Dear Misra
I wonder if the patient is suffering from in vivo haemolysis (have you
checked hepatoglobin and reticulocyle count) which could invalided the
HBA1c level hence give you a misleadingly low HBA1c and masked an
underlying diabetes which is the major contributing factor for his
un-controlled hypertriglyceridaemia not controlled with Fenofibrate and
atorvastatin.
Kind Regards
Ali
Dr Ali Al-bahrani MBCh.B MSc.Chem Path. CSci. FRCPath.
Director of Pathology
Consultant Chemical Pathologist and HOD of Chemical Pathology
St Mary's Hospital
Newport
Isle of Wight
PO30 5TG
United Kingdom
Te: 01983 534859/534917 Fax. 01983 825437
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]] On Behalf Of Shivani Misra
Sent: 30 September 2012 10:13
To: [log in to unmask]
Subject: Hypertriglyceridaemia and haemolysed sample
Dear All,
Grateful for some help with a lipid case;
40-year-old man, 4 years post-renal transplant found to have a severe
mixed hyperlipidaemia (cholesterol 10 mmol/L, HDL 0.3mmol/L,
triglycerides 30 mmol/L). Treatment on referral to lipid clinic was
Tacrolimus, atorvastatin, aspirin and Omacor. Lipid profile 1 year
after transplant (total cholesterol 5.3 mmol/Land trigs 2.1 mmol/L)
Started in lipid clinic on Fenofibrate and low fat diet - trigs reached
nadir of 10mmol/L and cholesterol came down to 5mmol/L.
No copies of E2 allele found on screening. No obvious secondary cause
detected.
Now his triglycerides are increasing again (27 mmol/L), though
non-compliance unlikely.
Has anyone had a case of autoantibodies to lipoprotein lipase? Any other
possible explanations?
Can anyone also explain why all serum and plasma samples since the onset
of hypertriglyceridaemia have haemolysed? I've taken the blood myself
and rushed to lab, have spun at low speed, tried serum / li hep and
still all samples grossly haemolysed. No evidence of in vivo haemolysis.
All comments appreciated!
Many thanks
Shivani
Dr Shivani Misra
SpR Metabolic Medicine
NIHR Academic Clinical Fellow
Imperial College London
Imperial Healthcare NHS Trust
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