Lipoprotein-X and Lipoprotein-Z Induced Hyperviscosity Syndrome in the Setting of Cholestatic Liver Failure

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  Figure 1. Spectral Deconvolution Analysis Lipid Methyl Signal Region of the Serum NMR Spectrum Obtained From the Patient’s First Visit Spectral deconvolution analysis was performed using models (A) without and (B) with inclusion of reference signals for lipoprotein X (LP-X) (broad signal centered at 0.84 ppm obtained from a synthetic preparation of LP-X) and LP-Z (sharp multiple centered at 0.80 ppm obtained from isolated LP-Z7), in addition to those of the constituent proteins and lipoproteins. The presence of substantial amounts of LP-X and LP-Z in the specimen is indicated by mismatched measured (orange) and calculated (black) serum signals in A and near superposition of measured and calculated serum signals in B. Subsequent visit analysis revealed no changes in spectral deconvolution despite the inclusion or omission of LP-X and LP-Z reference signals, reflecting the absence of these lipoproteins.