1
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Nielsen MH, Mørk M, Madsen P, Brock A. A simplified HPLC-based method for measuring unconjugated bilirubin, bilirubin-monoglucuronide, bilirubin-diglucuronide, and delta-bilirubin in plasma with increased conjugated bilirubin. Scand J Clin Lab Invest 2023; 83:64-67. [PMID: 36534490 DOI: 10.1080/00365513.2022.2155989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Prolonged icterus is an important and common problem in neonatology and accurate determination of the different bilirubin species, including differentiation between delta-bilirubin and mono- and di-conjugated bilirubin, is useful for diagnostic purposes. However, most bilirubin measurements routinely performed in the clinical laboratory are hampered by the lack of separation of the four bilirubin fractions (unconjugated bilirubin, mono-conjugated bilirubin, di-conjugated bilirubin, and delta-bilirubin). Herein, we propose a high-performance liquid chromatography-based method, independent of commercially available standards or reliable molar absorption coefficients, for the determination of bilirubin fractions in blood samples from icteric patients. The method is a robust and reliable candidate for a semi-automatized setup for measuring the various bilirubin fractions in a specialized laboratory handling samples from clinics with expertise in biliary disease.
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Affiliation(s)
- Morten Hjuler Nielsen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.,Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
| | - Morten Mørk
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.,Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
| | - Poul Madsen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark.,Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
| | - Axel Brock
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
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2
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Alahmari AS, El-Mekkawy HI, Al-Doaiss AA, Alduwish MA. Effect of Natural Commiphora myrrha Extract against Hepatotoxicity Induced by Alcohol Intake in Rat Model. TOXICS 2022; 10:toxics10120729. [PMID: 36548562 PMCID: PMC9786033 DOI: 10.3390/toxics10120729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 06/03/2023]
Abstract
The oral intake of alcohol has become a widespread concern due to its high risk to body health. Therefore, our purpose in this study was to reveal the antioxidant efficacies of natural Commiphora myrrha on hepatotoxicity and oxidative stress induced by ethanol in adult male rats, especially because these were not adequately revealed by previous studies. We examined the impacts of C. myrrha in male Sprague Dawley rats orally treated with C. myrrha (500 mg/kg) alone or in combination with 40% ethanol (3 g/kg), daily for 30 days. The results showed that treatment with C. myrrha after the oral consumption of ethanol caused a reduction in serum liver function parameters (alanine transferases, aspartate transaminase, and total bilirubin), hepatic tumor markers (α-L-flucosidase and arginase), and hepatic lipid peroxidation indicator (thiobarbituric acid reactive substances), as well as a slight restoration (not significant) in the levels of superoxide dismutase, catalase, reduced glutathione; and total antioxidant capacity. In addition, it alleviated histopathological changes in the liver, as revealed by decreased areas of inflammatory infiltrate, milder necrosis, and noticeably reduced periportal fibrosis and hemorrhage. The therapeutic efficiency of C. myrrha could be due to its rich sesquiterpenoids content which possesses anti-inflammatory properties and ROS-scavenging activities. Our findings provide evidence that the attenuation of oxidative stress by C. myrrha enables hepatic tissue to suppress inflammatory and oxidative mechanisms, resulting in enhanced liver structure and function. Therefore, C. myrrha extract shows promise as a protective and therapeutic supplement against toxic agents.
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Affiliation(s)
- Abeer S. Alahmari
- Biology Department, Faculty of Science, King Khalid University, Abha 61413, Saudi Arabia
- Research Center for Advanced Materials Science (RCAMS), King Khalid University, Abha 61413, Saudi Arabia
| | - Haitham I. El-Mekkawy
- Biology Department, Faculty of Science, King Khalid University, Abha 61413, Saudi Arabia
| | - Amin A. Al-Doaiss
- Biology Department, Faculty of Science, King Khalid University, Abha 61413, Saudi Arabia
- Anatomy and Histology Department, Faculty of Medicine, Sana’a University, Sana’a 1247, Yemen
| | - Manal A. Alduwish
- Department of Biology, Faculty of Science and Humanities, Prince Sattam Bin Abdulaziz University, Alkarj 11942, Saudi Arabia
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3
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Ikuta S, Aihara T, Nakajima T, Kasai M, Yamanaka N. Preoperative Alkaline Phosphatase-adjusted CA19-9 as a Superior Prognosticator for Extrahepatic Biliary Tract Cancer With Jaundice. CANCER DIAGNOSIS & PROGNOSIS 2022; 2:569-575. [PMID: 36060020 PMCID: PMC9425582 DOI: 10.21873/cdp.10144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND/AIM The major limitation of carbohydrate antigen (CA)19-9 as a tumor marker is the high incidence of false-positive results during cholestasis. We evaluated preoperative CA19-9 and its adjusted values [ratios of CA19-9 to total-bilirubin (TB), direct-bilirubin (DB), and alkaline phosphatase (ALP)] to investigate the most suitable prognostic parameter in extrahepatic biliary tract cancer (eBTC) patients with or without jaundice. PATIENTS AND METHODS eBTC patients (n=140) who underwent resection were divided based on the absence (TB <2.0 mg/dl, n=90) or presence (TB ≥2.0 mg/dl, n=50) of preoperative jaundice. Within each group, the associations with overall survival (OS) were assessed for CA19-9, CA19-9/TB, CA19-9/DB and CA19-9/ALP ratios using Cox regression, receiver operating characteristic (ROC) analyses, and area under the curve (AUC) estimates. RESULTS In univariate analysis in the group without jaundice, both high CA19-9 and high CA19-9/TB ratio were associated with poor OS, whereas other parameters were not. ROC-AUC for OS prediction was greater in CA19-9 than in the CA19-9/TB ratio, and CA19-9 was identified as an independent prognosticator in multivariate analysis. In the group with jaundice, CA19-9 was not significant; however, CA19-9/TB, CA19-9/DB, and CA19-9/ALP ratios were all associated with poor OS. In ROC-AUC analysis, CA19-9/ALP ratio showed the highest predictive value; furthermore, it was an independent prognosticator in multivariate analysis. CONCLUSION Adjustment of the CA19-9 value was less useful as a predictor in the absence of jaundice. On the other hand, the CA19-9/ALP ratio showed superior prognostic value in jaundiced patients with eBTC.
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Affiliation(s)
| | | | | | - Meidai Kasai
- Department of Surgery, Meiwa Hospital, Hyogo, Japan
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4
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Kouassi KC, Dorkenoo AM, Gbada K, Afanyibo YG, Têko M, Koura A. The Togo national proficiency test pilot programme for basic clinical chemistry tests. Afr J Lab Med 2022; 11:1565. [PMID: 35811750 PMCID: PMC9257935 DOI: 10.4102/ajlm.v11i1.1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/09/2022] [Indexed: 11/12/2022] Open
Abstract
Background A national proficiency test (PT) programme is not currently implemented in most low-income countries. However, participation in such PT programmes assists improves test performance and result accuracy. Objective This study assessed how well 11 government hospital laboratories performed 18 basic clinical chemistry tests and identified areas needing improvement. Methods A cross-sectional study was carried out by the Division of Laboratories of the Ministry of Health of Togo from 01 July 2016 to 31 December 2016. The test performance was evaluated using panels provided by One World Accuracy, Canada (Vancouver). The Clinical Laboratory Improvement Amendments criteria were used in evaluating the laboratories, and their success rates were compared with the World Health Organization Regional Office for Africa’s target of 80%. Results The overall rate of acceptable results at the laboratories was over 80% for glucose, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase, alkaline phosphatase and triglycerides tests. The laboratories using fully automated spectrophotometers had an acceptable results rate of 89% (p = 0.001). The overall performance of the laboratories by cycles varied from 71% to 82%. Conclusion This national PT programme identified the tests, which laboratories must improve their performance (urea, creatinine, uric acid, bilirubin, cholesterol, total protein, calcium, magnesium, phosphorus). It demonstrated the need for the use of routine appropriate internal quality control in all laboratories. The proficiency test programme should be extended to all clinical laboratories and target all biology disciplines.
