In addition to ultracentrifugation, Soleimani, Mohammadzadeh, and Asadian (2020) suggest the following additional elimination techniques: lipid extraction; sample dilution; and serum blank. They have suggested using serum blanks for samples that will be utilized to measure glucose, GGT, creatinine, albumin, CPK, and amylase as serum blanks eliminate the need for ultracentrifugation in cases of low degrees of lipemia.

For laboratories encountering cases of lipemia, specifically in the moderate to severe lipemic levels, ultracentrifugation is still the optimum removal technique for lipemic samples used for assessment of calcium, magnesium, phosphorus, total protein, iron, TIBC, urea, and chloride.

Reference:

• Soleimani, N., Mohammadzadeh, S., & Asadian, F. (2020). Lipemia interferences in biochemical tests, investigating the efficacy of different removal methods in comparison with ultracentrifugation as the gold standard. Retrieved from Journal of Analytical Methods in Chemistry, 2020, 1-6. https://doi.org/10.1155/2020/9857636

Ultracentrifugation can be replaced for some analytes by high-speed centrifugation or lipid-clearing agents. To enable the analysis and interpretation of various lipemic interference experiments' collected data, standardized methodologies and acceptability standards are necessary.

High-speed centrifugation (10,000×g for 15 minutes) can be used instead of ultracentrifugation to remove lipemia in serum/plasma samples. LipoClear and 1,1,2-trichlorotrifluoroethane are unsuitable as they interfere with the measurement of certain parameters (Maria Castro et al., 2018).

References :

Castro, M., Estébanez, B. et al. ( November 2018). Removing Lipemia in Serum/Plasma Samples: A Multicenter Study. Retrieved February 23, 2023 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056396/

Soh,S., Loh T., et al. ( November 15, 2021 ). Methods to reduce lipemic interference in clinical chemistry tests : a systematic review and recommendations. Retrieved February 23, 2023 from https://pubmed.ncbi.nlm.nih.gov/34773729/

The lipemic sample can be removed with the use of high-speed centrifugation of 10,000xg for 15 minutes. LipoClear and 1,1-2-tricholotrifluorethane are unsuitable for lipemic removal as they may interfere with the measurements.

Based on studies, commercial chemical agents and dilution methods posses risks that may affect the results.

Castro, M., Estébanez, B. et al. ( November 2018). Removing Lipemia in Serum/Plasma Samples: A Multicenter Study. Retrieved February 23, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056396/

ThermoFisherScientificInc. (2021) Lipemia removal in serum samples by centrifugation. Retrieved February 23, 2023, from https://assets.thermofisher.com/TFS-Assets/LPD/Application-Notes/LipemiaSample-AppNote-Global.pdf

It is essential to remove lipemia using an appropriate technique. CLSI recommends sample ultracentrifugation as the method of choice. However, due to their expensive cost, many laboratories lack the necessary equipment.

According to Dimeski and Jones (2011), the procedure utilized in this study using a high speed micro-centrifuge showed it is effective in reducing lipid levels and produce a suitable alternative to ultracentrifuged samples to provide accurate analytical results. This procedure may serve as a standardized guideline in laboratories with high speed micro-centrifuges to improve the handling of lipaemic samples and minimise analytical errors.

References:

Castro, M., Estébanez, B. et al. (November 2018). Removing Lipemia in Serum/Plasma Samples: A Multicenter Study. Annals of Laboratory Medicine, 38(6), 518–523. https://doi.org/10.3343/alm.2018.38.6.518

Dimeski, G., & Jones, B. (2011). Lipaemic samples: Effective process for lipid reduction using high speed centrifugation compared with ultracentrifugation. Biochemia Medica, 86–94. https://doi.org/10.11613/bm.2011.016