Lipemic specimens are a common and frequent, but yet unresolved problem in clinical chemistry, and may produce significant inter ferences in the. Evaluation of an automated chemiluminescent immunoassay for salivary cortisol measurement. Elevated bilirubin bilirubinemia and elevated lipids lipemia are common conditions that cause significant interferences with laboratory results. Effect of lipemia interferences in routine clinical. It uses chemical reactions to determine the levels of various chemical compounds in bodily fluids.
Fluorometry molecular luminescence spectroscopy measures the fluorescence or the energy emission that occurs when a certain compund absorb electromagnetic radiation, becomes excited and then returns to an energy level that is usually equal to or lower than original emitted light has longer wavelength than the incident. Clinical chemistry i introduction clinical chemistry is a very dynamic field of science. Hba1c platforms studied for lipemia interference cap today. The haemolytic, icteric and lipemic sample recommendations regarding their recognition and prevention of clinically relevant interferences. Specimen quality is extremely important for accurate results. Endogenous interferences in clinical laboratory tests. Some laboratories still use manual protocols with polyethylene glycol or. Chylomicrons are fat particles, 80500nm in diameter, that. Find this and other standards documents in the clsi shop. See section 6 for more detail about specific analytes. Pdf effects of lipemia on osmolality in native lipemic. Analysing the specimen once the form and specimen arrive at the laboratory reception, they are matched with a unique identifying number or bar code. For details on minimum fill volume requirements, refer to the operating instructions for your vitros chemistry system.
These effects can result in analyzers erroneously determining that insufficient sample is present or in pipetting inaccurate volumes of specimen. Lipemic spe diabetes mellitus, liver obs diseases involving lipid me endocrine disorders. Practices for identifying and rejecting hemolyzed specimens. Blood samples of lipemia caused by chylomicrons can be cleared using the lipemic serum clarification system from beckman coulter. Frequency and causes of lipemia interference of clinical chemistry. Lipemia and the cbc, immunohematology results medical. Retrospective study was done on the data from the core clinical laboratory at an academic medical center. Subcourses md0861 and md0863, clinical chemistry i and ii, address areas of particular importance in clinical chemistry and toxicology i dont. In this section, we will cover the effect of the three most common interferences in clinical pathologic testing, lipemia, hemolysis and icterus. Specimen collection and processing for clinical chemistry.
Ultracentrifugation has been by far the only reliable, but an unavailable and expensive, method to eliminate the lipemic effect. One is for a single blood specimen ordered to be drawn at a specific time. The other is for a test that may require multiple blood specimens to be collected at several specific times. The clinical laboratory management of lipemic specimens is not as well standardized as for hemolyzed specimens. This phenomenon causes the plasma or serum to appear turbid or milky. Usually, cell counts are performed next in hematology, followed by clinical chemistry testing.
Clinical chemistry is the branch of laboratory medicine that focuses primarily on molecules. Lastly, severely lipemic specimens are more prone to hemolysis. Clinical laboratories commonly encounter hemolyzed specimens which, if not managed appropriately, influence the reliability of patient results. Stabilized control materials must be at two different analytic levels ie, normal and high. National committee for clinical laboratory standards, procedures for the handling and processing of blood specimens, approved guideline, nccls. An internal quality control has to be performed daily. Lipemia interferences in routine clinical biochemical tests. Frequency and causes of lipemia interference of clinical. Powerpoint slide on clinical chemistry compiled by ashutosh singh. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Hemolysis, icterus, and lipemia turbidity indices as indicators of interference in clinical laboratory analysis. Lipemia interferences in routine clinical biochemical. Nov 01, 2004 q is it acceptable to clear lipemic serum in a highspeed centrifuge,000 rpm for 30 minutes seems to work well in order to produce more accurate chemistry results.
In this issue of clinical chemistry, bornhorst et al. Per institutional policy, the clinical laboratory called the ed regarding the test. Proposal of modified hilindices for determining hemolysis, icterus and lipemia interference on the beckman coulter au5800 automated platform yong kwan lim, m. Sep 26, 2016 blood samples of lipemia caused by chylomicrons can be cleared using the lipemic serum clarification system from beckman coulter. Erroneous laboratory results from hemolyzed, icteric, and. The percentages of samples with lipemia indices of 1, 2, and.
Some labs use ultracentrifuges for this purpose, but they require a large amount of serum and are not always reliable the specimen is often lost. Study 30 terms phlebotomy chapter 12 flashcards quizlet. Although certain proportion of the lipemic samples in the laboratory. The effect of these variables on clinical pathologic testing is method. Learn specimen collection clinical chemistry with free interactive flashcards. Blood samples for laboratory tests showed a significant lipemia figure, with com tg concentration of 12,355 mgdl.