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Affiliation(s)
- Kafui C Kouassi
- Unity of External Quality Assessement, Division of Laboratories, Ministry of Health and Public Hygiene, Lomé, Togo
- Medical and Biological Analysis-Biochemistry, Higher School of Biological and Food Techniques, University of Lomé, Lomé, Togo
| | - Améyo M Dorkenoo
- Division of Laboratories, Ministry of Health and Public Hygiene, Lomé, Togo
- Department of Health Sciences, Faculty of Health Sciences, University of Lomé, Lomé, Togo
| | - Komivi Gbada
- Division of Laboratories, Ministry of Health and Public Hygiene, Lomé, Togo
- Lomé Commune Regional Hospital, Ministry of Health and Public Hygiene, Lomé, Togo
| | - Yaovi-Gameli Afanyibo
- Division of Laboratories, Ministry of Health and Public Hygiene, Lomé, Togo
- National Institute of Hygene, Ministry of Health and Public Hygiene, Lomé, Togo
| | - Minogblon Têko
- Division of Laboratories, Ministry of Health and Public Hygiene, Lomé, Togo
- Bè Secondary Hospital, Ministry of Health and Public Hygiene, Lomé, Togo
| | - Adjane Koura
- Division of Laboratories - RESAOLAB, Ministry of Health and Public Hygiene, Lomé, Togo
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5
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Thomas M, Greaves RF, Tingay DG, Loh TP, Ignjatovic V, Newall F, Oeum M, Tran MTC, Rajapaksa AE. Current and emerging technologies for the timely screening and diagnosis of neonatal jaundice. Crit Rev Clin Lab Sci 2022; 59:332-352. [PMID: 35188857 DOI: 10.1080/10408363.2022.2038074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Neonatal jaundice is one of the most common clinical conditions affecting newborns. For most newborns, jaundice is harmless, however, a proportion of newborns develops severe neonatal jaundice requiring therapeutic interventions, accentuating the need to have reliable and accurate screening tools for timely recognition across different health settings. The gold standard method in diagnosing jaundice involves a blood test and requires specialized hospital-based laboratory instruments. Despite technological advancements in point-of-care laboratory medicine, there is limited accessibility of the specialized devices and sample stability in geographically remote areas. Lack of suitable testing options leads to delays in timely diagnosis and treatment of clinically significant jaundice in developed and developing countries alike. There has been an ever-increasing need for a low-cost, simple to use screening technology to improve timely diagnosis and management of neonatal jaundice. Consequently, several point-of-care (POC) devices have been developed to address this concern. This paper aims to review the literature, focusing on emerging technologies in the screening and diagnosing of neonatal jaundice. We report on the challenges associated with the existing screening tools, followed by an overview of emerging sensors currently in pre-clinical development and the emerging POC devices in clinical trials to advance the screening of neonatal jaundice. The benefits offered by emerging POC devices include their ease of use, low cost, and the accessibility of rapid response test results. However, further clinical trials are required to overcome the current limitations of the emerging POC's before their implementation in clinical settings. Hence, the need for a simple to use, low-cost POC jaundice detection technology for newborns remains an unsolved challenge globally.
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Affiliation(s)
- Mercy Thomas
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Australia.,Department of Nursing, Royal Children's Hospital, Melbourne, Australia
| | - Ronda F Greaves
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.,Victorian Clinical Genetics Services, Melbourne, Australia.,International Federation of Clinical Chemistry and Laboratory Medicine-Emerging Technologies Division (C-ETPLM), Milan, Italy
| | - David G Tingay
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Australia.,Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Neonatology, Royal Children's Hospital, Melbourne, Australia
| | - Tze Ping Loh
- International Federation of Clinical Chemistry and Laboratory Medicine-Emerging Technologies Division (C-ETPLM), Milan, Italy.,Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Vera Ignjatovic
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Hematology, Murdoch Children's Research Institute, Melbourne, Australia
| | - Fiona Newall
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Nursing, Royal Children's Hospital, Melbourne, Australia
| | - Michelle Oeum
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia
| | - Mai Thi Chi Tran
- International Federation of Clinical Chemistry and Laboratory Medicine-Emerging Technologies Division (C-ETPLM), Milan, Italy.,National Children's Hospital, Hanoi, Vietnam.,Hanoi Medical University, Hanoi, Vietnam
| | - Anushi E Rajapaksa
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research Centre, Royal Women's Hospital, Melbourne, Australia.,Think Project Global, Melbourne, Australia
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6
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Anaduaka EG, Ozioko C, Ugwuoke SC, Uchendu NO, Ndefo JC, Osuji DO, Ene LN. Biochemical changes associated with the administration of aqueous pulp extract of Irvingia gabonensis fruit on adult male Wistar rats. CLINICAL NUTRITION OPEN SCIENCE 2022. [DOI: 10.1016/j.nutos.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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7
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Shayesteh S, Guillemin GJ, Rashidian A, Faghir-Ghanesefat H, Mani AR, Tavangar SM, Dehpour AR. 1-Methyl tryptophan, an indoleamine 2,3-dioxygenase inhibitor, attenuates cardiac and hepatic dysfunction in rats with biliary cirrhosis. Eur J Pharmacol 2021; 908:174309. [PMID: 34252442 DOI: 10.1016/j.ejphar.2021.174309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 12/30/2022]
Abstract
Kynurenine Pathway (KP) is the dominant metabolic route of tryptophan which is catalyzed by indoleamine-2,3-dioxygenase (IDO). This pathway is upregulated in liver disease where the level of KP metabolites correlates with the severity of disease. Cirrhosis is associated with cardiac dysfunction, which manifests itself during severe physiological challenges such as liver transplantation. Cardiac dysfunction in cirrhosis is linked to systemic inflammation and impaired cardiac beta-adrenergic signaling pathways. The KP pathway is involved in modulation of cardiac signaling and is upregulated by systemic inflammation. Therefore, this study aimed to evaluate the effect of IDO inhibition on development of cardiac dysfunction in an experimental model of cirrhosis. Cirrhosis was induced by bile duct ligation (BDL). Experimental groups were given either 1-methyl tryptophan (1-MT, 1, 3, 9 mg/kg), or saline. 28 days after BDL, cardiac chronotropic response to epinephrine was assessed ex vivo. HPLC was employed to measure hepatic and cardiac levels of tryptophan, kynurenine and kynurenic acid. Cirrhosis in rats was associated with impaired cardiac chronotropic responsiveness to adrenergic stimulation. 1-MT dose-dependently improved cirrhosis-induced chronotropic dysfunction as well as elevated serum levels of CRP and IL-6 in BDL rats. Hepatic and cardiac kynurenine/tryptophan ratio were elevated in cirrhotic rats and were reduced following 1-MT administration. Chronic administration of 1-MT could also reduce hepatic inflammation, fibrosis and ductular proliferation. 1-MT attenuates cardiac dysfunction in rats with biliary cirrhosis. This protective effect is not limited to the cardiac function as liver histopathologic changes were also improved following chronic 1-MT administration.
