Test Id : CHLBF
Cholesterol, Body Fluid
Useful For
Suggests clinical disorders or settings where the test may be helpful
Aiding in the diagnosis of a cholesterol effusion or cholesterol-rich pseudochylous effusion in body fluids
Distinguishing between chylous and pseudochylous pleural effusions
Distinguishing between malignant and nonmalignant ascites
Method Name
A short description of the method used to perform the test
Colorimetry
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Aliases
Lists additional common names for a test, as an aid in searching
Cholesterol, Body Fluids
Cholesterol, Total, Body Fluids
Pseudochylous effusion
Chylothorax Analysis, Abnormal Body Fluid
Chylothorax Lipid Analysis, Abnormal Body Fluid
Fat, Body Fluids
CHLBF
Specimen Type
Describes the specimen type validated for testing
Body Fluid
Ordering Guidance
This test provides a measurement of cholesterol in body fluids, which is useful for screening of a cholesterol effusion or cholesterol-rich pseudochylous effusion. To distinguish between chylous and nonchylous effusions, order BFLA1 / Lipid Analysis, Body Fluid; which measures cholesterol and triglyceride concentrations, as well as chylomicrons and plasma lipoproteins.
Necessary Information
1. Date and time of collection are required.
2. Specimen source is required.
ORDER QUESTIONS AND ANSWERS
| Question ID | Description | Answers |
|---|---|---|
| FLD25 | Fluid Type: |
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Preferred Source:
-Peritoneal fluid (peritoneal, abdominal, ascites, paracentesis)
-Pleural fluid (pleural, chest, thoracentesis)
-Drain fluid (drainage, JP drain)
-Pericardial fluid
Acceptable Source: Write in source name with source location (if appropriate)
Collection Container/Tube: Sterile container
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Collection Instructions:
1. Centrifuge to remove any cellular material and transfer into a plastic vial.
2. Indicate the specimen source and source location on label
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
0.5 mL
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Gross hemolysis | OK |
| Gross lipemia | OK |
| Gross icterus | Reject |
| Anticoagulant or additive Amniotic fluid Breast milk Saliva Nasal secretions Sputum Synovial fluid Bronchoalveolar lavage (BAL) or bronchial washings Colostomy/ostomy Feces Spinal fluid Gastric secretions Urine Vitreous fluid | Reject |
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Body Fluid | Frozen (preferred) | 30 days | |
| Ambient | 24 hours | ||
| Refrigerated | 7 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Aiding in the diagnosis of a cholesterol effusion or cholesterol-rich pseudochylous effusion in body fluids
Distinguishing between chylous and pseudochylous pleural effusions
Distinguishing between malignant and nonmalignant ascites
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Serum cholesterol is measured to determine the concentration of circulating lipoprotein particles when screening for cardiovascular disease. The concentration is affected by genetic and lifestyle factors. Cholesterol concentrations in serous effusions increase due to exudative processes that cause cell lysis or increased vascular permeability. Measurement of cholesterol in body fluids is used for the diagnosis of a cholesterol effusion or cholesterol-rich pseudochylous effusion. Pseudochylous effusions contain low triglycerides and high cholesterol and occur from chronic pleural effusions such as rheumatic pleurisy and tuberculosis. Malignant effusions may become enriched with cholesterol due to increased synthesis and release from neoplastic cells or lymphatic obstruction.(1)
Pleural fluid:
Chylothorax is the name given to pleural effusions containing chylomicrons with accordingly high triglyceride and low cholesterol concentrations, which occurs when chyle accumulates from a disruption of the thoracic duct caused mainly by malignancy or trauma.(2)
Pseudochylous effusions accumulate gradually through the breakdown of cellular lipids in long-standing effusions such as rheumatoid pleuritis, tuberculosis, or myxedema, and by definition the effluent contains high concentrations of cholesterol, while chylous effusions contain high concentrations of triglycerides in the form of chylomicrons.(3)
Differentiation of pseudochylothorax from chylothorax is important as their milky or opalescent appearance is similar; however, therapeutic management strategies differ.
