Hindawi

Journal of Analytical Methods in Chemistry

Volume 2020, Article ID 9857636, 6 pages
https://doi.org/10.1155/2020/9857636

Research Article
Lipemia Interferences in Biochemical Tests, Investigating the
Efficacy of Different Removal Methods in comparison with
Ultracentrifugation as the Gold Standard

Neda Soleimani ,1 Sahand Mohammadzadeh ,1 and Fateme Asadian2

1
Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
2
Department of Medical Laboratory Sciences, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

Correspondence should be addressed to Sahand Mohammadzadeh; [email protected]

Received 14 November 2019; Accepted 21 January 2020; Published 12 February 2020

Academic Editor: Boryana M. Nikolova-Damyanova

Copyright © 2020 Neda Soleimani et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Introduction. As a common interferer in clinical chemistry, lipemic specimens could be a source of significant analytical errors.
Ultracentrifugation has been by far the only reliable, but an unavailable and expensive, method to eliminate the lipemic effect.
Materials and Methods. Among the daily samples, those with triglyceride >400 mg/dL (4.6 mmol/L) and also turbid were
selected, divided into three groups, based on triglyceride concentration, and three pooled serums were made for each group.
Then all pooled serums were investigated by using a DIRUI biochemistry analyzer CS-800 for routine chemistry tests in
different methods including direct measurement, serum blank, serum dilution, and measurement after ultracentrifugation.
Results. According to our study, there were significant differences before and after ultracentrifugation in all lipemic levels and
for all parameters except for alanine aminotransferase (ALT), alkaline phosphatase (ALP), bilirubin, and uric acid. Based on
allowable inaccuracy for each parameter, calcium, magnesium, phosphorus, total protein, iron, total iron-binding capacity
(TIBC), urea, and chloride are being influenced by all lipemic degree and neither serum dilution nor using serum blank is as
effective as ultracentrifuge for elimination. Serum blank was a proper method of lipid removal for the measurement of glucose.
Conclusion. Lipemia is a well-known interferer in clinical chemistry. One cannot avoid lipemia, but fortunately, severe lipemia
is a rare phenomenon in the laboratory, and for assessment of some analytes in a lower degree of lipemia, use of serum blank
eliminates the need for ultracentrifuge.

1. Introduction lipemic samples ranges from 0.5 to 2.5%, depending on the

type of hospital and the proportion of inpatient and out-
Published data states that up to 80% of patient care decisions patient samples [6–8].
are based on laboratory data [1]. Nowadays, reducing lab- The most common cause of lipemia is short fasting time.
oratory errors and improving patient safety are receiving a Other common causes include genetic background, diabetes
lot of attention [2]. Preanalytical phase encompasses all the mellitus, acute pancreatitis, renal failure, alcoholism, hy-
procedures before the start of laboratory testing. pothyroidism, and some drugs. Lipemia can cause inter-
This phase of the testing process is responsible for the ference in biochemistry results through a variety of
majority of laboratory errors [3]. A lot of these errors can mechanisms such as interference in spectrophotometric
link to the analytical sample integrity, of which lipemia is a methods (probably the most common way of interference),
contributor [4]. heterogeneity of the sample, and volume displacement effect.
Lipemia occurs when serum triglyceride (TG) levels Unlike for other interferences, lipemia can be removed,
exceed 400 mg/dL (4.6 mmol/L) [5]. The overall frequency of and measurement can be done in a clear sample. There are
2 Journal of Analytical Methods in Chemistry

