| A B C D E F G H I J K L M N O P Q R S T U V W X Y Z # |
LIPID CASCADE
Message"Patient should be fasting for 12 to 14 hours.
• If triglycerides are >400, the LDL cholesterol will reflex to the direct LDL at an additional cost.
• If LDL direct is <130, will reflex to NMR Lipoprotein Analysis by NMR Without IR (insulin resistance) Markers and Lipid Panel performed at LipoScience Inc at an additional charge.
• If LDL calculation is <130, will reflex to NMR Lipoprotein Analysis by NMR Without IR (insulin resistance) Markers and Lipid Panel performed at LipoScience Inc at an additional charge.
Note: Two specimens must be included with all test requests. See requirements for specimens below.
"
• If triglycerides are >400, the LDL cholesterol will reflex to the direct LDL at an additional cost.
• If LDL direct is <130, will reflex to NMR Lipoprotein Analysis by NMR Without IR (insulin resistance) Markers and Lipid Panel performed at LipoScience Inc at an additional charge.
• If LDL calculation is <130, will reflex to NMR Lipoprotein Analysis by NMR Without IR (insulin resistance) Markers and Lipid Panel performed at LipoScience Inc at an additional charge.
Note: Two specimens must be included with all test requests. See requirements for specimens below.
"
Test Code
361946
CPT Codes
80061 (If reflex testing is performed, additional CPT code(s) and concomitant charge(s)
Preferred Specimen
"Lipid panel: Serum (preferred) or plasma and lipoprotein reflex: Spun NMR LipoTube or serum from a plain red-top tube.
2 mL (each tube)
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2 mL (each tube)
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Minimum Volume
"1 mL (each tube)
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Instructions
"Lipid profile: Separate serum or plasma from cells within 45 minutes of collection.
Lipoprotein reflex: Patient should be fasting for 12 to 14 hours. Collect specimen in NMR LipoTube (black-and-yellow-top tube) or plain red-top tube. Gently invert tube to mix contents and allow specimen to clot for 30 minutes before centrifugation. Specimen should be kept refrigerated and centrifuged within 24 hours of collection. Centrifuge specimens for 15 minutes at 3000 rpm. To preserve specimen integrity, centrifuged specimens can be kept refrigerated up to four days before shipping and then they must be shipped with frozen cool packs. Do not freeze and do not store at room temperature. Do not open NMR LipoTube. Pipette separated serum from plain red-top tube to a plastic transport tube.
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Lipoprotein reflex: Patient should be fasting for 12 to 14 hours. Collect specimen in NMR LipoTube (black-and-yellow-top tube) or plain red-top tube. Gently invert tube to mix contents and allow specimen to clot for 30 minutes before centrifugation. Specimen should be kept refrigerated and centrifuged within 24 hours of collection. Centrifuge specimens for 15 minutes at 3000 rpm. To preserve specimen integrity, centrifuged specimens can be kept refrigerated up to four days before shipping and then they must be shipped with frozen cool packs. Do not freeze and do not store at room temperature. Do not open NMR LipoTube. Pipette separated serum from plain red-top tube to a plastic transport tube.
"
Transport Container
"Lipid panel: gel-barrier transport, green-top (heparin), or lavender-top (EDTA) tube
and
Lipoprotein reflex: NMR LipoTube (black-and-yellow-top tube) or plain red-top tube
Both specimens must be submitted with all requests.
"
and
Lipoprotein reflex: NMR LipoTube (black-and-yellow-top tube) or plain red-top tube
Both specimens must be submitted with all requests.
"
Transport Temperature
refrigerated
Specimen Stability
"Room temperature: gel-barrier tube, green-top (heparin) tube, or lavender-top (EDTA) tube.
Refrigerate: NMR LipoTube (black-and-yellow-top tube) or serum transport tube. Do not freeze sample, and do not store at room temperature.
Stable at room tempera
Refrigerate: NMR LipoTube (black-and-yellow-top tube) or serum transport tube. Do not freeze sample, and do not store at room temperature.
Stable at room tempera
Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
"Lipid panel: hemolysis
Lipoprotein reflex: unspun LipoTube or unseparated plain red-top tube; gross hemolysis; serum more than 10 days old; specimen in inappropriate container; frozen specimen; specimen stored at room temperature; EDTA plasma
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Lipoprotein reflex: unspun LipoTube or unseparated plain red-top tube; gross hemolysis; serum more than 10 days old; specimen in inappropriate container; frozen specimen; specimen stored at room temperature; EDTA plasma
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Methodology
"Lipid profile: enzymatic; lipoprotein reflex: nuclear magnetic resonance (NMR) "
Limitations
"If triglyceride level is >400 mg/dL, LDL cholesterol will not be calculated.
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Clinical Significance
"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
"
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
"
