Para protein effect on direct assays is a possible culprit, as already indicated, but another likely cause is substrate/co-substrate depletion in the enzyme-lined cholesterol assays (mega dose of ascorbate/vit C or certain meds). Worth ruling them out.
 
Godfrey

From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Bertholf, Roger
Sent: Wednesday, October 14, 2009 3:35 PM
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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