LAUSR

A 44-year-old G6P3 female at 25 weeks gestational age was transferred to our tertiary care center for threatened preterm birth and a stat cesarean section was performed upon presentation for abnormal fetal tracing. A group and screen specimen was found to be grossly lipemic (Figure 1). Intraoperatively, the on-call obstetrician made note of thick, oily, and milky appearing blood at the surgical and venipuncture sites. On the group and screen testing by gel, the reverse typing and antibody screen could not be read by the OrthoVision analyzer. (Figures 2A and 2B). As per our institution's policy, if there is interference detected due to lipemia on the automated analyzer, the results are repeated by tube testing and interpreted manually. The gel cards were manually read and testing using saline IAT confirmed the patient's blood group and negative antibody screen. The patient had an oral glucose tolerance test the day prior, which was suspected to have precipitated diabetic ketoacidosis (DKA) and exacerbated her underlying hypercholesterolemia. Post-operative bloodwork demonstrated an elevated triglyceride level at 154.8 mmol/L, which had been normal at 2.6 mmol/L 2 months prior. Sample interferences such as gross lipemia, hemolysis, and icterus can lead to erroneous results and delays in blood product administration. Gross lipemia can be due to sample collection shortly after parenteral administration or eating a large meal, underlying disease states (diabetes mellitus, pancreatitis, chronic kidney disease), and propofol infusions. In addition, interference of gel testing may be due to the presence of excess paraproteins, fibrin, cold-reacting antibodies, particulate matter in the plasma, and in this case, lipemia. Grossly hemolyzed or icteric samples may also lead to difficulties in interpretation of results. This was the first presentation of DKA and hypertriglyceridemia in a pregnant patient with no history of diabetes after an oral glucose challenge test. This acute FIGURE 1 Patient sample demonstrating gross lipemia after centrifugation Received: 10 December 2021 Revised: 18 August 2022 Accepted: 20 August 2022