Comparison of lipemia interference created with native lipemic material and intravenous lipid emulsion in emergency laboratory tests

Abstract

Graphical abstract Highlights • After hemolysis and icterus, lipemia is one of the most common errors encountered in the preanalytical phase • Mimicking lipemia is more challenging than other interference types because of the heterogenous property of lipids • Intravenous lipid emulsions are not sufficient for mimicking lipemia • Since almost all companies use intravenous lipid emulsion in lipemia interference studies, the results of these studies must be interpreted carefully by the laboratory experts IntroductionThis study aimed to investigate the effects of lipemia on clinical chemistry and coagulation parameters in native ultralipemic (NULM) and intravenous lipid emulsion (IVLE) spiked samples. Materials and methodsThe evaluation of biochemistry (photometric, ion-selective electrode, immunoturbidimetric method), cardiac (electrochemiluminescence immunoassay method) and coagulation (the viscosity-based mechanical method for prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen and the immunoturbidimetric method for D-dimer) parameters were conducted. In addition to the main pools, five pools were prepared for both types of lipemia, each with triglyceride (TG) concentrations of approximately 2.8, 5.7, 11.3, 17.0 and 22.6 mmol/L. All parameters’ mean differences (MD%) were presented as interferographs and compared with the desirable specification for the inaccuracy (bias%). Data were also evaluated by repeated measures of ANOVA. ResultsProthrombin time and APTT showed no clinically relevant interference in IVLE-added pools but were negatively affected in NULM pools (P < 0.001 in both parameters). For biochemistry, the most striking difference was seen for CRP; it is up to 134 MD% value with NULM (P < 0.001) at the highest TG concentration, whereas it was up to - 2.49 MD% value with IVLE (P = 0.009). Albumin was affected negatively upward of 5.7 mmol/L TG with IVLE, while there was no effect for NULM. Creatinine displayed significant positive interferences with NULM starting at the lowest TG concentration (P = 0.028). There was no clinically relevant interference in cardiac markers for both lipemia types. ConclusionsSignificant differences were scrutinized in interference patterns of lipemia types, emphasizing the need for careful consideration of lipemia interferences in clinical laboratories. It is crucial to note that lipid emulsions inadequately replicate lipemic samples.