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

Area of Science:

• Clinical Chemistry
• Hematology
• Oncology

Background:

• Routine laboratory testing is crucial for patient diagnosis and management.
• Spectrophotometric assays can be affected by interfering substances like hemolysis, icterus, and lipemia.
• High lipemia index readings can falsely suggest interference, complicating accurate biochemical measurements.

Observation:

• A 65-year-old female presented with a high lipemia index during routine testing, despite visually clear plasma.
• Standard blood glucose measurement via hexokinase method was impeded by this unexpected interference.
• Further investigation revealed normal triglyceride levels, ruling out true lipemia.

Findings:

• Serum protein electrophoresis and immunofixation identified a monoclonal IgM kappa gammopathy.
• Myelogram confirmed Waldenstrom macroglobulinemia with significant plasmacyte, lymphoplasmacytic, and mast cell infiltration.
• The monoclonal protein itself caused turbidity, mimicking lipemia and interfering with spectrophotometry.

Implications:

• This case underscores the need to consider monoclonal gammopathies when encountering a high lipemia index with clear plasma.
• A proposed diagnostic algorithm can guide clinicians in differentiating true lipemia from protein-induced turbidity.
• Accurate diagnosis and management of Waldenstrom macroglobulinemia are critical for patient outcomes.