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Affiliation(s)
- Sevda Shayesteh
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Gilles J Guillemin
- Neuroinflammation Group, Department of Biomedical Sciences, Centre for Motor Neuron Disease Research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Amir Rashidian
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hedyeh Faghir-Ghanesefat
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali R Mani
- Division of Medicine, University College London, London, UK
| | - Seyed Mohammad Tavangar
- Department of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad R Dehpour
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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8
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Nawaz H, Aslam M, Rehman T. Neonatal hyperbilirubinemia: Background and recent literature updates on the diagnosis and treatment. Physiol Int 2021; 108:151-171. [PMID: 34166220 DOI: 10.1556/2060.2021.00018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/26/2021] [Indexed: 11/19/2022]
Abstract
Hyperbilirubinemia or jaundice has been studied by many researchers because of its diverse causes and potential for toxicity especially in the neonate but to a lesser extent beyond the neonate as well. Several studies have been performed on the normal metabolism and metabolic disorders of bilirubin in last decades of the 20th century. The recent advancement in research and technology facilitated for the researchers to investigate new horizons of the causes and treatment of neonatal hyperbilirubinemia. This review gives a brief introduction to hyperbilirubinemia and jaundice and the recent advancement in the treatment of neonatal hyperbilirubinemia. It reports modifications in the previously used methods and findings of some newly developed ones. At present, ample literature is available discussing the issues regarding hyperbilirubinemia and jaundice, but still more research needs to be done.
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Affiliation(s)
- H Nawaz
- 1Department of Biochemistry, Bahauddin Zakariya University, 60800, Multan, Pakistan
| | - M Aslam
- 1Department of Biochemistry, Bahauddin Zakariya University, 60800, Multan, Pakistan
| | - T Rehman
- 2Department of Chemistry, The Women University Multan, 60000, Multan, Pakistan
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9
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Iijima S, Baba T, Kondo M, Fujita T, Ohishi A. Effects of Season of Birth and Meteorological Parameters on Serum Bilirubin Levels during the Early Neonatal Period: A Retrospective Chart Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052763. [PMID: 33803240 PMCID: PMC7967252 DOI: 10.3390/ijerph18052763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 11/16/2022]
Abstract
To establish whether serum bilirubin levels vary in healthy term neonates according to seasonal variations and meteorological factors, we retrospectively studied 3344 healthy term neonates born between 2013 and 2018. Total serum bilirubin (TSB) levels were measured on the fourth day after birth. The monthly and seasonal variations in TSB levels and clinical and meteorological effects on TSB levels were assessed. In the enrolled neonates, the median TSB level was 195 µmol/L. The TSB level peaked in December and was the lowest in July, but the variation was not statistically significant. The TSB level was significantly higher in the cold (October to March) than in the warm season (April to September; p = 0.01). The comparison between seasonal differences according to sex showed TSB levels were significantly higher in the cold than in the warm season in male infants (p = 0.001), whereas no significant difference was observed in female infants. A weakly negative but significant association existed between TSB levels and the mean daily air temperature (r = -0.07, p = 0.007) in only the male population; the female population showed no significant correlation between TSB levels and meteorological parameters. The season of birth is an etiological factor in neonatal jaundice, with an additional influence from sex.
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10
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Avan AA, Filik H. Dispersive Liquid-Liquid Microextraction Based on Ionic Liquid and Spectrophotometric Determination of Bilirubin in Biological Samples. CURR ANAL CHEM 2020. [DOI: 10.2174/1573411015666190212123437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background:
An Ionic Liquid-based based Dispersive Liquid-Liquid Microextraction
(IL-DLLME) method was not applied to preconcentration and determination of bilirubin. Ionic
Liquids (ILs) are new chemical compounds. In recent years, Ionic Liquids (ILs) have been employed
as alternative solvents to toxic organic solvents. Due to these perfect properties, ILs have already
been applied in many analytical extraction processes, presenting high extraction yield and selectivity
for analytes.
Methods:
In this study, IL-DLLME was applied to biological samples (urine and serum) for the spectrophotometric
detection of bilirubin. For bilirubin analysis, the full-color development was based on
the reaction with periodate in the presence of hydrochloric acid. The high affinity of bilirubin for the
ionic liquid phase gave extraction percentages above 98% in 0.3 M HCl solution.
Results:
Several IL-extraction parameters were optimized and room temperature ionic liquid 1-butyl-
1-methylpyrrolidinium bis(trifluoromethylsulfonyl)imide and ethanol were used as extraction and
disperser solution. The linear range was found in the range of 0.5-6.0 μM (0.3-3.5 μg mL-1) and the
limits of detection of the proposed method was 0.5 μM (0.3 μg mL-1). The proposed method was applied
for the preconcentration and separation of trace bilirubin in real urine samples. Also, the recoveries
for bilirubin in spiked biological samples (urine and serum) were found to be acceptable, between
95-102%.
Conclusion:
The proposed IL-DLLMEapproach was employed for the enrichment and determination
of trace levels of bilirubin in urine samples using NaIO4 as an oxidizing agent and Uv-vis spectrophotometric
detection. The periodate oxidation of bilirubin is rapid, effective, selective, and simple to
perform. The method contains only HCl, NaOI4, and an anionic surfactant. The method may be useful
for economizing in the consumption of reagents in bilirubin determining. The IL-DLLMEmethod
ensures a high yield and has a low toxicity no skin sensitization, no mutagenicity and no ecotoxicity in an
aquatic environment since only very low quantities of an IL is required. For full-color formation, no
any extra auxiliary reagents are required. Besides, the IL-DLLME technique uses a low-cost instrument
such as Uv-vis which is present in most of the medical laboratories.
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Affiliation(s)
- Asiye A. Avan
- Department of Chemistry, Faculty of Engineering, Istanbul University-Cerrahpaşa, 34320 Avcılar, Istanbul, Turkey
| | - Hayati Filik
- Department of Chemistry, Faculty of Engineering, Istanbul University-Cerrahpaşa, 34320 Avcılar, Istanbul, Turkey
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11
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Bandiera A, Corich L, Tommasi S, De Bortoli M, Pelizzo P, Stebel M, Paladin D, Passamonti S. Human elastin-like polypeptides as a versatile platform for exploitation of ultrasensitive bilirubin detection by UnaG. Biotechnol Bioeng 2019; 117:354-361. [PMID: 31691952 DOI: 10.1002/bit.27217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/25/2019] [Accepted: 11/01/2019] [Indexed: 01/21/2023]
Abstract
A new, bifunctional recombinant protein was expressed as the fusion product of human elastin-like polypeptide (HELP) and the bilirubin-binding protein UnaG. The engineered product displays both the HELP-specific property of forming a functional hydrogel matrix and the UnaG-specific capacity of emitting green fluorescence upon ligand binding. The new fusion protein has been proven to be effective at detecting bilirubin in complex environments with high background noise. A cell culture model of the stress response, consisting of bilirubin released in the cell culture medium, was set up to assess the bilirubin-sensing properties of the functional matrix obtained by cross-linking the HELP moiety. Our engineered protein allowed us to monitor cell induction by the release of bilirubin in the culture medium on a nanomolar scale. This study shows that elastin-like protein fusion represents a versatile platform for the development of novel and commercially viable analytical and biosensing devices.
