Severe hypertriglyceridemia caused lipemia-induced analytical interference resulting in a spuriously infinite prothrombin time, which was identified via mixing study.
Case Report (n=1)
Severe hypertriglyceridemia can cause lipemia-induced analytical interference in routine laboratory assays, such as coagulation parameters, which must be recognized to avoid misdiagnosis and enable timely management.
BACKGROUND: Severe hypertriglyceridemia can cause significant metabolic complications and spurious laboratory results, complicating clinical decision-making. Chylomicronemia syndromes, particularly multifactorial forms, are underrecognized, and may present with both pancreatitis and premature atherosclerotic cardiovascular disease. CASE SUMMARY: A 51-year-old man with diabetes and hypertension presented with chest pain and recent hypertriglyceridemia-induced normoenzymatic pancreatitis. Ischemic electrocardiographic changes prompted coronary angiography. Preprocedural testing showed a prothrombin time reported as "infinite" (no clot detected). Serum appeared grossly lipemic (triglycerides 4,038 mg/dL) with a creamy supernatant after centrifugation. Mixing study revealed normal coagulation parameters, confirming analytical interference rather than true coagulopathy. The combination of severe hypertriglyceridemia, relatively preserved apolipoprotein B, and multisystem manifestations favored a chylomicronemia phenotype (type IV-V spectrum). Coronary angiography confirmed obstructive disease, and following triglyceride-lowering therapies, successful percutaneous coronary angioplasty was performed. DISCUSSION: This case highlights the multisystem impact of severe hypertriglyceridemia and the importance of recognizing lipemia-related laboratory artifacts to avoid misdiagnosis and enable timely management. TAKE-HOME MESSAGES: Severe hypertriglyceridemia reflects a spectrum of triglyceride-rich lipoprotein disorders, often with combined chylomicron and very-low-density lipoproteins excess due to genetic-environmental interactions. Lipemia, associated with severe hypertriglyceridemia, may interfere with routine laboratory assays, leading to spurious results posing significant diagnostic and therapeutic challenges.
Kaur et al. (Mon,) conducted a case report in Severe hypertriglyceridemia with lipemia-induced analytical interference (n=1). Triglyceride-lowering therapies and percutaneous coronary angioplasty was evaluated. Severe hypertriglyceridemia caused lipemia-induced analytical interference resulting in a spuriously infinite prothrombin time, which was identified via mixing study.