Clinical biochemistry tests comprise over one third of all hospital laboratory. After hemolysis, lipemia is the most frequent endogenous interference that can influence results of various laboratory methods by. Specimen should be transported to the lab on wet ice within 5 minutes of collection. The following objectives are to be completed by the student for successful completion of this clinical rotation. Clarification of lipemic serum and removal of fatty particles. Erroneous laboratory results from hemolyzed, icteric, and lipemic specimens, clinical chemistry, volume 39, issue 1, 1 january 1993, page we use cookies to enhance your experience on our website. Buy c56a qg, examples of hemolyzed, icteric, and lipemic turbid samples quick guide, at clsi. Extraction of lipids from blood specimens with nhexane before coagulation testing has been described in the literature 1 but is not common practice in clinical laboratories.
Recommendations of the working group on preanalytical variables of the german society for clinical chemistry and the german society for laboratory medicine journal of laboratory medicine 2000. In reality, the lipemia index correlates weakly to the triglyceride. Pdf frequency and causes of lipemia interference of. Buy c56, hemolysis, icterus, and lipemia turbidity indices as indicators of interference in clinical laboratory analysis, from the official clsi shop. Submit a quantity of specimen sufficient to perform the test and avoid a qns quantity not sufficient, as indicated in the test requirements. Sources of biological variation, textbook of clinical chemistry, 2nd edition, w. Aug 23, 2019 clinical chemistry refers to the biochemical analysis of body fluids. The following specimen quality issues must be taken into consideration when drawing, storing and transporting blood specimens.
Laboratorygeneral specimen collection and handling. Lipemic specimens are common and frequent, but yet unresolved problem in clinical chemistry, and may produce significant interferences in the analytical results of different biochemical parameters. Glu instructions for use glucose testing procedure 4 pub. Jan 01, 2020 common biochemical tests affected by hemolyzed, lipemic and icteric samples and their mechanism of interference. The clinical biochemistry laboratory the use and the requirements of laboratory objective of the session 1. Procedures used in identification of hemolysis parameter participants total, no. The aim of this study was to examine the effect of lipid removal using ultracentrifugation. Certain disorders multiple myeloma, diabetes mellitus, acute pancreatitis, kidney failure, or hypothyreosis may also contribute to lipemia, as do certain drugs such as lasparaginase with a fat emulsion base. Full text of clinical chemistry 6th edition bishop see other formats.
Three levels of control is a conceptual carryover from clinical chemistry, and does not apply to hematology particle counting. There is also a quick summary of potential effects of these interferences on hematologic and clinical chemistry test results. Label a specimen correctly and provide all pertinent information required on the test request form. Review of interference indices in body fluid specimens. Clinical laboratory personnel modify patient results with quantitative estimates of hemolysis as an aid to physicians in. Feb 15, 2014 a clinical laboratory standards institute guideline clsi c56a hemolysis, icterus, and lipemiaturbidity indices as indicators of interference in clinical laboratory analysis gives detailed instructions of this practise.
Current knowledge in the field is reflected in the next two subcourses you are about to study. The specimen should be centrifuged, plasma aliquot removed to a plastic sample cup and tested within 20 minutes of collection. Specimens that cannot be tested immediately should be frozen. Blood is the most commonly used specimen for testing in the clinical laboratory. Automated chemistry analyzers determine lipemia on the basis of the absorbance at specific wavelengths following dilution of the sample. Microbiology, hematology, chemistry the microbial culture should be performed first to ensure that sterility of the specimen is not compromised. Laboratorygeneral specimen collection and handling guidelines page 3 of 49 specimen quality. Body fluids, defined as specimens other than plasma, serum, or urine, include cerebrospinal fluid csf, dialysate, postsurgical drain fluid, wound fluid, and other fluids often obtained using ultrasoundguided aspiration such as pancreatic, pericardial, and pleural fluid.
Our proposal outlined in the rest of this document, includes recommendations on. One of the requirements for a clinical laboratory is that common interferences related to sample integrity such as hemolysis, icterus, and lipemiaturbidity hil be evaluated with each reagent system. Handle all specimens as if you know them to be infectious. Lipemic indices were available for all chemistry specimens analyzed over a 16month period n552,029 specimens and for serumplasma triglycerides concentrations ordered for clinical. Laboratorygeneral specimen collection and handling guidelines. By continuing to use our website, you are agreeing to our use of cookies. Third, lipemic specimens can be nonhomogeneous, causing issues with how automated laboratory analyzers sense sample volume and pipettealiquot specimens. Clinicians depend on laboratories to detect these endogenous interferences. Lipemic indices were available for all chemistry specimens analyzed over a 16month period n552,029 specimens and for serumplasma triglycerides concentrations ordered for clinical purposes over a 16year period n393,085 specimens. Choose from 282 different sets of specimen collection clinical chemistry flashcards on quizlet. Thus, native lipemic patient samples have falsely low results for ceruloplasmin, prealbumin, and transferrin measured by immunoturbidimetry, whereas simulated lipemic samples prepared by adding intralipid do not.
