Hydrogen Peroxide Hemolysis: A Test for Biliary Obstruction

Abstract

To detect the presence of complete bilary obstruction in the neonatal period, we have utilized the red cell hydrogen peroxide hemolysis (PH) test. This simple procedure is based on the fact that vitamin E, a fat soluble vitamin, is dependent upon bile salts in the intestine for absorption. Red blood cells hemolyze in the presence of hydrogen peroxide when cellular vitamin E is depleted. Hence, in severe biliary obstruction, the PH test hsould be positive. The PH test was performed in 20 patients age 7 weeks to 7 months with documented obstructive liver disease. Eighteen of these patients came to surgery. All of the biliary atresia (BA) patients, regardless of age, had a positive PH test. One patient with BA had a positive PH test prior to corrective surgery. The PH test became normal when bile flow was restored. In contrast, the PH test was variable in neonatal hepatitis. Some patients with complet obstruction demonstrated by Rose Bengal excretion the obstruction ceased. Others were normal at the outset. We conclude that the PH test is a simple and useful adjunct in evaluation of jaundiced infants. IF normal, BA has been ruled out. If initially abnormal, but corrected with oral vitamin E, BA has also been ruled out. Thus the PH test rapidly provides as much diagnostic information as Rose Bengal excretion. It is not associated with sampling difficulties or radiation exposures and should be used as a diagnostic test for complete biliary obstruction in neonatal liver disease.