Lipid Cascade With Reflex to Lipoprotein Particle Assessment by NMR (With Graph if reflex)*

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Category:

Turnaround Time: Within 1 day
CPT Code:

80061

Test Type: Lipid profile: Serum (preferred) or plasma

Overview:

The lipid cascade supports risk assessment and management of patients who present with cardiometabolic risk (CMR) factors (eg, elevated blood pressure, abdominal obesity, insulin resistance (IR), lipoprotein abnormalities, and elevated blood glucose).

Conventional lipid profile results are indirect estimates of the actual lipoproteins that transport cholesterol, many of which may be atherogenic. Additionally, basic lipid profile results do not: (1) account for the variability in cholesterol subfraction content; (2) measure lipoprotein particle size and number; or (3) provide information suggestive of changes associated with IR progression.

In patients with an LDL cholesterol result <130 mg/dL, the lipid cascade automatically reflexes to lipoprotein analysis by NMR to evaluate LDL particle number (additional charge on reflex). The lipid cascade provides a lipoprotein IR score as a qualitative indicator of the patient's insulin resistance and risk for diabetes. In patients with a triglyceride result >400 mg/dL, the lipid cascade automatically reflexes to a direct LDL (additional charge on reflex). If the direct LDL result is <130 mg/dL, the lipid cascade automatically reflexes to lipoprotein analysis by NMR.

If triglyceride level is >400 mg/dL, LDL cholesterol will not be calculated.

Collection Details:

Patient Preparation:

Patient should fast for 12-14 hours.

Collection Instructions:

Two specimens must be included with all test requests. See requirements under the Specimen section below.

Lipid profile: Gel-barrier transport, green-top (heparin), or lavender-top (EDTA) tube. Lipoprotein reflex: One of the following: NMR LipoTube (black-and-yellow-top tube), preferred, plain red-top tube, lavender-top (EDTA-no gel) tube, or green-top (heparin-no gel) tube. Two specimens must be submitted with this profile, one for the lipid profile and another for lipoprotein reflex testing.

Lipid profile: Separate serum or plasma from cells within 45 minutes of collection. Lipoprotein reflex: Collect specimen in NMR LipoTube (black-and-yellow-top tube), which is the preferred specimen. Plain red-top tube, green-top (heparin-no gel), or lavender-top (EDTA-no gel) tubes are also acceptable. Serum or plasma drawn in gel-barrier collection tubes other than the NMR LipoTube should not be used. The LipoTube is the only acceptable gel barrier tube. Gently invert tube 8 to 10 times to mix contents and allow specimen to clot for 30 minutes upright at room temperature prior to centrifugation (plasma tubes should not clot). Centrifuge specimen within two hours of collection at 1800xg for 10 to 15 minutes to separate serum/plasma from the red cells and to avoid red cell contamination during shipment. If the sample cannot be centrifuged immediately, the sample should be refrigerated (at 2°C to 8°C) and centrifuged within 24 hours of collection. Note: Centrifuging the specimen while still cold may negatively affect the migration of the gel to the serum/red cell interface and may increase the likelihood of specimens being contaminated with red cells during shipment. All specimens should be centrifuged by the client, prior to shipment to LabCorp, to ensure sample integrity. Do not open NMR LipoTube (black-and-yellow top). Immediately after centrifugation, pipette separated red-top serum or green-top/lavender-top plasma into a transport tube and label accordingly (serum, heparin plasma, EDTA plasma). Keep samples refrigerated until shipment to the laboratory, and ship with frozen cool packs.

Lipid profile: Room temperature: Gel-barrier tube, green-top (heparin) tube, or lavender-top (EDTA) tube. Stable at room temperature for six hours or refrigerated for 10 days. Frozen is not acceptable. Lipoprotein reflex: Refrigerate all acceptable tube types as soon as possible after centrifugation and within 24 hours of collection. Keep refrigerated prior to shipment, and ship on frozen cool packs. Do not store at room temperature. Do not freeze the sample. Sample is stable refrigerated for six days.