Masson Pauline, Chutova Ecaterina, Oris Charlotte, Dannus Louis-Thomas, Sapin Vincent, Bouvier Damien
Service de biochimie et génétique moléculaire, CHU Clermont-Ferrand, France
Service médical aval des urgences, CHU Clermont-Ferrand, France
Ann Biol Clin (Paris). 2022 Sep 1;80(5):487-493. doi: 10.1684/abc.2022.1752.
A 65-year-old female was admitted to the Emergency Department for a fall. Upon admission, a blood sample was drawn for routine laboratory tests. Blood glucose measurement using the hexokinase method was made impossible due to a high lipemia index measured by the instrument despite a clear plasma specimen. It is well known that hemolysis, icterus, and lipemia interferences disrupt spectrophotometric quantifications. However, in this case, the absence of lipemia was confirmed by plasma triglycerides measurement in the normal reference range. Protein electrophoresis along with an immunofixation were carried out to characterize a monoclonal gammopathy since the presence of a monoclonal gammopathy in very high concentrations generates turbidity and interferes with spectrophotometric assays. A gamma peak evoking a monoclonal gammopathy was found on the serum electrophoresis and the immunofixation was positive for a monoclonal IgM kappa. Myelogram showed plasmocytes, lymphoplasmacytic cells and mast cells infiltration which led to the diagnosis of Waldenstrom macroglobulinemia. Based on this case, we propose a course of action to be taken in the case of a high lipemia index and clear plasma.
一名65岁女性因跌倒被送往急诊科。入院时，采集血样进行常规实验室检查。尽管血浆标本清晰，但仪器测得的血脂指数较高，导致无法使用己糖激酶法进行血糖测量。众所周知，溶血、黄疸和血脂干扰会破坏分光光度法定量。然而，在这种情况下，通过血浆甘油三酯测量证实血脂在正常参考范围内。由于高浓度单克隆丙种球蛋白病的存在会产生浊度并干扰分光光度法检测，因此进行了蛋白质电泳及免疫固定电泳以鉴定单克隆丙种球蛋白病。血清电泳发现一个提示单克隆丙种球蛋白病的γ峰，免疫固定电泳显示单克隆IgM κ阳性。骨髓检查显示浆细胞、淋巴浆细胞和肥大细胞浸润，从而诊断为华氏巨球蛋白血症。基于此病例，我们提出了在血脂指数高且血浆清晰的情况下应采取的行动方案。
