Dr. Bertholf
Have you checked for paraprotein interference? I have seen rare cases
in which this led to an artificially low hdl. Paraprotiens tend to cause precipitates
while the reaction is running.
Joe
From: Clinical
biochemistry discussion list [mailto:[log in to unmask]] On
Behalf Of Ian Young
Sent: Wednesday, October 14, 2009 3:54 PM
To: [log in to unmask]
Subject: Re: Unusual lipid results
Roger
This is a very unusual set of results, as you are fully
aware. I would be very suspicious that there is something causing
negative interference with the cholesterol measurement. Do you know if
the cholesterol methods used in the two labs relied on the same
principle? I would proceed to ultracentrifugation (if available),
plus measurement of apoA1 and apoB.
Best wishes
Ian
Ian S.Young
Professor of Medicine, Queen's University Belfast
Wellcome Research Laboratories
Top Floor ICS A Block
Royal Victoria Hospital
Grosvenor Road
Belfast BT12 6BJ
Northern Ireland
tel: +44 2890 632743
fax: +44 2890 235900
email: [log in to unmask]
From: Clinical
biochemistry discussion list [mailto:[log in to unmask]] On
Behalf Of Bertholf, Roger
Sent: 14 October 2009 20:35
To: [log in to unmask]
Subject: Unusual lipid results
Total cholesterol = 210 mg/dL
HDL cholesterol = 7 mg/dL
LDL cholesterol = 2 mg/dL
Triglyceride = 610 mg/dL
LPE results:
Appearance: Clear (?)
Chylomicrons: negative
Beta: normal
Pre-beta: elevated
Alpha: normal
All of the tests (except the
LPE) have been duplicated in two labs (and in one lab with two specimens). We
do not perform LPE, but the results came back with the interpretation “Type IV,” even though
texts say that serum in Type IV hyperlipidemia is cloudy.
Shouldn’t a specimen
with triglycerides
>600 mg/dL be turbid?
Can VLDL account for >95% of total cholesterol?
Would serum with HDL 7 mg/dL
and LDL 2 mg/dL give “normal”
alpha and beta bands on LPE?
The chair of our department
of medicine has told me that an LDL of 2 mg/dL is incompatible with life. This
is an (alive) 58 y/o female.
I would appreciate any
thoughts.
Roger
Roger L. Bertholf, PhD
Professor of Pathology
Director of Clinical
Chemistry, Toxicology,
and Point of Care Testing
University of Florida Health
Science Center/Jacksonville
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