several ways of removing lipids: centrifugation (ultra and of each group, Student’s t-test was used. Finally, as a ref-
high speed), lipid extraction (using polar solvents), sample erence method for lipid removal, the results of all methods
dilution, and serum blank [5, 9, 10]. were compared with ultracentrifugation in each group. The
Although ultracentrifugation is the recommended pro- percentage of differences (bias) was calculated to determine
cedure according to the CLSI, most laboratories do not have the effectivity of methods in lipid removal compared with
access to that because of the high cost [11]. That is why it is allowable inaccuracy (bias) [13]. The results of TG and
crucial to determine if there are other more accessible and cholesterol measurements were eliminated from the study
more practical methods to remove lipemia in routine bio- since, due to lipid removal, they were unreliable.
chemical tests. Many reagent suppliers provide information
on the effect of lipemia in their assays, but this is often vague, 3. Result
is not quantified, and may not be instrument-specific [12].
Neither all analytes nor all levels of lipemia are susceptible to A total of 21 parameters were evaluated in 202 serum
lipemia interference. Accordingly, it seems to be necessary to samples in three ranges of lipemia (TG: 400–700, TG:
choose method-dependent and parameter-dependent ways 700–1000, and TG: >1000 mg/dl) by spectrophotometric
for lipid removal which also should be compatible with the methods (Figure 1). The results of native serum, serum
level of lipemia. blank, and diluted serum were compared with ultracentri-
Our study is novel in which we evaluated the effect of fuge (as a reference method) and the differences were cal-
sample dilution and serum blank compared to ultracentri- culated as bias (percentage of difference). For the parameters
fugation for lipid removal in different levels of lipemia and that the bias between native serum and ultracentrifuged
21 biochemical parameters. serums does not exceed allowable bias, serum blank and
dilution were not applicable (Table 1).
2. Materials and Methods Table 2 shows the bias obtained in mild lipemia
(400–700 mg/dl) based on ultracentrifuged samples in
2.1. Samples. This study was conducted in the clinical lab- comparison with allowable bias. In this range of lipemia,
oratory of Shahid Motahari Clinic (an outpatient depart- calcium, chloride, glucose, iron, magnesium, phosphorus,
ment of Shiraz University of Medical Sciences) from August total protein, TIBC, and urea had a significant bias in results
to September of 2018. The study was approved by the Ethics (p value < 0.05 for calcium, phosphorus, and magnesium).
Committee of the university. Among more than 1000 daily In this group, using serum blank was helpful for glucose and
samples of the laboratory, about 1-2% of them have lipemic chloride measurement, unlike serum dilution.
serums. To study the effect of lipemia on routine bio- In moderate lipemia (700–1000 mg/dl), as shown in
chemistry tests, we selected the visibly turbid serums with a Table 3, only ALT, ALP, amylase, AST, bilirubin, and uric
TG concentration of >400 mg/dL (4.6 mmol/L). A total of acid are not influenced by lipemia. Using serum blank was
208 serums were collected of which 6 were excluded from the helpful for lipid elimination in the measurement of albumin,
study due to concurrent hemolysis or icterus. Specimens TG CPK, creatinine, glucose, and GGT, but serum dilution was
concentration ranged from 401 to 3562 mg/dL. not successful for removal of lipid interference in any of
these analytes.
According to Table 4 in severe lipemia (>1000 mg/dl),
2.2. Methods. The specimens were divided into three groups
only ALT, ALP, bilirubin, lipase, and uric acid had not been
according to TG level in mg/dL (mild lipemia: 400–700,
affected. Using serum blank was practical for lipid elimi-
moderate lipemia: 700–1000, and severe lipemia: >1000).
nation in the measurement of albumin, amylase, CPK, and
Three pooled serums were made for each group and all
glucose, and serum dilution was useful for removal of lipid
pooled serums were run for 21 parameters, on the DIRUI
interference in creatinine analyte.
biochemistry analyzer CS-800 directly and also with three
other different methods, including serum dilution (1/10 with
distilled water, automatically), use of serum blank option of 4. Discussion
autoanalyzer, and direct measurement after ultracentrifu-
gation (at 100,000 ×g for 15 min) in the same batch. Bio- In clinical chemistry, pre- and postanalytical factors are the
chemistry parameters consisted of alanine aminotransferase largest and the most important source of errors in com-
(ALT), albumin, alkaline phosphatase (ALP), aspartate parison with analytical elements. Preanalytic errors are even
aminotransferase (AST), amylase, bilirubin (total), more common than the postones, so effective correction of
calcium, chloride, creatine phosphokinase (CPK), creati- interference is recommended to release reliable results.
nine, γ-glutamyl transferase (GGT), glucose, iron, lactate Analytical interference is the effect of substances other than
dehydrogenase (LDH), lipase, magnesium, phosphorus, the analyte reacting with the reagents or detection system of
total protein, total iron-binding capacity (TIBC), urea, and the analytical method [14].
uric acid. The interference by hemolysis, icterus, paraproteinemia,
and lipemia is of main concern in the laboratory. Lipemia is
a common problem of the specimens. According to the
2.3. Statistical Analysis. The mean and standard deviation National Cholesterol Education Program Adult Treatment
were calculated for each parameter in all groups of lipemia Panel (NCEP ATP III) guidelines, an average TG level
and also for all four methods. To compare the mean results is < 150 mg/dl, but just extracted serums with TG > 400 mg/
Journal of Analytical Methods in Chemistry 3