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Affiliation(s)
| | - Lucia Corich
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Silvia Tommasi
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Marco De Bortoli
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Paola Pelizzo
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Marco Stebel
- Department of Life Sciences, University of Trieste, Trieste, Italy
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Abstract
The abnormal breakdown of circulating red blood cells (RBCs), also known as hemolysis, is a significant clinical issue that can present as a primary disorder or arise secondary to another disease process. The evaluation for pathologic hemolysis (and the establishment of a hemolytic disorder) is heavily dependent on assays performed and overseen by the divisions of Hematology, Blood Bank/Transfusion Medicine, Clinical Chemistry, and Immunology in the clinical laboratory. Because of the wide variety of assays used across the spectrum of clinical pathology and potential pitfalls/limitations associated with this testing, the decision of which assay to choose and, perhaps more importantly, how to interpret results, can both be quite challenging. Thus, the aim of this manuscript is to provide a comprehensive review on the laboratory investigation of pathologic forms of hemolysis and hemolytic disorders. This chapter will: (1) introduce basic concepts on the pathophysiology of hemolysis and (2) examine assays available for hemolysis on a laboratory-by-laboratory basis, with a particular emphasis on the strengths, limitations, and clinical interpretations of each of these assays.
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Affiliation(s)
- Alexa J Siddon
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, United States; Pathology & Laboratory Medicine Service, VA Connecticut Healthcare System, West Haven, CT, United States; Department of Pathology, Yale School of Medicine, New Haven, CT, United States
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, United States; Pathology & Laboratory Medicine Service, VA Connecticut Healthcare System, West Haven, CT, United States.
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13
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A Gold Nanoclusters Film Supported on Polydopamine for Fluorescent Sensing of Free Bilirubin. SENSORS 2019; 19:s19071726. [PMID: 30974923 PMCID: PMC6480062 DOI: 10.3390/s19071726] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 02/07/2023]
Abstract
Serum bilirubin is an important biomarker for the diagnosis of various types of liver diseases and blood disorders. A polydopamine/gold nanoclusters composite film was fabricated for the fluorescent sensing of free bilirubin. Bovine serum albumin (BSA)-stabilized gold nanoclusters (AuNCs) were used as probes for biorecognition. The polydopamine film was utilized as an adhesion layer for immobilization of AuNCs. When the composite film was exposed to free bilirubin, due to the complex that was formed between BSA and free bilirubin, the fluorescence intensity of the composite film was gradually weakened as the bilirubin concentration increased. The fluorescence quenching ratio (F0/F) was linearly proportional to free bilirubin over the concentration range of 0.8~50 μmol/L with a limit of detection of 0.61 ± 0.12 μmol/L (S/N = 3). The response was quick, the film was recyclable, and common ingredients in human serum did not interfere with the detection of free bilirubin.
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14
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Thangamuthu M, Gabriel WE, Santschi C, Martin OJF. Electrochemical Sensor for Bilirubin Detection Using Screen Printed Electrodes Functionalized with Carbon Nanotubes and Graphene. SENSORS 2018. [PMID: 29518901 PMCID: PMC5876756 DOI: 10.3390/s18030800] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Practice oriented point-of-care diagnostics require easy-to-handle, miniaturized, and low-cost analytical tools. In a novel approach, screen printed carbon electrodes (SPEs), which were functionalized with nanomaterials, are employed for selective measurements of bilirubin, which is an important biomarker for jaundice. Multi-walled carbon nanotubes (MWCNT) and graphene separately deposited on SPEs provide the core of an electrochemical sensor for bilirubin. The electrocatalytic activity towards bilirubin oxidation (bilirubin to biliverdin) was observed at +0.25 V. In addition, a further peak corresponding to the electrochemical conversion of biliverdin into purpurin appeared at +0.48 V. When compared to MWCNT, the graphene type shows a 3-fold lower detection limit (0.3 ± 0.022 nM and 0.1 ± 0.018 nM, respectively), moreover, the graphene type exhibits a larger linear range (0.1-600 µM) than MWCNT (0.5-500 µM) with a two-fold better sensitivity, i.e., 30 nA µM-1 cm-2, and 15 nA µM-1 cm-2, respectively. The viability is validated through measurements of bilirubin in blood serum samples and the selectivity is ensured by inhibiting common interfering biological substrates using an ionic nafion membrane. The presented approach enables the design and implementation of low cost and miniaturized electrochemical sensors.
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Affiliation(s)
- Madasamy Thangamuthu
- Nanophotonics and Metrology Laboratory (NAM), Swiss Federal Institute of Technology Lausanne (EPFL), 1015 Lausanne, Switzerland.
| | - Willimann Eric Gabriel
- Nanophotonics and Metrology Laboratory (NAM), Swiss Federal Institute of Technology Lausanne (EPFL), 1015 Lausanne, Switzerland.
| | - Christian Santschi
- Nanophotonics and Metrology Laboratory (NAM), Swiss Federal Institute of Technology Lausanne (EPFL), 1015 Lausanne, Switzerland.
| | - Olivier J F Martin
- Nanophotonics and Metrology Laboratory (NAM), Swiss Federal Institute of Technology Lausanne (EPFL), 1015 Lausanne, Switzerland.
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Zhang GM, Hu ZD. Conjugated bilirubin as a reflex test for increased total bilirubin in apparently healthy population. J Clin Lab Anal 2017; 32. [PMID: 28523701 DOI: 10.1002/jcla.22233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 03/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Total, unconjugated and conjugated bilirubin levels are usually ordered together in health check-up populations. The aim of this study was to investigate whether using increased total bilirubin (TBIL) as a reflex test can reduce conjugated bilirubin (CBIL) test. METHODS Medical records of 8433 males and 4496 females who visited Shuyang People's Hospital for health check-ups were retrospectively reviewed and the fasting serum TBIL, unconjugated bilirubin (UBIL) and CBIL of patients were extracted. Reference intervals for TBIL, UBIL, CBIL and C/TBIL were established using Q2.5 to Q97.5 . The relationship between TBIL and CBIL was analyzed by Spearman's approach. Receiver operating characteristics (ROC) curve analysis was used to evaluate the predictive accuracy of TBIL for abnormal CBIL and UBIL. RESULTS The reference intervals for TBIL in males and females were 6.9-29.3 μmol/L and 6.1-23.8 μmol/L, respectively. For CBIL, the reference intervals were 1.9-10.4 μmol/L and 1.6-8.8 μmol/L for males and females, respectively. CBIL was significantly positively correlated with TBIL, either in males (r=.75) or females (r=.73). Area under curve (AUC) of TBIL for predicting abnormal CBIL was 0.99 in both male and females. The optimal threshold of TBIL for predicting abnormal CBIL and UBIL were 21.0 μmol/L in males and 17.0 μmol/L in females. At these thresholds, <2% of subjects with abnormal CBIL or CBIL might be missed, but approximately 87% of the CBIL test could be eliminated. CONCLUSION Conjugated bilirubin measurement is not needed for the apparently healthy males with TBIL <21.0 μmol/L or females with TBIL <17.0 μmol/L.
