Lipemia-Induced Hemoglobin Overestimation and Correction by Plasma Replacement in a Pediatric Acute Lymphoblastic Leukemia Patient.

BACKGROUND

Pre-analytical and analytical errors in laboratory testing can lead to clinical misinterpretation. This case highlights a falsely elevated hemoglobin level due to lipemia and the corrective laboratory intervention.

CASE: A 3-year-7-month-old girl with acute lymphoblastic leukemia underwent a follow-up complete blood count which reported a hemoglobin level of 16.9 g/dL. The hemoglobin result was inconsistent with previous clinical findings and hematocrit. A simultaneously drawn venous blood gas sample showed a hemoglobin value of 9.2 g/dL. The biochemistry sample showed visible lipemia, with a lipemia index of 3041. The same sample revealed a triglyceride level of 8042 mg/dL (1:50 dilution) and total cholesterol of 492.2 mg/dL. These findings indicated a falsely elevated hemoglobin due to lipemia. The patient was not on parenteral nutrition. Pediatric endocrinology consultation attributed lipemia to L-asparaginase and corticosteroids in the treatment regimen. To eliminate lipemic interference, the EDTA blood sample was centrifuged at 1000 x g for 10 minutes, and the lipemic plasma was replaced with an equal volume of 0.9% NaCl solution. The sample was gently mixed to restore whole blood integrity. After this plasma replacement procedure, hemoglobin was measured as 10.2 g/dL, consistent with the blood gas result and clinical picture.

CONCLUSION

This case emphasizes the need to correlate laboratory results with clinical and biochemical data. In lipemic samples, plasma replacement may provide a practical correction method for falsely elevated hemoglobin values when resampling is not feasible. Recognition and prompt correction of lipemia-induced errors are crucial to avoid inappropriate clinical decisions.