Case Report

Interferensi sampel lipemik pada bayi dengan lipemia retinalis dikarenakan primary mixed hyperlipidemia: laporan kasus

Andi Munawirah , Habibah S. Muhiddin, Liong Boy Kurniawan, Ruland DN Pakasi

Andi Munawirah
Program Pendidikan Dokter Spesialis Patologi Klinik Fakultas Kedokteran Universitas Hasanuddin, Rumah Sakit Umum Pusat dr. Wahidin Sudirohusodo, Makassar. Email: m13_r4@yahoo.com

Habibah S. Muhiddin
Departemen Ilmu Kesehatan Mata Fakultas Kedokteran Universitas Hasanuddin, Rumah Sakit Umum Pusat dr. Wahidin Sudirohusodo, Makassar

Liong Boy Kurniawan
Departemen Ilmu Patologi Klinik Fakultas Kedokteran Universitas Hasanuddin, Rumah Sakit Umum Pusat dr. Wahidin Sudirohusodo, Makassar

Ruland DN Pakasi
Departemen Ilmu Patologi Klinik Fakultas Kedokteran Universitas Hasanuddin, Rumah Sakit Umum Pusat dr. Wahidin Sudirohusodo, Makassar
Online First: August 01, 2019 | Cite this Article
Munawirah, A., Muhiddin, H., Kurniawan, L., Pakasi, R. 2019. Interferensi sampel lipemik pada bayi dengan lipemia retinalis dikarenakan primary mixed hyperlipidemia: laporan kasus. Intisari Sains Medis 10(2). DOI:10.15562/ism.v10i2.370


Background: Interference is a condition of which sample components cause an error in the analyte measurement in the analyzer.  The most common cause of interference is lipemic sample. Lipemic sample is characterized by turbidity of the serum or plasma caused by an accumulation of lipoprotein particles. Primary mixed hyperlipidemia (PMH) is a cause of primary hypertrigliseridemia with lipemia manifestation.

Case report: A three month-old baby boy was admitted to a hospital, having white spots in his black eyes. The spots were seen clearer at light exposure, and ophthalmologic examination indicated lipemia retinalis. Patient’s sample was lipemic and its laboratory analysis resulted in as follow: WBC 13.103/μL, Hb 15.6 gr/dL, RBC 2.99 106/μL, triglyserida 10.435 mg/dL, total cholesterol 631 mg/dL, HDL 12 mg/dL, LDL 195 mg/dL, and apoprotein B 196 mg/dL. Due to a significant interference, SGOT, SGPT, ureum and creatinin were not obtained. Immunologic serum analysis of the patient and his mother showed an increasing of antibody IgG CMV: 28 dan 20 IU/ml, respectively.

Conclusion: Lipemic samples could directly affect most of laboratory examination methods. Laboratory results with such lipemia interferences shoud be interpretated critically and accurately to produce precise diagnosis, and in turn, monitoring of patient with lipemia.

References

Andrade NN, Souza CL. Procedures to minimize interference hypertriglyceridemia in laboratory exams of lipemic samples in acute pancreatitis : a case report. J Bras Patol Med Lab. 2016; 52(2): 103 – 106.

Kroll MH and Mccudden CR. Endogenous Interference Clinical Laboratory Test Icteric, Lipemic, and Turbid Samples Boston: Walter de Gruyter; 2012: 35 – 45.

Mainali S, Davis SR and Krasowski MD. Frequency and causes of lipemia interference of clinical chemistry laboratory tests. Pract Lab Med. 2017; 8: 1 – 9.

Stroes E, Moulin P, Parhofer KG, Rebours V, Lohr JM, Averna M. Diagnostic algorithm for familial chylomicronemia syndrome. Atheroscler Suppl. 2017; 23: 1 – 7.

Brahm A, Hegele RA. Hypertriglyceridemia. Nutrients. 2013; 5(3): 981 – 1001.

