Liver Function Test (Bilirubin | P)
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What is bili?
1) It is the end product of hgb metabolism 2) It is the principal pigment of bile
Process of bili metabolism?
1) The RBCs (that are already senescent / near to being senescent) are engulfed by macrophages / monocytes (from the spleen; from the reticuloendothelial system) 2) The RBCs will be broken down into hgb 3) Hgb will be broken down into heme 4) Heme will be converted into biliverdin reductase via the enzyme heme oxygenase 5) Biliverdin will be further metabolized into UCB via the enzyme biliverdin reductase 6) UCB will be bounded to albumin for it to be transported to the liver from the spleen 7) In the liver, this is where conjugation from UCB to CB happens. Along w/ conjugation, the albumin is removed for it to become H2O soluble (for it to become excreted in the urine) 8) Since CB is now already H2O soluble, it will combine w/ bile and will be excreted from the liver
What are the characteristics of UCB?
1) It is also called as unconjugated / bilirubin 1 2) It is H2O-insoluble 3) It is also called as indirect bili 4) It is also called as hemobilirubin 5) It is also called as pre-hepatic bilirubin
What are the characteristics of CB?
1) It is also called as conjugated / bilirubin 2 2) It is H2O-soluble 3) It is also called as direct bilirubin 4) It is also called as cholebilirubin 5) It is also called as post-hepatic bilirubin
What is delta bili?
It is a CB w/c is tightly bound to albumin
What are the characteristics of delta bili?
1) It has a longer half life compared to other forms of bili 2) It directly reacts w/ diazo rgnt
Why is delta bili formed?
It is formed due to prolonged elevation of CB in biliary obstruction (obstructive jaundice)
What is the condition present if a pt has jaundice?
The pt is icterus / hyperbilirubinemia
What are the characteristics of a pt w/ jaundice?
The pt has yellow discoloration of the: 1) Skin 2) Sclera 3) Mucus membranes
What is the bili lvls of a pt w/ jaundice (or possible to have jaundice)?
2 mg/dL >
What are the sx considerations for bili lvls determination?
1) The sx must be free from hemolysis 2) The serum should be stored in the dark 3) The sx / serum must be measured ASAP
What is the principle used for determination of bili lvls?
Van den Berg
What are the 2 procedures for determination of bili lvls (w/c uses the principle of Van den Berg)?
1) Evelyn and Malloy 2) Jendrassik and Grof
What is the product for Evelyn and Malloy & Jendrassik and Grof?
Azobilirubin
What is the color of the product in Evelyn and Malloy?
Pink to purple azobili
What is the color of the product in Jendrassik and Grof?
Pink to blue azobili
What is the accelerant used in Evelyn and Malloy?
Methanol
What is the accelerant used in Jendrassik and Grof?
Caffeine
What is the process (or steps) for determination of bili lvls?
1) Label test tubes: blank, standard, unknown 2) Dispense 1,000 uL of bilirubin working rgnt to all tubes 3) Add 50 uL Na nitrite to all tubes 4) Add 100 uL of each standard, blank, and sx to its respective tube. Mix well 5) Allow all tubes to stand for 5 mins at room temp 6) Set the wavelength of the instrument at 560 nm 7) Read and record the A of all tubes
What is the normal reference range of bili for infants (after 1 month) and for adults?
0.2 - 1.0 mg/dL
What is the normal reference range of bili for newborns who are 1 day old?
Up to 5.1 mg/dL
What is the normal reference range of bili for newborns who are 1 - 2 days old?
Up to 7.2 mg/dL
What is the normal reference range of bili for newborns who are 3 - 5 days old?
Up to 10.3 mg/dL