Buy c56a qg, examples of hemolyzed, icteric, and lipemicturbid samples quick guide, at clsi. Evaluation of the performance of indexor in the archive unit of a clinical laboratory. In the clinical laboratory setting, interferences can be a significant source of laboratory errors with potential to cause serious harm for the patient. Therefore, very lipemic specimens should be manually prediluted 1. However, the laboratory staff will not label these specimens and will only proceed with testing in situations where specimen integrity may be compromised by a delay in processing. Dec 01, 2014 automated chemistry analyzers determine lipemia on the basis of the absorbance at specific wavelengths following dilution of the sample 1. All staff should adhere to the cdc guidelines for prevention of hiv infection in health care workers. Lipemia is the increased concentration of triglyceriderich lipoproteins in blood resulting in the cloudyturbid appearance of serum or plasma.
Consequently, laboratories must have robust, systematic processes in place for identifying these samples and for consistently quantifying the degree of hemolysis. Tests affected by hemolyzed, lipemic and icteric samples. To make the students aware of the basic setup of laboratory, the procedure for sample collection, separation to the analysis. Department of laboratory medicine, chungang university college of medicine, seoul, korea. In the clinical laboratory setting, interferences can be a significant source of. Rejection criteria nova scotia health authority corporate. Lipemic specimens are a common and frequent, but yet unresolved problem in clinical chemistry.
Among the daily samples, those with triglyceride 400 mgdl 4. An identification waiver form provided by the laboratory must be completed and signed by the individual responsible for collection of the specimen prior to specimen. Analysis of hemolysis, icterus and lipemia in arterial blood gas specimens. The clinical biochemistry laboratory the use and the. Clarification of lipemic serum and removal of fatty. For chemistry profiles, 12 to 14hour fasting specimens are recommended. Initial laboratory tests were cancelled due to a high lipemic index of 7 beckman. Moreover, type of samples, analytical techniques and clinical implications are considerably different. Endogenous compounds can interfere with laboratory tests, decreasing accuracy and threatening patient safety. The au5800 analyzer is also able to detect hemolysis, icterus, and lipemia in samples. Jan 05, 2016 hemolysis on clinical specimens hemolysis due to the breakdown of red blood cells is essential to the laboratory because it can have an effect on laboratory results. The effects can be the result of products liberated from the red cells themselves, or due to interferences with laboratory analyzers. Lipemic indices were available for all chemistry specimens analyzed over a 16 month period n552,029 specimens and for serumplasma triglycerides.
Practical recommendations for managing hemolyzed samples in. We have investigated influence of intralipid induced lipemia on several clinical chemistry tests using reagents and analytical platforms from three manufacturers cobas 6000 by roche, au680 by beckman coulter and dimension vista system by siemens. The simplest recommendation is to encourage fasting collection. The contaminated area is cleaned with a solution of sodium hypochlorite bleach. The objectives within the psychomotor domain will be achieved by practice and evaluated through demonstration by the student. The number reported under lipemia on our chemistry reports is a measure of the lipid content of the plasma. Hemolysis, icterus, and lipemiaturbidity indices as. One of the requirements for a clinical laboratory is that common interferences related to sample integrity such as hemolysis, icterus, and lipemia turbidity hil be evaluated with each reagent system. The beckman coulter au5800 clinical chemistry analyzer beckman coulter, brea, ca, usa is a novel fully automated analytical platform designed for the analysis of routine chemistry assays, immunoassays, and therapeutic drugs. Lipemic indices were available for all chemistry specimens analyzed over a 16month period n552,029 specimens and for serumplasma triglycerides concentrations ordered for clinical purposes.
Lipemia most often results from specimens collected soon after an individual has had a particularly fatty meal. Lipemia is the presence of excess lipids or fats in the bloodstream. Lipemia interferences in biochemical tests, investigating. Lipemic specimens are a common and frequent, but yet unresolved problem in clinical chemistry, and may produce significant interferences in the analytical results of different biochemical parameters. Falsepositive results with this method are possible. If the lipemia is likely due to recent intravenous infusion of a lipid emulsion, then phlebotomy of future specimens can be coordinated to be as long as possible from the. There are a variety of methods to assess lipemia in laboratory samples. Analytical testing on body fluid specimens is a challenging aspect of clinical chemistry. The laboratorys role in identifying lipid and lipoprotein risk factors for chd. Specimens with an exceptionally high triglyceride concentration 3000 mgdl may produce a normal result. With the advent of automated hemolysis detection using.
Hemolysis and lipemia interference with laboratory testing. Tests affected by hemolyzed, lipemic and icteric samples and. For some of the tested parameters, the direction and the extent of lipemia interference. The tests in a clinical chemistry laboratory measure concentrations of biologically important ions salts and minerals, small organic molecules and large macromolecules primarily proteins. Lipemic specimens are a common and frequent, but yet unresolved problem in clinical chemistry, and may produce significant interferences in the analytical results of different biochemical. Little information regarding the handling of lipemic specimens is available.
Effects of lipemia on osmolality in native lipemic material and intravenous lipid emulsion added sera article pdf available in clinical chemistry and laboratory medicine 533 september 2014. To view a list of clsi documents helpful for covid19 testing click here. Absorbances due to hemoglobin, icteric bilirubin and lipemia may be. Pdf frequency and causes of lipemia interference of clinical.
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