200

150

100

50

–50
ALT

Albumin

ALP

Amylase

AST

Bilirubin

Calcium

CPK

Creatinine

GGT

Glucose

IRON

LDH

Lipase

Magnesium

Phosphorus

Total protein

TIBC

Urea

Uric acid
Chloride

Mild lipemia
Moderate lipemia
Severe lipemia
Figure 1: Percentage of bias for 21 biochemistry analytes in different levels of lipemia.

Table 1: Chemical methods, wavelength, and analytical range used for analysis.
Parameter Method Wavelength (nm) Analytical range Reagent
AST IFCC 340 3–300 IU/L BIOREX
Bilirubin (total) Diazo 546 0.1–30 mg/dL BIOREX
Calcium CPC 570 0.2–20 mg/dL BIOREX
Chloride Colorimetric (thiocyanate) 456 25–300 mmol/L BIOREX
CPK IFCC 340 10–1700 IU/L BIOREX
Creatinine Jaffe 500 0.2–20 mg/dL BIOREX
GGT Szasz IFCC 405 2–231 IU/L BIOREX
Glucose Glucose oxidase 546 5–400 mg/dL BIOREX
Iron Ferrene 600 5–500 μg/dL BIOREX
LDH DGKC 340 50–1200 IU/L BIOREX
Lipase Enzymatic 580 0–400 IU/L BIOREX
Magnesium Photometric (xylidyl blue) 546 0.5–5 mg/dL BIOREX
Phosphorus Ammonium phosphomolybdate 340 0.76–20 mg/dL BIOREX
TIBC Ferrene 600 70–700 μg/dL BIOREX
Total protein Biuret 546 0.5–15 g/dL BIOREX
Urea Urease 340 10–300 mg/dL BIOREX
Uric acid Enzymatic 555 0.5–25 mg/dL BIOREX

dL lead to visible turbidity and interference [15]. This level of To prevent the interference of lipemia, the patient should
TG could be due to short fasting time, ingestion of fatty fast for at least 12 to 14 hours before the test, not drink
meals, drugs (such as cholestyramine, estrogens, and oral alcohol for 24 hours, or take any fatty diet, discontinuation
contraceptives), alcohol, recent exercise, and pregnancy in of any offending medications should be considered as well,
addition to genetic predisposition [16]. and if there was still a lipemic serum, we have to look for a
Lipemia may interfere in any assay which uses the way to eliminate it [20].
transmission of light as part of the detection scheme and Available methods to remove lipids consist of ultra-
cause increased absorption of light. Lipemia can also cause centrifuge (as the gold standard), high-speed centrifuge,
interferences by volume displacement and heterogeneity of lipid extraction (using polar solvents), sample dilution, and
the sample. To evaluate the susceptibility of methods to serum blank [12].
interferences from icterus or hemolysis, it is appropriate to Ultracentrifuge is an expensive method of lipid removal,
prepare reference samples with added bilirubin and he- which is also unavailable for many laboratories; instead,
moglobin, respectively, but in the face of lipemia, there is no serum dilution and serum blank are easy and routine
standardized material and method [17–19]. methods for removing interferences.
4 Journal of Analytical Methods in Chemistry

Table 2: Comparison of the results of native serum, serum blank, and diluted serum with ultracentrifuged serum.
Mild lipemia (TG: 400–700 mg/dl)
Parameter Allowable bias (%)
Native serum (%)∗ Serum blank (%)∗ Diluted serum (%)∗
ALT +1 11.48
Albumin +1 1.43
ALP 0 6.72
Amylase +7 7.4
AST 0 6.54
Bilirubin (total) +6 8.95
Calcium +14 +19 +26 0.82
Chloride +17 +2 +21 0.5
CPK −9 11.5
Creatinine 0 3.96
GGT −2 11.6
Glucose +7 +1 +26 2.34
Iron +23 +13 +48 8.8
LDH +4 4.3
Lipase −5 11.31
Magnesium +80 +80 +100 1.8
Phosphorus +54 +54 +69 3.38
Total protein +6 − 18 +15 1.36
TIBC +2 +3 +24 1.3
Urea −8 − 10 − 21 5.57
Uric acid 0 4.87
∗
Difference with ultracentrifuged serum, calculated as bias.