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Affiliation(s)
- Guo-Ming Zhang
- Department of Laboratory Medicine, Shuyang People's Hospital, Shuyang, China
| | - Zhi-De Hu
- Department of Laboratory Medicine, the General Hospital of Ji'nan Military Command Region, Ji'nan, Shandong, China
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Effects of Myrtus communis extract treatment in bile duct ligated rats. J Surg Res 2016; 205:359-367. [PMID: 27664884 DOI: 10.1016/j.jss.2016.06.094] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/28/2016] [Accepted: 06/26/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of our study was to investigate the antifibrotic and antioxidant effects of Myrtus communis subsp. communis (MC) extract against liver injury and fibrosis occurring in rats with biliary obstruction. MATERIALS AND METHODS The rats were randomized into four groups (n = 8). Control group (C), MC-administrated group (MC), the bile duct ligation (BDL), and BDL + MC groups. MC was administered at a dose of 50 mg/kg a day orally for 28 days. In blood samples, total bilirubin, direct bilirubin, alanine aminotransferase, aspartate aminotransferase levels, tumor necrosis factor-α, and interleukin-1β measurement were measured. Oxidative injury was examined by measuring luminol and lucigenin chemiluminescence, malondialdehyde and glutathione levels, superoxide dismutase and myeloperoxidase activities. Transforming growth factor-beta and hydroxyproline levels were measured for analyzing fibrosis. The hepatic injury was also analyzed microscopically. RESULTS Plasma total bilirubin, direct bilirubin, alanine aminotransferase, aspartate aminotransferase, tumor necrosis factor-α, and interleukin-1β levels were found significantly high in the BDL group, while these values significantly decreased in the BDL group treated with MC. On the other hand, the glutathione and superoxide dismutase values significantly decreased in the BDL group compared to the control group but increased markedly in BDL + MC group compared to the BDL group. Malondialdehyde levels, myeloperoxidase activity, tissue luminol, lucigenin, transforming growth factor-beta, and hydroxyproline levels when compared with the control group increased dramatically in the BDL group and reduced the MC + BDL group. CONCLUSIONS Our results suggest that MC protects the liver tissues against oxidative damage following BDL via its radical scavenging and antioxidant activities, which appear to involve the inhibition of tissue neutrophil infiltration.
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Postoperative Care of a Liver Transplant Recipient Using a Classification System: Type A (Stable) Versus Type B (Unstable). Crit Care Nurs Q 2016; 39:252-66. [PMID: 27254641 DOI: 10.1097/cnq.0000000000000119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Liver transplantation has become an effective and valuable option for patients with end-stage liver disease and hepatocellular carcinoma. Liver failure, an acute or chronic condition, results in impaired bile production and excretion, clotting factor production, protein synthesis, and regulation of metabolism and glucose. Some acute conditions of liver disease have the potential to recover if the liver heals on its own. However, chronic conditions, such as cirrhosis, often lead to irreversible disease and require liver transplantation. In this publication, we review the pathophysiology of liver failure, examine common conditions that ultimately lead to liver transplantation, and discuss the postoperative management of patients who are either hemodynamically stable (type A) or unstable (type B).
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Neonatal total bilirubin measurements: Still room for harmonization. Clin Biochem 2014; 47:1112-5. [DOI: 10.1016/j.clinbiochem.2014.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/29/2014] [Accepted: 04/02/2014] [Indexed: 11/17/2022]
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Shleev S, Andoralov V, Falk M, Reimann CT, Ruzgas T, Srnec M, Ryde U, Rulíšek L. On the Possibility of Uphill Intramolecular Electron Transfer in Multicopper Oxidases: Electrochemical and Quantum Chemical Study of Bilirubin Oxidase. ELECTROANAL 2012. [DOI: 10.1002/elan.201200188] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Harpavat S, Finegold MJ, Karpen SJ. Patients with biliary atresia have elevated direct/conjugated bilirubin levels shortly after birth. Pediatrics 2011; 128:e1428-33. [PMID: 22106076 PMCID: PMC3387898 DOI: 10.1542/peds.2011-1869] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Healthy infants are thought to acquire biliary atresia (BA) in the first weeks of life. Because those diagnosed earlier have better outcomes, we were interested in determining the earliest time BA could be detected. We started by examining the immediate postnatal period, hypothesizing that newborns would not yet have acquired disease and still have normal direct/conjugated bilirubin (DB/CB) levels. PATIENTS AND METHODS Newborn DB/CB levels were obtained retrospectively from birth hospitals. Subjects with BA were born between 2007 and 2010 and cared for at Texas Children's Hospital. Those with BA splenic malformation syndrome or born prematurely were excluded. Control subjects were term newborns who later never developed neonatal liver disease. RESULTS Of the 61 subjects with BA, 56% had newborn DB/CB levels measured. All DB/CB levels exceeded laboratory norms and rose over time. At 24 to 48 hours of life, subjects with BA had mean DB levels significantly higher than those of controls (1.4 ± 0.43 vs. 0.19 ± 0.075 mg/dL, P < .0001), even while their mean total bilirubin (TB) levels remained below phototherapy limits. Finally, despite the elevated DB/CB levels, the majority of patients (79%) had normal DB:TB ratios ≤ 0.2. CONCLUSIONS Patients with BA have elevated DB/CB levels shortly after birth. To detect affected infants earlier and improve outcomes, the results suggest two possibilities: (1) screen all newborns for elevated DB/CB levels, rather than just those who appear jaundiced; and then (2) follow all newborns with elevated DB/CB levels, rather than just those with DB:TB ratios >0.2.
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Affiliation(s)
- Sanjiv Harpavat
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, and
| | - Milton J. Finegold
- Department of Pathology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Saul J. Karpen
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, and
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Donohoe CD. Rational Use of Laboratory Testing. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00007-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Cascavilla N, Falcone A, Sanpaolo G, D'Arena G. Increased serum bilirubin level without jaundice in patients with monoclonal gammopathy. Leuk Lymphoma 2009; 50:1392-4. [DOI: 10.1080/10428190903046730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kirk JM. Neonatal jaundice: a critical review of the role and practice of bilirubin analysis. Ann Clin Biochem 2008; 45:452-62. [DOI: 10.1258/acb.2008.008076] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Neonatal jaundice is common, and usually harmless, because of physiological jaundice or breast-feeding. In some neonates unconjugated bilirubin concentration, coupled with other risk factors, is sufficient to allow free bilirubin to cross the blood-brain barrier and cause kernicterus. Another subgroup of infants is jaundiced because of elevated conjugated bilirubin; a marker for a number of pathological conditions. Bilirubin measurement must identify those infants at risk. Transcutaneous bilirubin measurement is increasingly used in healthy infants, especially before early discharge or at home, to assess the need for laboratory bilirubin measurement. Transcutaneous measurements are not covered by laboratory quality assessment schemes. Guidelines on management of neonatal jaundice utilize age in hours and other risk factors to define bilirubin action thresholds, which may be as low as 100 μmol/L for sick premature infants, whereas early discharged babies may only present after bilirubin concentrations are extremely high. Hence, there is a requirement for accurate total bilirubin measurement from <100 to >500 μmol/L, with sufficient precision to assess the rate of bilirubin change with time. Babies presenting with late jaundice always require conjugated bilirubin measurement. It is of concern that many total and direct bilirubin automated kit methods suffer from haemolysis interference, while use of in-house methods or modification of commercial methods has virtually disappeared. External quality assessment has a vital role in providing data on different methods' performance, including accuracy, precision and susceptibility to interference. Laboratories should consider whether their adult bilirubin methods are suitable for neonates.
