Methods to reduce lipemic interference in clinical chemistry tests: a systematic review and recommendations

Abstract

Objectives Lipemia is the presence of abnormally high lipoprotein concentrations in serum or plasma samples that can interfere with laboratory testing. There is little guidance available from manufacturers or professional bodies on processing lipemic samples to produce clinically acceptable results. This systematic review summarizes existing literature on the effectiveness of lipid removal techniques in reducing interference in clinical chemistry tests. Methods A PubMed search using terms relating to lipid removal from human samples for clinical chemistry tests produced 1,558 studies published between January 2010 and July 2021. 15 articles met the criteria for further analyses. Results A total of 66 analytes were investigated amongst the 15 studies, which showed highly heterogenous study designs. High-speed centrifugation was consistently effective for 13 analytes: albumin, alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, creatine kinase (CK), creatinine (Jaffe method), gamma-glutamyl transferase (GGT), glucose (hexokinase-based method), lactate dehydrogenase (LDH), phosphate, potassium, and urea. Lipid-clearing agents were uniformly effective for seven analytes: ALT, AST, total bilirubin, CK, creatinine (Jaffe method), lipase, and urea. Mixed results were reported for the remaining analytes. Conclusions For some analytes, high-speed centrifugation and/or lipid-clearing agents can be used in place of ultracentrifugation. Harmonized protocols and acceptability criteria are required to allow pooled data analysis and interpretation of different lipemic interference studies.

Metabolic and Endocrine Insights in Donkeys

“…Opalescent (lipemic) serum or plasma can interfere with the measurement of other blood analytes, such as creatinine, gamma-glutamyl transferase (GGT), phosphorus and calcium, causing a false decrease [12]. To obtain accurate analyte values, ultracentrifugation or extraction are recommended to clear the lipids and repeat the analysis.…”

Association between serum alanine transaminase/aspartate aminotransferase (ALT/AST) ratio and cognitive impairment in US older adults

“…Furthermore, the ALT/AST ratio has generally been acknowledged as a more reliable predictor of liver injury [37,38]. Numerous studies have validated that liver function markers could serve as improved prognostic biomarkers [39][40][41][42][43][44]. To date, however, no studies have investigated the potential link between the ALT/AST ratio and cognitive impairment.…”

Interferencia generada por la lipemia en la medición de constituyentes bioquímicos

“…La lipemia absorbe y dispersa la luz a diferentes longitudes de onda, además, puede reducir la fracción acuosa del suero sanguíneo y por su naturaleza hidrofóbica pueden retener en su interior analitos, reactivos o productos de la reacción. Este tipo de interferencia produce sesgos en la medición de las magnitudes bioquímicas y puede conducir a diagnósticos equivocados y por consiguiente a suministrar tratamientos innecesarios o potencialmente perjudiciales para los pacientes (2)(3)(4) .…”

“…Las causas de sueros lipémicos en el laboratorio son múltiples, entre ellas, el insuficiente tiempo de duración del ayuno para la toma de muestras sanguíneas, a ciertas condiciones clínicas como la diabetes mellitus, pancreatitis, o cuando se administra nutrición parenteral y ciertos fármacos como el propanolol, glucocorticoides, antivirales, etc. (2,3) En el laboratorio clínico se determina la concentración de gran variedad de constituyentes bioquímicos mediante técnicas espectrofotométricas. Los dos métodos más utilizados son las de química líquida que utiliza la espectrofotometría de absorción con reactivos en estado líquido y la de química seca que utiliza espectrofotometría de reflectancia con reactivos adheridos a superficies sintéticas o slides.…”