Table 3: Comparison of the results of native serum, serum blank, and diluted serum with ultracentrifuged serum.
Moderate lipemia (TG: 700–1000 mg/dl)
Parameter ∗
Allowable bias (%)
Native serum (%) Serum blank (%)∗ Serum dilution (%)∗
ALT +10 11.48
Albumin +7 0 +34 1.43
ALP 0 6.72
Amylase +7 7.4
AST 0 6.54
Bilirubin (total) 0 8.95
Calcium +32 +20 +34 0.82
Chloride +35 +6 +33 0.5
CPK − 13 − 11 − 24 11.5
Creatinine −7 0 − 34 3.96
GGT − 30 −2 +144 11.6
Glucose +16 0 +33 2.34
Iron +11 +26 +41 8.8
LDH +2 4.3
Lipase +42 − 20 +177 11.31
Magnesium +146 +92 +123 1.8
Phosphorus +106 +103 +128 3.38
Total protein +26 −8 +32 1.36
TIBC +13 +16 +34 1.3
Urea −6 −6 − 21 5.57
Uric acid +2 4.87
∗
Difference with ultracentrifuged serum, calculated as bias.

According to previous studies, high-speed centrifuge is cheaper to remove lipemia in serum/plasma samples. A large
almost as effective as ultracentrifuge, but lipid extraction number of parameters were analyzed, and the methods most
methods do not always work [2, 21]. We investigated which commonly used for lipemia removal in laboratories were
parameters are more susceptible to lipemia of sample and compared.
whether the current reference method, ultracentrifugation, According to our study, magnesium was responsible for
could be replaced with a technique that is more available and the most significant interference among all analytes and all
Journal of Analytical Methods in Chemistry 5

Table 4: Comparison of the results of native serum, serum blank, and diluted serum with ultracentrifuged serum.
Severe lipemia (TG > 1000 mg/dl)
Parameter Allowable bias
Native serum (%)∗ Serum blank (%)∗ Serum dilution (%)∗
ALT 0 11.48
Albumin +13 0 +43 1.43
ALP −3 6.72
Amylase +14 +4 +15 7.4
AST +14 − 27 +36 6.54
Bilirubin (total) 0 8.95
Calcium +40 +30 +57 0.82
Chloride +82 +22 +90 0.5
CPK − 22 −5 − 61 11.5
Creatinine − 20 − 80 0 3.96
GGT −9 11.6
Glucose +44 +2 +63 2.34
Iron −9 +660 +21 8.8
LDH +9 +8 +7 4.3
Lipase +7 11.31
Magnesium +180 +108 +325 1.8
Phosphorus +109 +187 +210 3.38
Total protein +59 −3 +70 1.36
TIBC +34 +33 +78 1.3
Urea +11 +17 − 17 5.57
Uric acid +4 4.87
∗
Difference with ultracentrifuged serum, calculated as bias.

