Jaundice profile

 

Approximate Price of test

 

in egypt

:

 

 

 

Total .bilirubin  ;  15 pound

 

Direct .Bilirubin :

15 pound

Serum . Bilirubin (total ; ind ;direct) :  30 pound

 

Introduction :

 

  •  

    Jaundice

    :  Yellow discoloration of 

    skin and eyes due to increase of bile pigment in the blood

 

  •  

    Bilirubin

    it is byproduct of heme 

    catabolism from aged RBCs

 

It is useful

in diagnosis and monitoring of liver disease and hemolytic disease and

assessment of severity of jaundice .

 

  • Serum

    bilirubin  :  contain two different form of bilirubin

 

1-      indirect bilirubin

(unconjugated)

2-      Direct bilirubin  ( conjugated)

 

Heme degradation & Bilirubin metabolism:

 

  • The protoporphyrin ring of the

    heme is opened to the biliverdin form and iron is released

  • Biliverdin is reduced to produce

    the yellow-pigmented molecule unconjuagted bilirubin ( insoluble or has low

    solubility in water or plasma)

  • the liver enzyme uridyl

    diphosphate glucuronyltransferase (UDPG-transferase) transfers moleculesof

    glucuronate, a sugar, to the bilirubin molecule. About 85% of bilirubin is

    conjugated  two molecules of glucuronate

    to form diglucuronate-bilirubin. Most of the rest of bilirubin is conjugated

    with one sugar molecule to form monoglucuronate-bilirubin.

  • Conjugated

    bilirubin passes into the intestine through the bile duct, where intestinal

    bacteria reduce bilirubin to urobilinogen

  • Some

    urobilinogen may be reabsorbed through the intestinal mucosa and returned to

    the portal circulation and the liver.

  • The

    remaining urobilinogen is excreted into urine or oxidized to form urobilin and

    excreted in the feces

 

 

 

 

Practical part :

 

  • Sampling precautions: 

 

1.     

 

protect serum from

light ? why

 

 

 

     Due to photo

degradation of bilirubin by light exposure

 

 

2.     

Avoid hemolysis  ? why

 

 

    Due to hemolysis

interfere with result cause decrease bilirubin value

 

 

 

 

Note : 

 

For bilirubin determination in

newborns, pipette 50 μL of sample. Multiply the result by

2.

 

Principle of Reaction  :

Direct bilirubin

 

Sulfanilic acid + NaNo2                                 diazide

sulfanilic acid

 

Bilirubin  + diazide sulfanilic acid                            Azobilirubin

 

In Total Bilirubin :  

we

use

 

 

 

Caffine: used as activator to release unconjugted bilirubin from

albumin which attach to it

Titrate: used to stop reaction 

 

 

Na oH : convert

pH of reaction so colure convert to yellow then green

 

INDICATIONS:

 

• Assist in the differential diagnosis of

obstructive jaundice

 

• Assist in the evaluation of liver and biliary

disease

• Monitor the effects of drug reactions  on liver function

• Monitor jaundice in newborn patients

• Monitor the effects of phototherapy on  jaundiced newborns

 

Interpretation of results :

 

Prehepatic ( increased indirect bilirubin):

  •  All forms of hemolytic anemia
  • Hemolytic disease of newborn 

 

Hepatic

 

                Impaired hepatic uptake (increased

indirect )

 

  •  Gilbert syndrome
  • Hepatits
  • Cirrhosis 

 

           Impaired conjugation (increased both

direct& indirect)

 

  • Viral Hepatits
  • Cirrhosis
  • Premature infants
  • Crigler-Najjer syndrome
  • Novobiocin intake

       Impaired Secretion ( increase Direct)

  • Dubin Jonson syndrome
  • Rotor syndrome
  • Generalized liver

    damage 

 

Posthepatic (Increase direct)

  • Gall stone
  • Cancer of head of pancreas

 

Gilbert syndrome

 

Mild deficiency of UDPG Transferase enzyme

 

Increased after  fasting or

Caffien

 

Crigler_Najjer Syndrome

Marked Reductionof UDPG transferase enzyme

In neonate; may lead to kernicterus and then death

 

Dubin_Jonson syndrome

Defect in transfer of conjugated bilirubin

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