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Annals of Clinical Biochemistry

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This version was published on 1 May 2009
Ann Clin Biochem 2009;46:250-252
doi:10.1258/acb.2008.008192
© 2009 Association for Clinical Biochemistry

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Case Reports

A monoclonal protein identified by an anomalous lipaemia index

Christopher Monk1, Michael Wallage1, Julie Wassell1, Alastair Whiteway2, Jacqueline James2 and Robert Beetham1


1 Department of Clinical Biochemistry; 2 Department of Haematology, North Bristol NHS Trust, Frenchay Hospital, Bristol BS16 1NY, UK


Corresponding author: Dr. Julie Wassell. Email: julie.wassell{at}nbt.nhs.uk

We describe a patient being investigated for anaemia where the lipaemia index on a Beckman Coulter DxC800 analyser was markedly elevated and out of keeping with the visual appearance of the serum. Subsequent investigation revealed a monoclonal IgM kappa immunoglobulin with type I cryoglobulin behaviour. The patient was then diagnosed with a non-Hodgkin B-cell lymphoma. We later identified a second patient with a similar anomalous index with an IgM lambda paraprotein, and a known marginal zone splenic lymphoma but were unable to confirm cryoglobulin behaviour prior to treatment. A review of 50 consecutive IgM paraproteins revealed no other anomalous lipaemia indices. We postulate that it is the properties of the paraprotein that determine its cryoglobulin behaviour that also render it susceptible to precipitation in the index diluent, not the fact of it being an IgM paraprotein per se. This appears to be the first reported case of a paraprotein identified following an anomalous lipaemia index.


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