degrees of lipemia. We found significant differences before These inconsistencies are because the effect of lipemia on
and after ultracentrifugation in all lipemic levels and for all biochemical tests is analyte-, method-, and analyzer de-
parameters except for ALT, ALP, bilirubin, and uric acid. pendent, and also some autoanalyzers perform an initial
Calcium, magnesium, phosphorus, total protein, iron, blank reading at the start of the reaction [12]. Therefore,
TIBC, urea, and chloride are being influenced by all lipemic every laboratory should determine the amount of lipemia
degree and neither serum dilution nor using serum blank is interactions depending on equipment and have a protocol
effective for elimination, so for measurement of these pa- for resolving them.
rameters, just ultracentrifuge is reliable.
Using serum blank is as successful as ultracentrifuge in 5. Conclusion
lipid removal for the measurement of glucose. LDH and AST
are just affected by severe lipemia, which is uncorrectable One cannot avoid lipemia, but fortunately, severe lipemia is
unless using an ultracentrifuge. a rare phenomenon in the laboratory, and for assessment of
In lipase measurement, there is incurable interference in some analytes in a lower degree of lipemia, use of serum
moderate and severe lipemia. About GGT and creatinine, blank eliminates the need for ultracentrifuge.
there is an intervention in moderate and severe lipemia and
using serum blank helps to be carried away in average levels. Abbreviations
About albumin, CPK, and amylase, although mild lipemia
has no effects on results, using serum blank is applicable for TG: Triglyceride
all lipemic levels. CLSI: Clinical and Laboratory Standards Institute
Till now, some studies have investigated the effect of ALT: Alanine aminotransferase
lipemia on biochemistry parameters with variable results. ALP: Alkaline phosphatase
One study designed by Randall et al. showed lipemia in- AST: Aspartate aminotransferase
terferences with determination of glucose, phosphorus, total CPK: Creatine phosphokinase
bilirubin, uric acid, and total protein by the Beckman GGT: c-Glutamyl transferase
Synchron CX5 [22]. Falsely low levels of amylase and rarely LDH: Lactate dehydrogenase
lipase are also seen in lipemic samples [23, 24]. According to TIBC: Total iron-binding capacity.
Agarwal study, glucose and albumin are not affected by
lipemia [25]. Another study by Biljali et al. showed signif- Data Availability
icant differences before and after ultracentrifugation in all
analytes except total bilirubin, glucose, total protein, and The data used to support the findings of this study are in-
AST [12]. Although some studies investigated the effect of cluded in the article. Previously reported data were used to
lipemia on routine biochemical tests, none of them men- support this study and are available at DOI: 10.11613/BM.
tioned the importance of the amount of lipemia [26]. 2011.025 and DOI: 10.3343/alm.2018.38.6.518.
6 Journal of Analytical Methods in Chemistry

