As per my opinion, It is always best that you should not perform the test from lipemic sample. What we can do if sample come for lipid profile? still by lipid precipatating agents u can precipitate Tg and than you can perform the Test. This is my opinion only. But the best answer is - "AVOID USE OF LIPEMIC SAMPLES"

the best solution is high speed centrifugation (do not wait too long  as the lipid particles have a tendency to become smaller)

another alternative is extraction with Lipoclear (but this may result in an extraction /denaturaion of some compounds)

I think that the best way to work with a lipemic serun samples is high speed centrifugation

A few points here.

1. Not analysing such specimens can be clinically inappropriat. What do we tell the patient with potential pancreatitis, came back in a week when they might be dead?

2. Some solvents are not allowed/available on health and safety grounds. How many have been compared to the gold standard of high speed centrifugation?

3. Lipoclear is available but again there is limited data available compared to high speed centrifugation.

Hujjjjjjj4. Polyethylene glycol produces similar results to Lipoclear apart from bicarbonate if my memory is correct when we checked this many years ago.

5. Availability of any of the above when you have lipaemia is important and a protocol to follow!

6. Investigation and treatment are important! The highest triglyceride that I saw in a patient was 180 mmol/L. As a Chemical Pathologist, I was lucky enough to also have treated him (diagnosing his diabetes and treating this and his dyslipidaemia at our clinic next day).

Thank you for your answer, Patrick. I agree with you in the need to have a protocol for this type of samples. The results obtained would be very useful for the patients health.

After our minicentrifuges reach 10 000 g centrifugation of serum/plasma for 10 min at this speed is sufficient in most cases. Before lipids and other requested lipophile molecules should be tested (drugs), because they tend to accumulate in the lipid phase.

Ref. Quality of Diagnostic Samples third ed 2010, Oxford BD, pp 24-27.

I would always vote for high-speed centrifuge. For drugs, either dilute or do in lipemic serum (but be sure that lipemia is not interferring). Test electrolytes by using direct ISE method.

High speed micro-centrifuge is effective in reducing lipids and provides a suitable alternative to ultracentrifuged samples to provide accurate results. This was studied by Dimeski and Jones in: Dimeski G, Jones BW. Lipaemic samples: Effective process for lipid reduction using high speed centrifugation compared with ultracentrifugation. Biochemia Medica 2011;21(1):86-94.  http://dx.doi.org/10.11613/BM.2011.016

Also, please be aware that manufacturer's declarations about interfering effect of lipemia are not correct and certainly not always useful. We have investigated this for three big IVD companies. :-((( 

See more at: Nikolac N, Simundic AM, Miksa M, Lima-Oliveira G, Salvagno GL, Caruso B, Guidi GC. Heterogeneity of manufacturers' declarations for lipemia interference--an urgent call for standardization. Clin Chim Acta. 2013;426:33-40. 

Finally, one very nice paper summarizing all about lipemia: Nora Nikolac. Lipemia: causes, interference mechanisms, detection and management. Biochemia Medica 2014;24(1):57-67. http://dx.doi.org/10.11613/BM.2014.008

We do prefer high speed centrifugation.

Additionally use of lipoclear, or in some cases diluition with phosphate buffered saline may be an option.

The best method for clarifying strongly lipemic serum is the Beckman Coulter's Lipemic Serum Clarification System. This is an exceedingly straightforward and rapid, offers an excellent solution. The device uses a desktop Air Fuge Ultracentrifuge and a customized rotor with disposable liners to finish the task in 10 minutes. The Beckman Coulter Lipemic Serum Clarification System can clear blood samples of lipemia brought on by chylomicrons. Chylomicrons are fat particles with a diameter of 80–500 nm that have an impact on the accuracy of spectrophotometric analysis findings. Moreover, clarifying lipemic serum by centrifuging an aliquot of it while a layer of a solvent designed to dissolve fat adheres centripetally to it can also be utilized. The test tube and its contents can then be centrifuged for at least five minutes at a relative centrifugal field (RCF) of around 1500. Of course, the minimum centrifugation time needed depends on how much lipemia needs to be eliminated.

Source: Coulter, Beckman. “Clarification of Lipemic Serum and Removal of Fatty Particles Using Beckman Coulter Airfuge Ultracentrifuge.” News-Medical.net, 26 Sept. 2016, www.news-medical.net/whitepaper/20160926/Clarification-of-Lipemic-Serum-and-Removal-of-Fatty-Particles-Using-Beckman-Coulter-Airfuge-Ultracentrifuge.aspx. Accessed 13 Sept. 2022.