When we receive fluids for ? chyle my usual protocol is to measure the
cholesterol and triglycerides on the sample, as well as on a sample of
plasma from the patient. Usually the diagnosis is obvious with trigs
significantly higher than cholesterol (both in mmol/L) in the fluid and
this can be taken as evidence of chylomicrons in the fluid. Typical results
may be triglycerides 6 mmol/L and cholesterol 1.5 mmol/L although much
higher values may be seen. The simultaneous plasma sample just provides
some security that the fluid has not originated from the circulation. An
alternative method I have seen in use is to ultracentrifuge the sample and
take the presence of a white, creamy supernatant as a marker for
chylomicrons and therefore chyle.
If the patient has already been placed on a very low fat diet these methods
may not work but the diagnosis is easily made by observing the chest tube
(if present) for 0.5 - 1 hour after the patient has a meal containing fat.
Graham Jones
Staff Specialist in Chemical Pathology
St Vincent's Hospital, Sydney
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