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Cholesterol Total, Blood Level

Test Codes

EPIC: LAB60, Beaker: CHOL, Antrim: 17120

Department

Chemistry

Instructions

If total cholesterol is part of a Lipid Panel, the patient should be fasting 9-12 hours. If total cholesterol is requested by itself, fasting is not necessary.

Specimen Collection Criteria

Collect: One Gold-top SST tube. (Minimum Whole Blood 4.0 mL)

Contact the Laboratory for the acceptability of other tube types.

Physician Office/Draw Specimen Preparation

Let SST specimens clot for 30-60 minutes then immediately centrifuge to separate serum from cells. Refrigerate (2-8°C or 36-46°F) the centrifuged SST tube within two hours of collection. (Minimum: 0.5 mL)

Preparation for Courier Transport

Transport: Centrifuged SST tube, refrigerated (2-8°C or 36-46°F). (Minimum: 0.5 mL)

Rejection Criteria

• Moderate to grossly hemolyzed specimens.
• Red-top tubes with serum not separated from cells within two hours of collection. 

In-Lab Processing

Let SST specimens clot 30-60 minutes. Centrifuge SST tubes or Microtainers^® to separate serum from cells. Deliver immediately to the appropriate testing station.

Storage

Specimen Stability for Testing:

Centrifuged SST Tubes and Microtainers^® with Separator Gel
Room Temperature (20–26°C or 68–78.8°F): 2–4 hours
Refrigerated (2–8°C or 36–46°F): 7 days
Frozen (-20°C/-4°F or below): Unacceptable

Red-top Tubes and Microtainers^® without Separator Gel
Room Temperature (20–25°C or 68–77°F): 2–4 hours
Refrigerated (2–8°C or 36–46°F): Unacceptable
Frozen (-20°C/-4°F or below): Unacceptable

Serum Specimens (Pour-Overs)
Room Temperature (20-26°C or 68-78.8°F): 2-4 hours
Refrigerated (2-8°C or 36-46°F): 7 days
Frozen (-20°C/-4°F or below): 7 days

Specimen Storage in Department Prior to Disposal:

Refrigerated (2–8°C or 36–46°F): 7 days

Laboratory

Dearborn Chemistry Laboratory
Farmington Hills Chemistry Laboratory 
Grosse Pointe Chemistry Laboratory 
Royal Oak Automated Chemistry Laboratory 
Troy Chemistry Laboratory
Trenton Chemistry Laboratory

Performed

Sunday – Saturday, 24 hours a day.
Results available within 4 hours.

Reference Range

Farmington Hills, Grosse Pointe, Royal Oak & Troy:

Age	Risk of Coronary Artery Disease
Male and Female Adults	<200 mg/dL: Desirable 200 – 239 mg/dL: Borderline High Greater than or equal to 240 mg/dL: High
Ages 2 to 17 Years	<170 mg/dL: Desirable 170 – 199 mg/dL: Borderline High Greater than or equal to 200 mg/dL: High
Ages Less Than 2 Years	No ranges available

Test Methodology

Enzymatic, Spectrophotometry.

Interpretation

Total cholesterol represents cholesterol that is present in all lipoprotein particles although low density lipoprotein (LDL) usually contains the greatest proportion. Total cholesterol is usually increased when LDL cholesterol is increased, but high HDL cholesterol levels may result in an increased total cholesterol, even though LDL cholesterol is normal. Increased levels of total cholesterol (due to an increase in LDL cholesterol) are associated with increased risk of atherosclerotic cardiovascular disease (ASCVD) are associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). Total cholesterol may be low in malignancies, malnutrition, hyperthyroidism and in inherited lipoprotein disorders (e.g., abetalipoproteinemia, Tangier disease).

Clinical Utility

Total cholesterol is used to assess the risk of ASCVD. It is recommended that HDL Cholesterol, non-LDL Cholesterol, LDL Cholesterol and Triglycerides also be obtained in initial screening.

Several organizations have issued guidelines for management of dyslipidemias, all aiming to standardize and optimize patient care. The recent ACC/AHA guidelines aim to reduce/prevent heart disease, peripheral vascular disease and stroke by taking into account lifestyle and lipid levels (1). Based on this information an estimate of ASCVD risk can be calculated and a decision on whether or not to treat (e.g. with statins) and modify lifestyle can be made. The ACC/AHA guidelines do not recommend specific cholesterol set-points but aim for a particular percent decrease in LDL cholesterol. Our lab will continue to use the ATP guideline cut-points in lipid reporting (2). The National Lipid Association also has recommendations that are similar to the ATP III guidelines (3).

Total cholesterol may be decreased after acute myocardial infarction (AMI). Assessment of lipid status should therefore be determined within 24 hours of chest pain or 12 weeks following the AMI.

Reference

1. Stone NJ, Robinson JG, Lichetenstein AH et al: ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014 63:2889-2934.
2. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation and treatment of high blood cholesterol in adults (ATP III). Circulation 2002;106:3143-3421.
3. Jacobson TA, Ito MK, Maki KC et al. National Lipid Association recommendations for patient-centered management of dyslipidemia. Part 1 – executive summary. J Clin Lipidol 2014;8:473-488.

CPT Codes

82465

Contacts

Last Updated

10/18/2024