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Affiliation(s)
- Jean M Kirk
- Department of Paediatric Biochemistry/Haematology, Royal Hospital for Sick Children, Sciennes Road, Edinburgh EH9 1LF, UK
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Yang Y, Howanitz PJ, Howanitz JH, Gorfajn H, Wong K. Paraproteins are a common cause of interferences with automated chemistry methods. Arch Pathol Lab Med 2008; 132:217-23. [PMID: 18251580 DOI: 10.5858/2008-132-217-paacco] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2007] [Indexed: 11/06/2022]
Abstract
CONTEXT Previous studies have shown that paraproteins caused spurious results on individual analytes including total bilirubin (TBIL), direct bilirubin (DBIL), or HDL-cholesterol (HDL-C). Studies demonstrating paraprotein interferences with multiple analytes measured by different analyzers have not been reported. OBJECTIVE To systemically investigate interferences of paraproteins on TBIL, DBIL, and HDL-C measured by the Roche MODULAR and the Olympus AU2700. DESIGN Eighty-eight serum specimens with monoclonal gammopathies were analyzed using the Roche MODULAR and the Olympus AU2700. Paraprotein interferences with the MODULAR and AU2700 were identified by abnormal absorbance curves and confirmed by results from the Ortho Vitros 950 or inconsistent laboratory information. RESULTS Spurious results occurred in 89 of 528 measurements; 29 specimens did not demonstrate any interferences whereas 26 specimens gave spurious results in 2 to 4 of the 6 assays. Paraprotein interferences caused spuriously high levels of TBIL in 4 sera measured by the MODULAR. In contrast, paraprotein interferences on DBIL were observed by at least 1 method in 44% (39/88) of sera assayed, occurring almost exclusively with the AU2700. Paraprotein interferences with HDL-C results were present in 35% of specimens assayed with the MODULAR and 16% of specimens assayed with the AU2700. In specimens with interferences, spuriously low AU2700 DBIL, MODULAR HDL-C, and AU2700 HDL-C results occurred with 28%, 90%, and 91% of specimens, respectively. CONCLUSIONS We demonstrated that paraprotein interferences with TBIL, DBIL, and HDL-C are relatively common and provided explanations why these interferences occurred. Although it is difficult to predict which specimens cause interferences, spurious results appeared method and concentration dependent.
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Affiliation(s)
- Yusong Yang
- Department of Pathology, Box 24, State University of New York Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, USA.
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Algeciras-Schimnich A, Cook WJ, Milz TC, Saenger AK, Karon BS. Evaluation of hemoglobin interference in capillary heel-stick samples collected for determination of neonatal bilirubin. Clin Biochem 2007; 40:1311-6. [PMID: 17825810 DOI: 10.1016/j.clinbiochem.2007.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Revised: 08/03/2007] [Accepted: 08/05/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In this study, we determined the assay performance criteria necessary to produce acceptable results for >or=98% of neonate bilirubin samples collected by capillary heel-stick. STUDY DESIGN AND METHODS We determined serum free hemoglobin levels in 151 heel-stick serum samples to determine the hemolysis level. We then tested the effect of hemolysis on total bilirubin levels determined by four commercially available assays. RESULTS The mean level of serum free hemoglobin was 1.62 g/L. Of the serum total bilirubin assays tested, the Total Bilirubin Special (Roche Diagnostics) and the TBILI (Roche Diagnostics) reagents did not show significant interference at the concentrations of free hemoglobin observed in >or=98% of heel-stick samples. The Vitros Bu/Bc slide (Ortho-Clinical Diagnostics) showed significant interference only at normal bilirubin concentrations; while the Bilirubin DPD reagent (Amresco Inc.) showed significant interference starting at hemoglobin concentrations of 1.0 g/L. CONCLUSIONS Bilirubin assays that are not sensitive to approximately 6 g/L free hemoglobin should provide accurate results for most samples obtained via capillary heel-stick. Of the four assays tested, the Bilirubin DPD reagent (Amresco Inc.) was the most susceptible to the presence of free hemoglobin and will result in a higher rejection rate of neonate capillary heel-stick samples.
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Affiliation(s)
- Alicia Algeciras-Schimnich
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Donohoe CD. Rational Use of Laboratory Testing. Pain Manag 2007. [DOI: 10.1016/b978-0-7216-0334-6.50010-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ahmad N, Arif K, Faisal SM, Neyaz MK, Tayyab S, Owais M. PLGA-microsphere mediated clearance of bilirubin in temporarily hyperbilirubinemic rats: An alternate strategy for the treatment of experimental jaundice. Biochim Biophys Acta Gen Subj 2006; 1760:227-32. [PMID: 16388906 DOI: 10.1016/j.bbagen.2005.11.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Revised: 11/14/2005] [Accepted: 11/16/2005] [Indexed: 11/16/2022]
Abstract
In the present study, we have demonstrated the suitability of microspheres in removal of plasma bilirubin from systemic circulation of hyperbilirubinemic rats. Poly (lactide co-glycolide) microspheres (PLGA microspheres) have been shown to bind with bilirubin in both a concentration and time dependent manner. The binding affinity of bilirubin to microspheres was enhanced when rat serum albumin (RSA) was loaded into the microspheres. On evaluating the potential of microspheres in elimination of bilirubin from the systemic circulation, RSA bearing microspheres were found to be competent in both removing bilirubin from the systemic circulation and controlling elevated plasma levels of liver function enzymes in temporarily hyperbilirubinemic rats. On the basis of results of the present study, we suggest that microsphere-based delivery system may help in development of safe, effective and alternate strategy for the treatment of hyperbilirubinemic conditions in model animals.
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Affiliation(s)
- N Ahmad
- Inter-Disciplinary Biotechnology Unit, Aligarh Muslim University, India
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Sheppard CA, Allen RC, Austin GE, Young AN, Ribeiro MA, Fantz CR. Paraprotein interference in automated chemistry analyzers. Clin Chem 2005; 51:1077-8. [PMID: 15914801 DOI: 10.1373/clinchem.2004.045740] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Smogorzewska A, Flood JG, Long WH, Dighe AS. Paraprotein interference in automated chemistry analyzers. Clin Chem 2004; 50:1691-3. [PMID: 15331512 DOI: 10.1373/clinchem.2004.037499] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Agata Smogorzewska
- Department of Pathology, Massachusetts General Hospital, 55 Fruit St., Boston 02114, USA
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Araujo JA, Meng L, Tward AD, Hancock WW, Zhai Y, Lee A, Ishikawa K, Iyer S, Buelow R, Busuttil RW, Shih DM, Lusis AJ, Kupiec-Weglinski JW. Systemic rather than local heme oxygenase-1 overexpression improves cardiac allograft outcomes in a new transgenic mouse. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2003; 171:1572-80. [PMID: 12874251 DOI: 10.4049/jimmunol.171.3.1572] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Heme oxygenase-1 (HO-1), a rate-limiting enzyme in heme catabolism, exhibits potent antioxidant and anti-inflammatory properties. We developed HO-1 transgenic (Tg) mice using a rat HO-1 genomic transgene under the control of the endogenous promoter. Transgene expression was demonstrated by RT-PCR in all studied tissues, and a modest HO-1 overexpression was documented by Western, ELISA, and enzyme activity assays. To assess the effect of local vs systemic HO-1 in the acute rejection response, we used Tg mice as organ donors or recipients of MHC-incompatible heart grafts. In the local HO-1 overexpression model, Tg allografts survived 10.5 +/- 0.7 days (n = 10), compared with 6.5 +/- 0.4 days (n = 6) for wild-type donor controls (p = 0.0001). In the systemic HO-1 overexpression model, Tg recipients maintained allografts for 26.8 +/- 3.4 days (n = 10), compared with 6.3 +/- 0.1 days (n = 12) in wild-type controls (p = 0.00009). Inhibition of HO activity by treatment with tin protoporphyrin blunted survival advantage in Tg mice and resulted in acute graft rejection (n = 3). Increased carboxyhemoglobin levels were consistently noted in Tg mice. Comparisons of grafts at day 4 indicated that HO-1 overexpression was inversely associated with vasculitis/inflammatory cell infiltrate in both models. Hearts transplanted into Tg recipients showed decreased CD4(+) lymphocyte infiltration and diminished immune activation, as judged by CD25 expression. Thus, although local and systemic HO-1 overexpression improved allograft outcomes, systemic HO-1 led to a more robust protection and resulted in a significant blunting of host immune activation. This Tg mouse provides a valuable tool to study mechanisms by which HO-1 exerts beneficial effects in organ transplantation.
