Lipid Screening in Children Clinical Pathway, Primary Care – Laboratory Testing

Lipid Screening in Children Clinical Pathway — Primary Care

Laboratory Testing

Universal Screening

  • First screening: once between 9–11 yrs old for all children
  • Second screening: once between 17–21 yrs old for all adolescents
  • Many offices screen with point of care (POC) testing initially
    • These panels are often non-fasting

Non-Fasting Lipid Panel

  • POC testing yields Total Cholesterol (TC), HDL (high-density lipoprotein), and non-HDL
  • Serum Lipid Panel performed in a lab additionally yields LDL and Triglycerides

Fasting Lipid Panel

  • Ideally, obtain two fasting lipid panels 2 wks to 3 mos apart
  • Use average of results to determine need for referral
  • Definition of fasting
    • NPO except for water 8 hrs prior to draw
    • Schedule lab draw for first thing in the morning to minimize daytime fasting hours
  • Serum lipid panel yields TC, HDL, non-HDL, Triglycerides and LDL

If there are significant barriers to obtaining multiple fasting lipid panels, refer based on
clinical judgment.

Guidance for Lipid Panel Components

Components Guidance for Results
Total Cholesterol (TC)
  • Management is not based on total cholesterol
  • Difficult to interpret without considering non-HDL and HDL components
High-Density Lipoprotein (HDL)
  • < 20 mg/dL, refer to Genetics
  • 20–40 mg/dL
    • No need to perform confirmatory serum HDL or refer based on isolated low HDL
    • Encourage 45–60 mins of moderate-vigorous physical activity 5–7 days per week
Non-High Density Lipoprotein (Non-HDL)
  • Measure of all atherogenic lipoproteins in the serum
  • Non-fasting non-HDL ≥ 145 mg/dL, order two fasting lipid panels per schedule above
Triglycerides
  • Fasting sample necessary for accurate interpretation
  • Non-fasting sample, triglycerides are likely to be elevated
Low-Density Lipoprotein (LDL)
  • Measurement of "bad cholesterol"
  • Critical lab used to consider medication management

Labs to Consider When Referring to Lipid Specialist

  • When referring, consider ordering a TSH, CK, and CMP along with fasting lipid panel for the lipid specialist to review
    • TSH: abnormalities of thyroid function can cause hyperlipidemia
    • CK: necessary safety lab in the event of needing to start a statin
    • CMP: necessary to evaluate liver enzymes and glucose before starting a statin