Download PDF
CC BY-NC-ND 4.0 · J Lab Physicians 2023; 15(02): 269-275
DOI: 10.1055/s-0042-1758664
Original Article

Evaluating Interference of Lipemia on Routine Clinical Biochemical Tests

Subramaniam ArulVijayaVani
1   Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Karaikal, Puducherry, India
,
Palani Selvam Mohanraj
2   Department of Biochemistry, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India
,
Rajagambeeram Reeta
3   Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective Lipemia is an important cause of preanalytical errors in laboratory results. They affect the specimen integrity and trustworthiness of laboratory results. The present study was to assess the impact of lipemia on routine clinical chemistry analytes.

Methods Anonymous leftover serum samples with normal levels of routine biochemical parameters were pooled. Twenty such pooled serum samples were used for the study. The samples were spiked with commercially available intralipid solution (20%) to produce lipemic concentrations of 0, 400 (mild, 20 μL), 1,000 (moderate, 50 μL), and 2,000 mg/dL (severe, 100 μL). Glucose, renal function test, electrolytes, and liver function test were estimated in all the samples. Baseline data without the effect of interference was considered as true value and percentage bias for the spiked samples was calculated. Interference was considered significant if the interference bias percentage exceeded 10%.

Result Parameters like glucose, urea, creatinine, direct bilirubin, sodium, potassium, and chloride showed negative interference at mild and moderate lipemic concentration and positive interference at severe lipemic concentration. Parameters like aspartate transaminase (AST) and alanine transaminase (ALT) showed negative interference at mild and positive interference at moderate and severe lipemic concentration. Whereas uric acid, total protein, albumin, total bilirubin, alkaline phosphatase, gamma-glutamyl transferase, calcium, magnesium, and phosphorous showed positive interference at all concentrations. Significant interference (> 10%) was shown for magnesium (mild lipemia), albumin, direct bilirubin, ALT, and AST at moderate lipemic concentration. All parameters showed significant interference at severe lipemic concentration.

Conclusion All the study parameters are affected by lipemic interference at varying levels. Laboratory-specific data regarding lipemic interference at various concentrations on the clinical biochemistry parameters is needed.

Keywords

lipemia - interference - preanalytical errors

Authors' Contributions

S.A. contributed to the design of the study and analysis of the samples. P.S.M. contributed to the design of the study and statistical analysis. R.R. contributed to the design of the study and expert guidelines.




Publication History

Article published online:
05 December 2022

© 2022. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Kroll MH. Evaluating interference caused by lipemia. Clin Chem 2004; 50 (11) 1968-1969
    CrossrefPubMedGoogle Scholar
  • 2 Steen G, Klerk A, Laan Kv, Eppens EF. Evaluation of the interference due to haemoglobin, bilirubin and lipids on Immulite 2500 assays: a practical approach. Ann Clin Biochem 2011; 48 (Pt 2): 170-175
    CrossrefPubMedGoogle Scholar
  • 3 Nikolac N. Lipemia: causes, interference mechanisms, detection and management. Biochem Med (Zagreb) 2014; 24 (01) 57-67
    CrossrefPubMedGoogle Scholar
  • 4 Lippi G, Plebani M, Favaloro EJ. Interference in coagulation testing: focus on spurious hemolysis, icterus, and lipemia. Semin Thromb Hemost 2013; 39 (03) 258-266
    PubMedGoogle Scholar
  • 5 Nelson RH. Hyperlipidemia as a risk factor for cardiovascular disease. Prim Care 2013; 40 (01) 195-211
    CrossrefPubMedGoogle Scholar
  • 6 Salvagno GL, Lippi G, Gelati M, Guidi GC. Hemolysis, lipaemia and icterus in specimens for arterial blood gas analysis. Clin Biochem 2012; 45 (4-5): 372-373
    CrossrefPubMedGoogle Scholar
  • 7 Fliser E, Jerkovic K, Vidovic T, Gorenjak M. Investigation of unusual high serum indices for lipemia in clear serum samples on siemens analysers dimension. Biochem Med (Zagreb) 2012; 22 (03) 352-362
    CrossrefPubMedGoogle Scholar
  • 8 Nanji AA, Poon R, Hinberg I. Lipaemic interference: effects of lipaemic serum and intralipid. J Clin Pathol 1988; 41 (09) 1026-1027
    CrossrefPubMedGoogle Scholar
  • 9 Agarwal S, Vargas G, Nordstrom C, Tam E, Buffone GJ, Devaraj S. Effect of interference from hemolysis, icterus and lipemia on routine pediatric clinical chemistry assays. Clin Chim Acta 2015; 438: 241-245
    CrossrefPubMedGoogle Scholar
  • 10 Biljali S, Beadini N, Beadini S, Nuhii N, Beadini A. Effect of lipemia interferences in routine clinical Biochemical Tests (Intralaboratory Study). Published 2015. . Accessed July 4, 2022, at: https://www.semanticscholar.org/paper/Effect-of-lipemia-interferences-in-routine-clinical-Biljali-Beadini/84cf78855f5267f1fcb4223a9b8a428fe6300a82
    Google Scholar
  • 11 Soleimani N, Mohammadzadeh S, Asadian F. Lipemia interferences in biochemical tests, investigating the efficacy of different removal methods in comparison with ultracentrifugation as the gold standard. J Anal Methods Chem 2020; 2020: 9857636
    CrossrefPubMedGoogle Scholar
  • 12 Nikolac N, Simundic AM, Miksa M. et al. Heterogeneity of manufacturers' declarations for lipemia interference–an urgent call for standardization. Clin Chim Acta 2013; 426: 33-40
    CrossrefPubMedGoogle Scholar
  • 13 Ji JZ, Meng QH. Evaluation of the interference of hemoglobin, bilirubin, and lipids on Roche Cobas 6000 assays. Clin Chim Acta 2011; 412 (17-18): 1550-1553
    CrossrefPubMedGoogle Scholar
  • 14 Calmarza P, Cordero J. Lipemia interferences in routine clinical biochemical tests. Biochem Med (Zagreb) 2011; 21 (02) 160-166
    CrossrefPubMedGoogle Scholar
  • 15 Bossuyt X, Schiettekatte G, Bogaerts A, Blanckaert N. Serum protein electrophoresis by CZE 2000 clinical capillary electrophoresis system. Clin Chem 1998; 44 (04) 749-759
    CrossrefPubMedGoogle Scholar
  • 16 Dimeski G, Mollee P, Carter A. Effects of hyperlipidemia on plasma sodium, potassium, and chloride measurements by an indirect ion-selective electrode measuring system. Clin Chem 2006; 52 (01) 155-156
    CrossrefPubMedGoogle Scholar
  • 17 Sen Gupta P, Sharma M, Timms PM. Laboratory samples deemed ‘unsuitable for analysis’ can be diagnostically useful. Clin Med (Lond) 2013; 13 (03) 309-311
    CrossrefPubMedGoogle Scholar
  • 18 LipoClear.pdf. . Accessed July 4, 2022, at: https://www.lornelabs.com/assets/client-files/spec-sheet-pdfs/LipoClear.pdf
    Google Scholar