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Affiliation(s)
- Jesus A Araujo
- Division of Cardiology, University of California, Los Angeles, CA 90095, USA
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Brodkin CA, Moon JD, Camp J, Echeverria D, Redlich CA, Willson RA, Checkoway H. Serum hepatic biochemical activity in two populations of workers exposed to styrene. Occup Environ Med 2001; 58:95-102. [PMID: 11160987 PMCID: PMC1740098 DOI: 10.1136/oem.58.2.95] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether hepatic biochemical changes, as measured by routinely available tests indicative of hepatocellular necrosis, cholestasis, or altered hepatic clearance of bilirubin, occur in association with low to moderate exposure to styrene commonly experienced in industrial production. METHODS Two independent cross sectional studies were performed comparing serum hepatic transaminases (alanine aminotransferase (ALT) and aspartate aminotransferase (AST)), cholestatic enzymes (alkaline phosphatase (AP) and gamma glutamyl transpeptidase (GGT)), and bilirubin in (a) 47 workers of fibreglass reinforced plastics who were exposed to styrene and (b) 21 boat and tank fabricators, with separate referent groups of unexposed workers. Exposure to styrene was assessed in air by dosimetry, and in venous blood by headspace analysis. Hepatic biochemical variables were assessed across strata of exposure to styrene defined as 25 ppm in air, or 0.275 mg/l in blood, adjusting for age, sex, body mass index, and ethanol consumption. RESULTS A consistent and significant linear trend for increasing direct bilirubin and direct/total bilirubin ratio was found in association with increasing exposure to styrene, by both air and blood monitoring, in both studies. Mean direct bilirubin concentrations increased from 0.05-0.08 mg% in referents to 0.12-0.19 in workers exposed above 25 ppm, with a significant exposure-response trend (p<0.005). Significantly increased direct/total bilirubin ratios, ranging from 0.22 to 0.35 were associated with exposure to styrene (p<0.001), indicating diminished hepatic clearance of conjugated bilirubin. Also, a significant linear association between the hepatic transaminases ALT and AST and exposure to styrene was found in pooled regression analyses, with an increase in AP of about 10 IU/ml in workers exposed above 25 ppm air or 0.275 mg/l blood styrene in pooled analyses from both studies. CONCLUSIONS The consistent finding of increased direct bilirubin and AP concentrations in these two independent studies provides evidence for diminished hepatic clearance of conjugated bilirubin with associated cholestasis in workers exposed to styrene. The finding of a significant linear association between hepatic transaminase concentrations and exposure to styrene in pooled analyses is consistent with mild hepatic injury and associated metabolic dysfunction.
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Affiliation(s)
- C A Brodkin
- Department of Medicine, University of Washington, Seattle, WA, USA.
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Abstract
This paper presents certain simple procedures for assessing the most common types of interference, due to haemolysis, icterus or lipaemic serum in 19 routine Clinical Chemistry tests and suggests steps to overcome the problem in some tests. A change in the measured concentration, to be analytically significant, had to exceed 2.8 X % coefficient of variation (cv) of the intra-assay analytical variation of each assay. Haemolysis caused interference in 10 of the 19 assays investigated. A haemolysate haemoglobin concentration of 0.29 g/dl, visible to the eye, caused an analytically significant increase in creatinine kinase MB subunit (CKMB), lactate dehydrogenase (LDH), total protein, triglyceride, uric acid and urea, and a significant decrease in alkaline phosphatase (ALP), and total bilirubin. A higher concentration of haemoglobin (0.68 g/ dl) caused an additional significant increase in CK, and a decrease in direct bilirubin. Addition of bilirubin caused interference in all the peroxidase linked reactions as well as in the creatinine assay. At a serum concentration of 5.2 mg/dl it caused a decrease in creatinine, glucose, triglyceride and uric acid. At a higher concentration (15.9 mg/dl) it also decreased cholesterol. Lipaemia interference affected the least number of assays. An added triglyceride of 537-561 mg/dl caused an increase in glucose, uric acid, and amylase. At a level of 1122 mg/dl it also increased CKMB, and at a value of 2244 mg/dl it increased total and direct bilirubin. At the highest levels of haemolysis and lipaemia, the serum glutamate oxaloacetate transaminase (GOT) and giutamate pyruvate transaminase (GPT) gave erratic results. Overall uric acid and CKMB were the analytes most susceptible to interference, while serum caicium and phosphate did not suffer from any. The interference depends on the exact assay conditions used and the susceptibility of each individual laboratory's tests should be determined by them. The reasons for the interferences described are discussed.
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Affiliation(s)
- J J Fleming
- Department of Clinical Biochemistry, Christian Medical College and Hospital, 632 004 Vellore, Tamil Nadu
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Juretić D, Cepelak I, Flegar-Mestrić Z. External quality assessment in clinical chemistry: review of the situation in Croatia with particular reference to equipment. Clin Chem Lab Med 1999; 37:667-73. [PMID: 10475076 DOI: 10.1515/cclm.1999.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The effect of the use of new flame photometers (Ciba Corning 480, Chiron, Salzburg, Austria) and multichannel analyzers (BM Hitachi 904 or BM Hitachi 911, both Boehringer GmbH, Mannheim, Germany) on analytical quality was assessed in a number of medical biochemical laboratories (n=58) at health centers and general hospitals that provide primary health care services for the respective catchment areas. The laboratories were supplied during 1996 and 1997 with new equipment, as part of the First Croatian Health Project, Primary Health Care Subproject, carried out by the Croatian Ministry of Health and Croatian Institute of Health Insurance. We evaluated analytical performance of these laboratories for 19 analytes, according to the results reported in the Croatian External Quality Assessment Program for medical biochemical laboratories, performed four times per year. Changes of percentages of particular methods used by the participating laboratories were observed for inorganic phosphate, total bilirubin, urea and creatinine. Such changes were even more pronounced for enzymes, where changes in the measurement procedure such as incubation temperature and buffers were observed in the methods used. Evaluation of method performance revealed that after the introduction of new equipment interlaboratory variation decreased, so that an increasing proportion of laboratories included in the Project produced results within the target limits.
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Affiliation(s)
- D Juretić
- Farmaceutsko-biokemijski fakultet, Zavod za medicinsku biokemiju i hematologiju, Sveuciliste u Zabrebu, Croatia
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Keffler S, Kelly DA, Powell JE, Green A. Population screening for neonatal liver disease: a feasibility study. J Pediatr Gastroenterol Nutr 1998; 27:306-11. [PMID: 9740202 DOI: 10.1097/00005176-199809000-00007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Extra-hepatic biliary atresia and several other causes of neonatal liver disease carry high mortality and morbidity rates, especially if not treated early in life. Despite professional recommendations, delayed referral of infants with prolonged jaundice continues to be a significant problem. One approach to reducing the age of referral and diagnosis is population screening to detect significant conjugated hyperbilirubinaemia as an index of liver dysfunction. METHODS To investigate this possibility, and to provide reference data on bilirubin and its conjugated and unconjugated fractions in a normal newborn population, 1157 neonates were anonymously tested (median age 7 days, range 4-28 days) using surplus plasma from routinely collected neonatal screening specimens, using dry slide chemistry. RESULTS Of 2310 specimens received, 50% were suitable for analysis. The remainder were either haemolysed or insufficient (10% and 40% of the total, respectively). Total bilirubin concentrations ranged from 9 to 428 micromol/l and conjugated bilirubin from 0 to 175 micromol/l, although the latter was rarely increased to more than 30 micromol/l (2.5th-97.5th percentile ranges 15-285 micromol/l and 0-18 micromol/l, respectively). The range of the percentage of conjugated bilirubin was 0-57% (2.5th-97.5th percentile; range 0-20%). CONCLUSION An increased conjugated bilirubin, expressed as a concentration or as the percentage of the total bilirubin, could be used as a specific marker to screen for liver dysfunction in neonates. This approach has the potential to improve the age of referral and the prognosis of infants with neonatal liver disease.
