GPR: 2020 - Week 46

From MGH Learn Pathology

Clinical history



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Normal – Lipemic – Icteric – Hemolyzed
  • Yellow-light green, clear-semi-opaque




  • “Milky” (lipids)
  • Causes include post-meal sampling, diabetes and pancreatitis
  • Turbidity does not correlate well with triglyceride concentration
  • May cause interference due to physical/chemical interactions




  • Green-orange/yellow-brown pigment (bilirubin)
  • Visual inspection subjective and highly variable
  • Causes include liver/biliary disease and Gilbert’s syndrome
  • May cause interference through light absorbance




  • Pink-tinged – Red (hemoglobin)
  • Causes can be in vivo (hemolysis or mechanical) or in vitro (sample handling/collection)
  • Visual inspection can be unreliable, but useful for identifying gross hemolysis
  • May cause interference through release of cellular components
  • Walter “Sunny” Dzik, M.D
  • Kyleigh Getchell
  • [1] Twomey P.J., Don-Wauchope A.C., McCullough D. Unreliability of triglyceride measurement to predict turbidity induced interference. J Clin Pathol. 2003;56(11):861–862.
  • [2] Kroll M., McCudden C. De Gruyter; Berlin: 2013. Endogenous Interferences in Clinical Laboratory Tests.
  • [3] Nikolac N. Lipemia: causes, interference mechanisms, detection and management. Biochem Med (Zagreb). 2014;24(1):57–67. Published 2014 Feb 15. doi:10.11613/BM.2014.008
  • [4] Icteric index and its significance Dr. Usha Sachidananda Adiga, International Journal of Medical and Health Research ISSN: 2454-9142, Impact Factor: (RJIF 5.54) Volume 2; Issue 4; April 2016; Page No. 32-34
  • [5] Icteric plasma suggests Gilbert’s syndrome in the blood donor. Naiman JL, Sugasawara EJ, Benkowsky SL, Mailhot, Transfusion 1996 Nov-Dec; 36(11-12):974-8
  • [6] 3. Simundic AM., Nikolac N., Ivankovic V., Ferenec-Ruzic D., Magdic B., Kvaternik K., et al. Comparison of visual vs. Automated detection of lipemic, icteric and hemolyzed specimens. Can we rely on a human eye? Clin Chem Lab Med. 2009;47 (11):1361-1365
  • [7] Wan Azman WN, Omar J, Koon TS, Tuan Ismail TS. Hemolyzed Specimens: Major Challenge for Identifying and Rejecting Specimens in Clinical Laboratories. Oman Med J. 2019;34(2):94–98. doi:10.5001/omj.2019.19
  • [8] Heireman L, Van Geel P, Musger L, et al. Causes, consequences and management of sample hemolysis in the clinical laboratory. Clinical Biochemistry. 2017 Dec;50(18):1317-1322. DOI: 10.1016/j.clinbiochem.2017.09.013.

This week's Gross Pathology Roundup was presented by Jakob Moran MD on 2020-11-09.