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Test ID: CHLE Cholesteryl Esters, Serum

Reporting Name

Cholesteryl Esters, S

Useful For

Establishing a diagnosis of lecithin-cholesterol acyltransferase deficiency


Evaluating the extent of metabolic disturbance by bile stasis or liver disease

Clinical Information

Cholesterol in the blood serum is normally 60% to 80% esterified with fatty acids, largely as a result of the action of the enzyme lecithin-cholesterol acyltransferase (LCAT), which circulates in the blood in association with the high-density lipoproteins.


Familial deficiency of LCAT is uncommon, usually occurring individuals of northern Europe descent, and is associated with erythrocyte abnormalities (target cells) and decreased (20% or less) esterification of serum cholesterol. This is associated with early atherosclerosis, corneal opacification, hyperlipidemia, and mild hemolytic anemia.


Persons with liver disease may have impaired formation of LCAT and, therefore, an acquired LCAT deficiency and reduced cholesterol ester concentration.


In patients with lecithin-cholesterol acyltransferase deficiency, the concentration of unesterified cholesterol in serum may increase 2 to 5 times the normal value, resulting in a decrease in esterified serum cholesterol to 20% or less of the total serum cholesterol.

Report Available

1 to 3 days

Day(s) Performed

Monday through Friday

Clinical Reference

1. Meikle PJ, Mundra PA, Wong G, et al: Circulating lipids are associated with alcoholic liver cirrhosis and represent potential biomarkers for risk assessment. PLoS One. 2015 Jun 24;10(6):e0130346. doi: 10.1371/journal.pone.0130346

2. Leach NV, Dronca E, Vesa SC, et al: Serum homocysteine levels, oxidative stress and cardiovascular risk in non-alcoholic steatohepatitis. Eur J Intern Med. 2014 Oct;25(8):762-767. doi: 10.1016/j.ejim.2014.09.007

3. Santamarina-Fojo S, Hoeg JM, Assmann G, Brewer B: Lecithin cholesterol acyltransferase deficiency and fish eye disease. In: Valle DL, Antonarakis S, Ballabio A, Beaudet AL, Mitchell GA. eds. The Online Metabolic and Molecular Bases of Inherited Disease. McGraw-Hill; 2019. Accessed June 8, 2021. Available at

Method Name

Enzymatic Colorimetric

Specimen Type


Specimen Required

Collection Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 1 mL

Collection Instructions: Centrifuge and aliquot serum into plastic vial. Send refrigerated.

Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 7 days
  Frozen  60 days
  Ambient  24 hours

Reference Values

≥18 years: 60-80% of total cholesterol

Reference values have not been established for patients who are less than 18 years of age.

Test Classification

This test was developed, and its performance characteristics 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


LOINC Code Information

Test ID Test Order Name Order LOINC Value
CHLE Cholesteryl Esters, S 21197-9


Result ID Test Result Name Result LOINC Value
CHLES Cholesteryl Esters, S 21197-9


If not ordering electronically, complete, print, and send a Cardiovascular Test Request Form (T724) with the specimen.

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