Ethical Approval tests (intralaboratory study),” Standard Scientific Research

and Essays, vol. 3, no. 7, pp. 187–191, 2006.
The study protocol has been approved by the research in- [13] J. O. Westgard, “Desirable specifications for total error, impre-
stitute’s committee on human research. cision, and bias, derived from intra and inter individual biologic
variation,” 2014, http://www.Westgard.com/biodatabase_1.htm.
[14] M. H. Kroll and R. J. Elin, “Interference with clinical labo-
Consent ratory analyses,” Clinical Chemistry, vol. 40, no. 11,
pp. 1996–2005, 1994.
Subject has given his written informed consent. [15] National Cholesterol Education Program, “Executive sum-
mary of the third report of the national Cholesterol education
Conflicts of Interest Program (NCEP) expert Panel on detection, evaluation, and
treatment of high blood Cholesterol in adults (Adult treat-
The authors declare that they have no conflicts of interest. ment Panel III,” Journal of the American Medical Association,
vol. 285, pp. 2486–2497, 2001.
[16] K. D. Pagana, T. J. Pagana, and T. N. Pagana, Mosbys Di-
Authors’ Contributions agnostic and Laboratory Test Reference, Elsevier Mosby,
Amsterdam, Netherlands, 12th edition, 2015.
Dr. Neda Soleimani and Fateme Asadian conducted the [17] M. H. Kroll and C. R. McCudden, Endogenous Interferences in
study including patient recruitment, data collection, and Clinical Laboratory Tests, Springer, Berlin, Germany, 2010.
analysis. Both authors approved the final manuscript. [18] S. Mainali, S. R. Davis, and M. D. Krasowski, “Frequency and
causes of lipemia interference of clinical chemistry laboratory
tests,” Practical Laboratory Medicine, vol. 8, pp. 1–9, 2017.
References [19] M. H. Kroll, “Evaluating interference caused by lipemia,”
Clinical Chemistry, vol. 50, no. 11, pp. 1968-1969, 2004.
[1] D. J. Boone, “Is it safe to have a laboratory test?” Accreditation [20] Y. P. Paudel, A. K. Kasyap, A. Shrestha, and R. Baral, “High
and Quality Assurance, vol. 10, no. 1-2, pp. 5–9, 2004. lipemic serum: a case report,” Nepal Medical College Journal:
[2] G. Dimeski and B. W. Jones, “Lipaemic samples: effective NMCJ, vol. 12, no. 12, pp. 61-62, 2010.
process for lipid reduction using high speed centrifugation [21] M.-J. Castro-Castro, B. Candás-Estébanez, M. Esteban-Salán
compared with ultracentrifugation,” Biochemia Medica, et al., “Removing lipemia in serum/plasma samples: a mul-
vol. 21, no. 1, pp. 86–94, 2011. ticenter study,” Annals of Laboratory Medicine, vol. 38, no. 6,
[3] G. Lima-Oliveira, W. Volanski, G. Lippi, G. Picheth, and pp. 518–523, 2018.
G. C. Guidi, “Pre-analytical phase management: a review of [22] A. G. Randall, P. Garcia-Webb, and J. P. Beilby, “Interference
the procedures from patient preparation to laboratory anal- by haemolysis, icterus and lipaemia in assays on the beckman
ysis,” Scandinavian Journal of Clinical and Laboratory In- Synchron CX5 and methods for correction,” Annals of
vestigation, vol. 77, no. 3, pp. 153–163, 2017. Clinical Biochemistry: An International Journal of Biochem-
[4] G. Dimeski, “A commentary on the effect of lipid emulsions istry and Laboratory Medicine, vol. 27, no. 4, pp. 345–352,
on pathology tests,” Anaesthesia, vol. 64, pp. 1033–1035, 2009. 1990.
[5] R. McPherson, M. Pincus, N. Abraham et al., Henry’ S clinical [23] A. Singh, M. Shrestha, and C. Anand, “Acute pancreatitis with
diagnosis and management by laboratory methods, Saunders/ normal amylase and lipase–an ED dilemma,” American
Elsevier, Philadeiphia, PA, USA, 22nd edition, 2011. Journal of Emergency Medicine, vol. 34, p. 940, 2016.
[6] M. R. Glick, K. W. Ryder, S. J. Glick, and J. R. Woods, [24] M. D. Shephard and M. J. Whiting, “Falsely low estimation of
“Unreliable visual estimation of the incidence and amount of triglycerides in lipemic plasma by the enzymatic triglyceride
turbidity, hemolysis, and icterus in serum from hospitalized method with modified trinder’s chromogen,” Clinical
patients,” Clinical Chemistry, vol. 35, no. 5, pp. 837–839, 1989. Chemistry, vol. 36, no. 2, pp. 325–329, 1990.
[7] A. M. Simundic, N. Nikolac, I. Vukasovic, and N. Vrkic, “The [25] S. Agarwal, G. Vargas, C. Nordstrom, E. Tam, G. J. Buffone,
prevalence of preanalytical errors in Croatian ISO 15189 and S. Devaraj, “Effect of interference from hemolysis, icterus
accredited laboratory,” Clinical Chemistry and Laboratory and lipemia on routine pediatric clinical chemistry assays,”
Medicine, vol. 48, pp. 1009–1014, 2010. Clinica Chimica Acta, vol. 438, pp. 241–245, 2015.
[8] B. Goswami, B. Singh, R. Chawla, and V. Mallika, “Evaluation [26] P. Calmarza and J. Cordero, “Lipemia Interferences in
of errors in a clinical laboratory: a one-year experience,” Routine Clinical Biochemical Tests,” Biochemia Medica,
Clinical Chemistry and Laboratory Medicine, vol. 48, vol. 21, no. 2, pp. 160–166, 2011.
pp. 63–66, 2010.
[9] N. Nicolac, “Lipemia: causes, interference mechanisms, de-
tection and management,” Biochemia Medica, vol. 24, no. 1,
pp. 57–67, 2014.
[10] C. B. Dias, P. J. Moughan, L. G. Wood, H. Singh, M. L. Garg,
and P. lipemia, “Factoring in lipemic response for ranking
foods for their healthiness,” Lipids in Health and Disease,
vol. 16, no. 1, p. 178, 2017.
[11] CLSI, Statistical Quality Control for Quantitative Measure-
ment Procedures: Principles and Definitions; Approved
Guideline, Clinical Laboratory Standards Institute, Wayne,
PA, USA, 3rd edition, 2006.
[12] S. Biljali, N. Beadini, S. H. Beadini, N. Nuhii, and A. Beadini,
“Effect of lipemia interferences in routine clinical biochemical