Zhao Xi-Chen, Ju Bo, Wei Na, Ding Jian, Meng Fan-Jun, Zhao Hong-Guo
Department of Hematology, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China.
Department of Clinical Laboratory, The Central Hospital of Qingdao West Coast New Area, Qingdao 266555, Shandong Province, China.
World J Clin Cases. 2020 Oct 6;8(19):4595-4602. doi: 10.12998/wjcc.v8.i19.4595.
Severe hyperlipemia (SHLE) has an impact on the results of many kinds of laboratory tests. Complete blood count (CBC) examination by automated blood cell counter (ABCC) is a quick and convenient measurement for screening abnormalities of blood cells that are triggered by various pathogenic insults in disease diagnosis and for monitoring changes in the treatment of existing hematological conditions. However, CBC results are frequently affected by many intrinsic and extrinsic factors from blood samples, such as in the setting of hypergammaglobulinemia and certain anticoagulants. SHLE could also affect CBC results.
A 33-year-old Chinese male presented with painful foot numbness and abdominal pain. He was initially misdiagnosed as having a myeloproliferative neoplasm (MPN) because of the marked abnormalities in CBC examination by the ABCC. Morphological evaluation of the bone marrow smears and biopsy showed no evidence of MPN. Gene mutations in (), (), (), (), and () were negative. Having noticed the thick chylomicron layer on blood samples and the dramatically fluctuating CBC results, we speculated that the fat droplets formed by shaking the blood samples in the setting of SHLE were mistakenly identified as blood cells due to the limited parameters of ABCC. Therefore, we removed a large part of the chylomicron layer and then reexamined the CBC, and the CBC results, as we expected, differed significantly from that of the sample before the chylomicron layer was removed. These significant differences had been validated by the subsequently repeated laboratory tests by measuring dual blood samples that the chylomicron layer was removed in one sample and was not in another, and comparing the CBC results. Computerized tomography reexamination of the upper abdomen revealed an exudative lesion surrounding his pancreas. After intensive consultation, definitive diagnosis was made as recurrent pancreatitis, hyperlipemia and pseudoerythrocytosis.
SHLE may become a potential cause of misdiagnosis of hyperlipemia-related diseases as MPNs and the resultant mistreatment. It may also lead to the misinterpretation of transfusion indications in patients with hematological disorders who critically need blood transfusion for supportive treatment.
严重高脂血症（SHLE）会影响多种实验室检查结果。通过自动血细胞计数器（ABCC）进行全血细胞计数（CBC）检查是一种快速便捷的检测方法，可用于筛查疾病诊断中由各种致病因素引发的血细胞异常情况，并监测现有血液系统疾病治疗过程中的变化。然而，CBC结果经常受到血液样本中许多内在和外在因素的影响，例如在高球蛋白血症和某些抗凝剂的情况下。SHLE也可能影响CBC结果。
一名33岁中国男性因足部疼痛性麻木和腹痛就诊。由于ABCC进行的CBC检查结果明显异常，他最初被误诊为骨髓增殖性肿瘤（MPN）。骨髓涂片和活检的形态学评估未发现MPN证据。（）、（）、（）、（）和（）的基因突变均为阴性。注意到血液样本上有厚厚的乳糜微粒层以及CBC结果大幅波动后，我们推测在SHLE情况下摇晃血液样本形成的脂肪滴由于ABCC参数有限而被误识别为血细胞。因此，我们去除了大部分乳糜微粒层，然后重新检查CBC，正如我们所预期的，CBC结果与去除乳糜微粒层之前的样本结果有显著差异。通过测量一个样本去除乳糜微粒层而另一个样本未去除乳糜微粒层的双份血液样本并比较CBC结果，随后的重复实验室测试验证了这些显著差异。上腹部计算机断层扫描复查显示其胰腺周围有渗出性病变。经过深入会诊，最终诊断为复发性胰腺炎、高脂血症和假性红细胞增多症。
SHLE可能成为将高脂血症相关疾病误诊为MPN并导致不当治疗的潜在原因。它还可能导致急需输血进行支持治疗的血液系统疾病患者的输血指征被误判。
