Waldenstrom’s macroglobulinemia highlighted by turbidity interference: a case report

A 65-year-old female was admitted to the Emergency Department for a fall. Upon admission, a blood sample was drawn for routine laboratory tests. Blood glucose measurement using the hexokinase method was made impossible due to a high lipemia index measured by the instrument despite a clear plasma specimen. It is well known that hemolysis, icterus, and lipemia interferences disrupt spectrophotometric quantifications. However, in this case, the absence of lipemia was confirmed by plasma triglycerides measurement in the normal reference range. Protein electrophoresis along with an immunofixation were carried out to characterize a monoclonal gammopathy since the presence of a monoclonal gammopathy in very high concentrations generates turbidity and interferes with spectrophotometric assays. A gamma peak evoking a monoclonal gammopathy was found on the serum electrophoresis and the immunofixation was positive for a monoclonal IgM kappa. Myelogram showed plasmocytes, lymphoplasmacytic cells and mast cells infiltration which led to the diagnosis of Waldenstrom macroglobulinemia. Based on this case, we propose a course of action to be taken in the case of a high lipemia index and clear plasma.