Spurious dyslipidemia due to paraprotein in a patient with Waldenström macroglobulinemia.

Autor: Zhao Y; Department of Laboratory Medicine, West China Hospital, Sichuan University; Sichuan Clinical Research Center for Laboratory Medicine, and Clinical Laboratory Medicine Research Center of West China Hospital, Chengdu 610041, China. Electronic address: zhaoyanhau527@163.com., Zhang H; Department of Laboratory Medicine, West China Hospital, Sichuan University; Sichuan Clinical Research Center for Laboratory Medicine, and Clinical Laboratory Medicine Research Center of West China Hospital, Chengdu 610041, China. Electronic address: zhangheyq@163.com., Liang S; Department of Laboratory Medicine, West China Hospital, Sichuan University; Sichuan Clinical Research Center for Laboratory Medicine, and Clinical Laboratory Medicine Research Center of West China Hospital, Chengdu 610041, China. Electronic address: liangshangshan0101@163.com., Wang Y; Department of Laboratory Medicine, West China Hospital, Sichuan University; Sichuan Clinical Research Center for Laboratory Medicine, and Clinical Laboratory Medicine Research Center of West China Hospital, Chengdu 610041, China. Electronic address: 13882377998@163.com., Gan W; Department of Laboratory Medicine, West China Hospital, Sichuan University; Sichuan Clinical Research Center for Laboratory Medicine, and Clinical Laboratory Medicine Research Center of West China Hospital, Chengdu 610041, China. Electronic address: 2004ganwei@scu.edu.cn.
Jazyk: angličtina
Zdroj: Clinica chimica acta; international journal of clinical chemistry [Clin Chim Acta] 2024 Sep 15; Vol. 563, pp. 119900. Date of Electronic Publication: 2024 Aug 05.
DOI: 10.1016/j.cca.2024.119900
Abstrakt: Introduction: Serum lipid profiles play a crucial role in diagnosing and evaluating cardiovascular diseases. However, the presence of paraprotein can lead to inaccurate dyslipidemia results on automated analyzers.
Case Report: A 65-year-old woman whose combined concentrations of HDL-cholesterol (HDL-C) and LDL-cholesterol (LDL-C) consistently surpassed her total serum cholesterol levels over a period of three months presented with unusual lipid component detection. Further analysis revealed the presence of a monoclonal paraprotein, identified as an IgMλ band, with a concentration of 28.0 g/L. The patient was subsequently diagnosed with Waldenström macroglobulinemia. The use of abnormal reaction kinetic curves and the β quantification method, along with an alternative method that did not suffer from interference, revealed that the monoclonal paraprotein interfered with the measurements of HDL-C, LDL-C, apolipoprotein A-I (apoA-I), and apolipoprotein B (apoB) when using the Roche detection system. This interference led to spurious elevated HDL-C concentrations and falsely decreased apoA-I and apoB concentrations, while the LDL-C results were minimally affected. Although diluting the sample normalized the HDL-C and LDL-C measurements, the interference with the apoA-I and apoB assays persisted. No other common biochemical tests were interfered with this paraprotein.
Conclusion: Caution is advised when using a homogenous method for direct measurement of HDL-C and LDL-C in patients with monoclonal paraprotein. Techniques to recognize and eliminate this interference are available. However, immunoturbidimetric detection of apoA-I and apoB levels is also susceptible to this interference, which is not readily removable.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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