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Affiliation(s)
- S Keffler
- Department of Clinical Chemistry, Birmingham Children's Hospital NHS Trust, United Kingdom
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Jagarinec N, Flegar-Mestrić Z, Surina B, Vrhovski-Hebrang D, Preden-Kereković V. Pediatric reference intervals for 34 biochemical analytes in urban school children and adolescents. Clin Chem Lab Med 1998; 36:327-37. [PMID: 9676391 DOI: 10.1515/cclm.1998.055] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Concentrations of 34 biochemical constituents of sera were determined on 998 randomly selected urban school children and adolescents aged 8-18 years from Zagreb, Croatia. Reference intervals were obtained by using non-parametric methods to estimate 2.5 and 97.5 percentiles of distribution as upper and lower normal reference intervals, according to the IFCC recommendations. These were compared to reference intervals in the healthy adult population, aged 20-30 years from the same geographical area. Serum glucose, potassium, sodium, chloride, magnesium, iron, zinc, total serum proteins and electrophoretic fractions, and amylase, did not show age or sex differences; total serum bilirubin, total calcium, phosphate, high density lipoprotein cholesterol, total iron binding capacity, unsaturated iron binding capacity, copper, aspartate aminotransferase, alkaline phosphatase, cholinesterase, creatine kinase, and lactate dehydrogenase had higher reference intervals than the adult population. Urea, creatinine, urate, alanine aminotransferase, gamma-glutamyltransferase, total cholesterol and low density lipoprotein-cholesterol, and triglycerides had lower reference intervals than the adult population.
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Affiliation(s)
- N Jagarinec
- Zavod za klinicku kemiju, Klinicka bolnica Merkur, Zagreb, Croatia
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Parviainen MT. A modification of the acid diazo coupling method (Malloy-Evelyn) for the determination of serum total bilirubin. Scand J Clin Lab Invest 1997; 57:275-9. [PMID: 9238764 DOI: 10.3109/00365519709060037] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A simple and reliable method for the determination of total bilirubin from human serum is described. In this method, indirect bilirubin is liberated by the tenside in 0.12 mol l-1 HCl (R1), and the total bilirubin is coupled with a 2,5-dichlorobenzene diazonium (DBD) salt to obtain the corresponding azobilirubin having a lambda max of about 520-522 nm. The method can easily be applied to the KONE Delta, a fully automated, discrete random access clinical analyser, and also to less modern instruments. A sample volume of 5 microliters, R1 volume of 180 microliters, and R2 volume of 36 microliters was used on the KONE Delta. After a 5-min incubation at 37 degrees C, measurement at 575 nm was done (main wavelength). The within-run imprecision (CV%) varied from 2.9 to 0.3% within the serum total bilirubin range of 14-290 mumol l (n = 10). The between-run imprecision was from 2.2 to 1.3% within the range 13-97 mumol l-1 (n = 8). The method is linear up to at least 340 mumol l-1 (19.8 mg dl-1), and dilution extends the test limit to 3400 mumol l-1 (198.8 mg dl-1). The linearity of dilution was good over the practical measuring range. The present method had a strong linear correlation with the Boehringer 2,5-dichlorophenyl diazonium (DPD) method on the Hitachi 717 analyser: y(DBD) = 1.018x(DPD)+0.758, r = 0.9955 (n = 61). The stability of R2 (diazo reagent) in the analyser reagent compartment lasts at least 2 weeks.
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Affiliation(s)
- M T Parviainen
- Department of Clinical Chemistry, University of Kuopio, Finland
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Affiliation(s)
- L P Palilis
- University of Athens, Laboratory of Analytical Chemistry, Greece
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Gulian JM, Dalmasso C, Millet V, Unal D, Charrel M. Influence of photoisomers in bilirubin determinations on Kodak Ektachem and Hitachi analysers in neonatal specimens study of the contribution of structural and configurational isomers. EUROPEAN JOURNAL OF CLINICAL CHEMISTRY AND CLINICAL BIOCHEMISTRY : JOURNAL OF THE FORUM OF EUROPEAN CLINICAL CHEMISTRY SOCIETIES 1995; 33:503-12. [PMID: 8547434 DOI: 10.1515/cclm.1995.33.8.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We compared data obtained with the Kodak Ektachem and Hitachi 717 Analysers and HPLC from 83 neonates under phototherapy. Total bilirubin values determined with the Kodak and Hitachi are in good agreement, but we observed a large discrepancy in the results for conjugated (Kodak) and direct (Hitachi) bilirubin. HPLC revealed that all the samples contained configurational isomers, while only 7.7% and 30.8% contained conjugated bilirubin and structural isomers, respectively. We developed a device for the specific and quantitative production of configurational or structural isomers, by irradiation with blue or green light. In vitro, total bilirubin values are coherent for the routine analysers in the presence of configurational or structural isomers. With configurational isomers, unconjugated bilirubin (Kodak) is lower than total bilirubin (Kodak), and conjugated bilirubin (Kodak) is always equal to zero, so the apparatus gives a false positive response for delta bilirubin. In contrast, the direct bilirubin (Hitachi) is constant. Furthermore, in the presence of structural isomers, unconjugated bilirubin (Kodak) is unexpectedly higher than total bilirubin (Kodak), conjugated bilirubin (Kodak) is proportional to the quantity of these isomers, and direct bilirubin (Hitachi) is constant. The contribution of photoisomers in bilirubin measurements is discussed.
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Affiliation(s)
- J M Gulian
- Laboratoire de Chimie Biologique, Faculté de Médecine, Marseille, France
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Boot S, LaRoche N, Legg EF. Elimination of bilirubin interference in creatinine assays by routine techniques: comparisons with a high performance liquid chromatography method. Ann Clin Biochem 1994; 31 ( Pt 3):262-6. [PMID: 8067667 DOI: 10.1177/000456329403100308] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The aim of this study was to find a method for creatinine analysis unaffected by jaundice by comparing four different methods with high performance liquid chromatography (HPLC) as a reference method. The methods investigated were Kodak DTSC single slide, Boehringer alkaline picrate with and without blank correction and a Boehringer enzymatic method, the last three using the Hitachi 737 analyser. HPLC results were compared with the results of the methods studied. In addition, graphs plotting the difference from the HPLC result against the bilirubin concentration were made; the ideal method would yield a slope and intercept of zero. While all methods showed a positive bias compared with HPLC, the Kodak slide and the Boehringer alkaline picrate with blank correction methods eliminated bilirubin interference and we have changed to the latter method as a consequence of this work.
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Affiliation(s)
- S Boot
- Department of Clinical Biochemistry, East Birmingham Hospital, Bordesley Green, UK
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Franzini C, Cattozzo G, Galletta G. Methods for the measurement of serum delta-bilirubin. Ann Clin Biochem 1992; 29 ( Pt 1):116-7. [PMID: 1536520 DOI: 10.1177/000456329202900121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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