Sniderman A, Couture P, De Graaf J. Diagnosis and treatment of apolipoprotein B dyslipoproteinemias. Nat Rev Endocrinol. 2010; 6(6): 335 – 46.

Matera D, Seydewitz H, Niederhoff H, Wiebusch H and Brandis M. Dyslipidaemia in a boywith recurrent abdominal pain, hypersalivation and decreased lipoprotein lipase activity. Europe Journal Pediatrics. 1996:660-664.

Nagasaka H, Kikuta H, Chiba H, Murano T, Hiroshima H, Ohtake A et al. Two cases with transient lipoprotein lipase (LPL) activity impairment: evidence for the possible involvement of an LPL inhibitor. Eur J Pediatr. 2003; 162(3): 132 – 138.

Remaley AT, Rifai N, Warnick GS. Lipids, Lipoproteins, Apolipoproteins, and Other Cardiovascular Risk Factors. In: Burtis CA, Bruns DE. (eds.) Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. United States of America: Elsevier Saunders; 2012: 775 – 778.

Sapountzi P, Lopez N, Almeda FQ. Lipid Disorder. In: P. M. Camacho. (ed.) A Color Handbook Clinical Endocrinology and Metabolism. UK: Manson Publishing; 2011: 169 – 187.

Semenkovich CF, Goldberg AC, Gallagher IJ. Disorder of Lipid Metabolism. In: S Melmed, KS Polonsky, PR Larsen, HM Kronenberg. (eds.) William Textbook of Endocrinology. 12th ed. Philadelpia: Elsevier Saunders; 2011: 1650-1653.

Sriram CS, Gulati SF, Chopra V, Vashist S, Menon PS. Familial combined hyperlipidemia in a North Indian kindred. Indian J Pediatr. 2005; 72(11):987–9.

Nikolac N. Lipemia : causes, interference mechanism, detection, and management. Biochem Med (Zagreb). 2014; 24(1):57–67.

Calmarza P, Cordero J. Lipemia interferences in routine clinical biochemical tests. Biochem Med (Zagreb). 2011; 21(2): 160–6.

Smock KJ, Perkins SL. Examination of the Blood and Bone Marrow. In: JP Greer, DA Arber, B Glader. (eds.) Wintrobe's Clinical Hematology. 13th ed. China: Wolters Kluwers Health; 2014: 1 – 5.

Wellen KE, Hotamisligil GS. Inflammation, stress, and diabetes. J Clin Invest. 2005; 115(5): 1111 – 9.

Ji JZ, Meng QH. Evaluation of the interference of hemoglobin, bilirubin, and lipids on Roche Cobas 6000 assays. Clin Chim Acta. 201; 412(17-18): 1550–3.

Nikolac N, Simundic A, Miksa M, Lima-Oliveira G, Salvagno GL, Caruso B, Guidi GC. Heterogeneity of manufacturers' declarations for lipemia interference — an urgent call for standardization. Clin Chim Acta. 2013; 426: 33 – 40.

Schiettecatte J, Anckaert E, Smitz J. Interferences in Immunoassays. Advances in Immunoassay. Available at : http://www.intechopen.com/books/advances-in-immunoassay-technology/interference-in-immunoassays [Accessed April 2018]

Bannister B, Gillespie SH, Jones J. Congenital and Perinatal Infections. In: Infection Microbiology and Management. 3rd ed. Australia: Blackwell Publishing; 2006: 344–358.

Demmler GJ. Cytomegalovirus. In: J Fletcher and M Dudlick. (eds.) Feigin & Cherry's Textbook of Pediatric Infectious Diseases. United States of America: Saunders Elsevier; 2009: 2023–2037.

Berglund L, Brunzell JD, Goldberg AC, Goldberg IJ, Sacks F, Murad MH et al. Evaluation and treatment of hypertriglyceridemia : an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012; 97(9):2969–89.


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