Lipaemia

Remnant removal disease (RRD, also called remnant lipaemia, familial dysbetalipoproteinemia) (uncommon) in which there is a defect of apolipoprotein E. This is the major ligand that allows internalisation and subsequent metabolism of remnant particles derived from VLDL and chylomicrons. The consequence is accumulation of VLDL remnants called intermediate density lipoprotein (IDL) with cholesterol and triglycerides usually in the range 6-9 mmol/1. Patients experience severe macrovascular disease (as above). 

Patients with remnant lipaemia (RRD hyperlipidaemia) may respond excellently to diet, weight loss (and possibly the addition of a fibrate). 

Remnant removal disease (remnant lipaemia) responds to dietary modification and weight reduction (above) and a fibrate nicotinic acid and/or a statin may be added where there is failure to respond. 

In cases of severe fatty liver, there is indeed a risk of fat embolism occurring in the lungs, brain and kidneys. In view of the considerable fat masses stored in the hepatic parenchyma due to this condition, R. Virchow suspected the manifestation of fat embolism as early as 1886. (s. tab. 31.9) Blunt traumatism of the (enlarged) liver with subsequent mobilization of fat is thought to be the cause of this condition. It is not clear at present whether this so-called inundation theory offers sufficient explanation or whether it needs to be amended or even replaced by the so-called segregation theory (high lipaemia, deemulsification of blood fats, etc.). While hepatic fat embolism may be rare, it is nevertheless clinically relevant. 

Leukaemia, mild lipaemia, carbon monoxide and bilirubin up to 30 mg/dl do not interfere with the measurement. Severe lipaemia as well as bilirubin levels >30 mg/dl result in elevated haemoglobin values. 

Interferences Mild haemolysis or lipaemia will not disturb the measurement. Strong haemolysis will interfere. 

Leary NO, Pembroke A, Duggan PF. Adapting the uricase/peroxidase procedure for plasma urate to reduce interference due to haemolysis, icterus or lipaemia. Ann Clin Biochem 1992 29 85-9. 

K,N. Frayn, Non-esterified fatty acid metabolism and postprandial lipaemia, Atherosclerosis, 1998, 141, 41-46. 

P3. Peltier, L. F., Fat embolism. The failure of lipaemia to potentiate the degree of fat embolism accompanying fractures of the femur in rabbits. Surgery 38, 720-722 (1955). 

There is a marked decrease or clearing of lipaemia when these compounds are injected into lipaemic subjects. This is readily demonstrated... 

Coagulation Inhibition and Lipaemia Clearing After Intravenous Injection of Heparin and Heparinoids... 

Increasing the amount of heparin injected correspondingly increases the maximum response up to a limit. For the effect on coagulation, the limit is set by the amount of heparin cofactor present in the plasma for the effect on lipaemia, this is set by the amount of enzyme available for immediate mobilization. Further, each of these systems competes with the other for heparin . Both of these limiting factors can be decreased by repeated injection of heparin or heparinoid. 

Cohn, J.S. Oxidized fat in the diet, postprandial lipaemia and cardiovascular disease. Current Opinion in Lipidology 13, 19-24 (2002). 

Carbohydrate-induced hyper-lipaemia 1 390 7.4 75.0 9.7 7.9 Christian and co-workers [23]... 

Mamo, J.C., James, A.P., Soares, M.J., Purcell, K., Griffiths, D., and Schwenke, J.L, Carbohydrate rich diets exacerbate postprandial lipaemia in moderately dyslipidemic subjects, whereas red meat protein-enriched diets have no adverse effects. Asia Pac. J. Clin. Nutr. 13, S52, 2004. 

Repeated use of Cremophor EL-containing injections in animals has given rise to abnormal plasma lipid patterns [141]. Triton WR-1339 and linear non-ionic surface-active agents produce lipaemia associated with an increase in blood cholesterol and stripping of lipids from the adrenal cortex [142]. 

This condition results in inability to remove chylomicrons from the blood. It presents in childhood with eruptive xanthomas, lipaemia retinalis, retinal vein thrombosis, pancreatitis and hepatosplenomegaly... 

Shortly after the consumption of a fatty meal, the presence of chylomicrons is very apparent in a sample of plasma (lipaemia). The very large particles scatter light giving the plasma an opalescent appearance. The particles can be isolated as a floating layer after a short low speed centrifugation and can be withdrawn from the top of the tube with a Pasteur pipette for analysis. 

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