Measurement of pleural fluid cholesterol has also been investigated in multiple studies for the purpose of differentiating exudates from transudates.(4) Most of these studies concluded that cholesterol performs as well as measurement of lactate dehydrogenase and total protein applying Light's criteria, but does not add much value beyond that.
Peritoneal fluid:
Ascites is the pathologic accumulation of excess fluid in the peritoneal cavity. Cholesterol analysis in peritoneal fluid may be a useful index to separate malignant ascites from nonmalignant, often cirrhotic ascites. Studies report concentrations ranging from greater than 32 to 70 mg/dL are greater than 88% sensitive and greater than 80% specific for malignant ascites, outperforming cytology.(4)
Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
An interpretive report will be provided
Interpretation
Provides information to assist in interpretation of the test results
Pleural fluid cholesterol concentrations between 46 to 65 mg/dL are consistent with exudative effusions. Cholesterol concentrations above 200 mg/dL suggest a pseudochylous effusion.(2)
Peritoneal fluid cholesterol concentrations between 33 to 70 mg/dL suggest a malignant cause of ascites.(4)
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
In very rare cases, gammopathy, in particular type IgM (Waldenstrom macroglobulinemia), may cause unreliable results.
Acetaminophen intoxications are frequently treated with N-acetylcysteine.
N-acetylcysteine, at the therapeutic concentration when used as an antidote, and the acetaminophen metabolite N-acetyl-p-benzoquinone imine (NAPQI), may independently cause falsely low results.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Gulyas M, Kaposi AD, Elek G, Szollar LG, Hjerpe A. Value of carcinoembryonic antigen (CEA) and cholesterol assays of ascitic fluid in cases of inconclusive cytology. J Clin Pathol. 2001;54(11):831-5. doi:10.1136/jcp.54.11.831
2. Hooper C, Lee YC, Maskell N. BTS Pleural Guideline Group. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65 Suppl 2:ii4-17. doi:10.1136/thx.2010.136978
3. Staats BA, Ellefson RD, Budahn LL, et al. The lipoprotein profile of chylous and nonchylous pleural effusions. Mayo Clin Proc. 1980;55(11):700-704
4. Block DR, Algeciras-Schimnich A. Body fluid analysis: clinical utility and applicability of published studies to guide interpretation of today's laboratory testing in serous fluids. Crit Rev Clin Lab Sci. 2013;50:107-124. doi:10.3109/10408363.2013.844679
5. Bhatnagar M, Fisher A, Ramsaroop S, Carter A, Pippard B. Chylothorax: pathophysiology, diagnosis, and management - a comprehensive review: J Thorac Dis. 2024;16(2):1645-1661. doi:10.21037/jtd-23-1636
Method Description
Describes how the test is performed and provides a method-specific reference
Cholesterol esters are cleaved by the action of cholesterol esterase to yield free cholesterol and fatty acid. Cholesterol oxidase then catalyzes the oxidation of cholesterol to cholest-4-en-3-one and hydrogen peroxide. In the presence of peroxidase, the hydrogen peroxide formed effects the oxidative coupling of phenol and 4-aminophenazone to form a red quinone-imine dye. The color intensity of the dye formed is directly proportional to the cholesterol concentration. It is determined by measuring the increase in absorbance.(Package insert: CHOL2, Cholesterol Gen 2. Roche Diagnostics; V 13.0, 10/2023)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Monday through Saturday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
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- Prospective clients should contact their account representative. For assistance, contact Customer Service.
Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
This test has been modified from the manufacturer's instructions. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.
CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
84311-Spectrophotometry, analyte not specified (cholesterol)
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| CHLBF | Cholesterol, BF | 12183-0 |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| FLD25 | Fluid Type: | 14725-6 |
| BFCHL | Cholesterol (BF) | 12183-0 |