Lipemia retinalis: Microcirculatory changes and lipid studies in a family

A 13-year-old girl with diabetic acidosis had lipemia retinalis and massive hyperchylomicronemia ( 19.5 Gm. 100 ml. total lipids) corrected by insulin administration. Fat uptake by embryonic cells in tissue culture using the patient's lipemic serum was very marked and was maximal after heparin administration. Red-cell aggregation could be induced in the retinal vessels at the height of her hypertriglyceridemia while conjunctival red-cell aggregation persisted at lower levels of hyperlipemia. Whole-blood viscosity was actually subnormal during the stage of lipemia. With clearing of the hyperchylomicronemia a pre-β band appeared in the lipoprotein electrophoretic pattern of the plasma, which persisted when blood lipid levels returned to normal. The patient's father, mother and brother had pre-β bands despite normal blood lipid and insulin levels and normal glucose tolerance. The pre-β band disappeared on heparin administration. This pattern may represent a prototype of carbohydrate-induced lipemia.