Cholesterol, Total and Fractions

Cholesterol, Total and Fractions is a topic covered in the Davis's Lab & Diagnostic Tests.

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Synonym/Acronym:
α1-Lipoprotein cholesterol, high-density lipoprotein cholesterol (HDLC); and β-lipoprotein cholesterol, low-density lipoprotein cholesterol (LDLC), very-low-density lipoprotein (VLDL); lipid fractionation; lipoprotein phenotyping.

Rationale
To assess and monitor risk for coronary artery disease (CAD); to assist in categorizing lipoprotein as an indicator of cardiac health.

Patient Preparation
There are no medication restrictions unless by medical direction. Instruct the patient to fast 6 to 12 hr before specimen collection if lipoprotein fractionation or triglyceride measurements are ordered and recommend fasting if cholesterol levels alone are measured for screening. Instruct the patient to avoid excessive exercise for at least 12 hr before lipoprotein fractionation testing and to refrain from alcohol consumption for 24 hr before lipoprotein fractionation testing. Protocols may vary among facilities.

Normal Findings
Method: Spectrophotometry for total cholesterol, HDLC and LDLC. Lipoprotein fractionation: Electrophoresis and 4°C test for specimen appearance. There is no quantitative interpretation of this test. The specimen appearance and electrophoretic pattern are visually interpreted.

Total Cholesterol
RiskConventional UnitsSI Units (Conventional Units × 0.0259)
Children and adolescents (less than 20 yr)
 DesirableLess than 170 mg/dLLess than 4.4 mmol/L
 Borderline170–199 mg/dL4.4–5.2 mmol/L
 HighGreater than 200 mg/dLGreater than 5.2 mmol/L
Adults and older adults
 DesirableLess than 200 mg/dLLess than 5.2 mmol/L
 Borderline200–239 mg/dL5.2–6.2 mmol/L
 HighGreater than 240 mg/dLGreater than 6.2 mmol/L
HDLCConventional UnitsSI Units (Conventional Units × 0.0259)
Birth6–56 mg/dL0.16–1.45 mmol/L
Children, adults, and older adults
DesirableGreater than 60 mg/dLGreater than 1.55 mmol/L
Acceptable40–60 mg/dL1–1.55 mmol/L
LowLess than 40 mg/dLLess than 1 mmol/L
LDLCConventional UnitsSI Units (Conventional Units × 0.0259)
OptimalLess than 100 mg/dLLess than 2.59 mmol/L
Near optimal100–129 mg/dL2.59–3.34 mmol/L
Borderline high130–159 mg/dL3.37–4.11 mmol/L
High160–189 mg/dL4.14–4.9 mmol/L
Very highGreater than 190 mg/dLGreater than 4.92 mmol/L
Hyperlipoproteinemia: Fredrickson TypeSpecimen AppearanceElectrophoretic Pattern
Type IClear with creamy top layerHeavy chylomicron band
Type IIaClearHeavy β band
Type IIbClear or faintly turbidHeavy β and pre-β bands
Type IIISlightly to moderately turbidHeavy β band
Type IVSlightly to moderately turbidHeavy pre-β band
Type VSlightly to moderately turbid with creamy top layerIntense chylomicron band and heavy β and pre-β bands

Critical Findings and Potential Interventions
N/A

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