Abstract

Background: Cholestasis in primary biliary cholangitis (PBC) induces delta bilirubin and lipoprotein-X (LpX), complicating biochemical interpretation.
Methods: Comparative wet/dry chemistry analyses, total cholesterol (TC)/apolipoprotein B (Apo B) ratio calculation, and clinical-laboratory integration were utilized.
Results: Delta bilirubin (87.4 µmol/L) masked true bilirubin levels, while LpX falsely elevated LDL-cholesterol (LDL-C) (23.98 mmol/L) and induced pseudohyponatremia (Na⁺: 135 → 142 mmol/L).
Conclusions: Integrated methodologies and clinician-laboratory collaboration are essential to mitigate diagnostic pitfalls in PBC.

DOI: 10.7754/Clin.Lab.2025.250444