Question 7.1
The following image is of the blood sample tubes into which a specimen of blood from a critically ill patient had been drawn by the phlebotomist.
(a) What does this image show?
(b) List three (3) causes for this appearance in blood samples from critically ill patients.
(c) If the condition causing this appearance in the blood tubes were to be long standing, what clinical signs specific to this condition may be found in this patient?
College Answer
(a) What does this image show?
A creamy supernatant in blood tubes (serum and plasma) due to severe hypertriglyceridaemia (lipaemic serum).
(b) List three (3) causes for this appearance in blood samples from critically ill patients.
Familial hyperlipedemia
Propofol infusion
TPN use
Pancreatitis from hyperlipedemia
(c) If the condition causing this appearance in the blood tubes were to be long standing, what clinical signs specific to this condition may be found in this patient?
Eyes
- Lipaemia retinalis
- Corneal arcus senilis
- Xanthelasma
Skin
- Xanthomata
- Tendon
- Eruptive
Discussion
Of the ICU trainees, I am sure very few would have seen such a thing as this.
The specific "chicken fat" supernatant demonstrated in the college photograph is characteristic - that "cream" is all chylomicrons. In fact, this finding had in the olden days formed part of the classification of hyperlipidaemias- they used to observe "standing serum" to see if a supernatant would form. In the most severe forms of hyperlipidaemia, this fatty impurity can cause the blood to look milky and turbid.
There is little one can add to the college answer.
References
FREDRICKSON, DONALD S. "An international classification of hyperlipidemias and hyperlipoproteinemias." Annals of internal medicine 75.3 (1971): 471-472.
Aviram, Michael, Yael Sechter, and J. Gerald Brook. "Chylomicron-like particles in severe hypertriglyceridemia." Lipids 20.4 (1985): 211-215.