extreme hypertriglyceridemia due to rejection of a lipemic sample
Jan Van Elslande[1]
Samira Hijjit[2]
Katrien De Vusser[2]
Michel Langlois[3]
Björn Meijers[2]
Ann Mertens[4]
Glynis Frans[1]
[1] Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
[2] Clinical department of Nephrology, University Hospitals Leuven, Leuven, Belgium
[3] Department of Laboratory Medicine, AZ Sint-Jan Brugge, Belgium
[4] Clinical Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
[5] Nutrition & Obesity Unit, Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Aging, KU Leuven, Leuven, Belgium.
[6] Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
Author notes:
[*] Corresponding author: pieter.vermeersch@uzleuven.be
Introduction
Most laboratories routinely determine haemolysis, icterus and lipemia indices to identify lipemic samples and reject potentially affected results. Hypertriglyceridemia is the most common cause of lipemia and severe hypertriglyceridemia (≥ 11.3 mmol/L) is a major risk factor of acute pancreatitis.
Laboratory analysis
A 56-year-old woman attended the outpatient clinic for a follow-up visit 1 month after a kidney transplantation. Her immunosuppressive therapy consisted of corticosteroids, cyclosporine, and mycophenolic acid. The routine clinical chemistry sample was rejected due to extreme lipemia. The comment “extreme lipemic sample” was added on the report, but the requesting physician could not be reached. The Cobas 8000 gave a technical error (absorption > 3.3) for the HIL-indices (L-index: 38.6 mmol/L) which persisted after high-speed centrifugation. The patient was given a new appointment 2 days later. The new sample was also grossly lipemic and gave the same technical error (L-index: 35.9 mmol/L).
What happened
The second sample was manually diluted 20-fold after centrifugation to obtain a result for triglycerides within the measuring range (0.10–50.0 mmol/L). Triglycerides were 169.1 mmol/L, corresponding to very severe hypertriglyceridemia. This result was communicated to the nephrologist and the patient immediately recalled to the hospital. She received therapeutic plasma exchange the next day and did not develop acute pancreatitis.
Keywords: extra-analytical phase; hypertriglyceridemia; interferences; lipemia; lipoprotein metabolism
