Estimation Of Total Bilirubin Research Articles

PREVALENCE OF HYPOMAGNESEMIA IN CIRRHOSIS OF LIVER AND ITS ASSOCIATION WITH SEVERITYOF THE DISEASE

Objectives: The objectives of the study are as follows: (1) To study the prevalence of hypomagnesemia in liver cirrhosis patients. (2) To evaluate association between hypomagnesemia and severity of liver disease. Methods: It was a cross-sectional study for 1 year. Seventy-one liver cirrhosis patients attending medicine OPD and those admitted in ward, ICU at Government Medical College, Kozhikode. Informed consent was taken from 71 liver cirrhosis patients. Samples for serum magnesium, total bilirubin, and albumin were collected from cases in blood collection tube without anticoagulant and centrifuged to get serum. Estimation of magnesium was done using colorimetric end point method. Estimation of total bilirubin was done using Diazo method and that of serum albumin with Bromocresol Green dye method. SPSS (Version 22.0) was used for analysis. Results: Among the study patients, hypomagnesemia was prevalent in majority (71.8%) of cases. The mean magnesium levels between different grades of liver cirrhosis were statistically significant at p=0.001. Levels of serum magnesium were significantly decreased with advancement of liver cirrhosis. Conclusion: Hypomagnesemia is prevalent in liver cirrhosis patients. Serum magnesium decreases significantly with severity of liver cirrhosis. A routine assessment of serummagnesium in liver cirrhosis patients may be effective in management protocol ofliver cirrhosis.

Hyperuricemia in patients with pulmonary hypertension: A study in a tertiary care center

Pulmonary Hypertension is one of a life-threatening disease with high rate of patient mortality. Decreased cardiac output and tissue hypoxia is measured using Uric acid as a marker for assessment of pulmonary hypertension. 75 patients who were diagnosed with a mean pulmonary arterial pressure of >22mmHg were categorized as group A and 75 healthy patients were considered to be Group B. Blood was collected for Uric acid, creatinine and total Bilirubin estimation. Pulmonary arterial systolic pressure as well as the ventricular function of the patients was evaluated using Colour Doppler ECG and a value of ≥50 mmHg, or a mean pulmonary arterial pressure (at rest) of ≥25 mmHg was taken and the right arterial pressure was calculated. Using the Simpson’s formula, the right and left ventricular ejaculation factors (RVEF, LVEF) were calculated. The serum uric acid levels among the patients were 8.3±1.4mg/dL, creatinine levels were 2.1 ± 0.5 mg/dL, and the total bilirubin levels were 1.9 ± 0.8 mg/dL all of which was significantly higher than the controls. The uric acid levels were also positively correlated to the NHYA class. The blood pressure and the pulmonary arterial pressure were also higher than that of the controls. The correlation was done between the elevated uric acid and ejection fractions and the correlation coefficients of MPAP, LVEF, RVEF and the NYHA class were all significantly associated and the values were 0.394, -0.513, -0.467 and 0.38 respectively. High serum uric acid levels is significantly associated with higher blood pressure, pulmonary arterial pressure and NYHA class. High serum uric acid levels can be a reliable prognostic marker for the detection of pulmonary hypertension. Early therapy may help in the reduction of mortality rate.

False high level in total bilirubin estimation in nonicteric serum

In day to day clinical biochemistry laboratory practices, occasionally abnormal levels of individual parameters are noted. These reports cannot be explained immediately with certainty always. Inquisitiveness with in-depth analysis might reveal the possible cause sometimes. To find out the possible cause of false elevation in total bilirubin estimation in nonicteric serum from one patient was the objective. Routine estimation of total bilirubin in serum/plasma by the decade old practice of using very reliable and stable reagent kit from Roche in the biochemistry laboratory of a general hospital revealed a falsely very high value of total bilirubin in a patient’s blood sample for the first time. Subsequently, the same sample was subjected to estimation of total bilirubin by DiaSys and Randox reagents along with simultaneous re-estimation by Roche reagents in next three days. Repeated estimations by Roche reagents showed falsely very high level of total bilirubin. However, estimation by DiaSys and Randox reagents showed acceptable normal levels as per visual estimation. There was interference, most probably due to paraprotein in the estimation of total bilirubin by Roche reagents but not by DiaSys and Randox reagents in that particular sample.Keywords: False, high, positive, total bilirubin, nonicteric, serum.

A Curious Case of Hyperbilirubinemia

A 60-year-old patient suffering from easy fatigability was noted to have high total but normal conjugated bilirubin level though serum colour was pale. On further investigation the patient was found to be suffering from multiple myeloma and gamma globulin was possibly interfering with total bilirubin estimation.

Perspective on Neonatal Hyperbilirubinemia

Jaundice in newborns provides a different response from the parents whencompared to jaundice in older children and adults. Physiologic hyperbilirubinemia occurs commonly in term newborn infants in the absence of any underlying pathologic cause. Yet, the jaundice itself is commonly regarded as a problem in the transition to extrauterine life.In Neonatal hyperbilirubinemia (NHB) the total bilirubin level is greater than 15mg/dL in 15 day or less old neonates and 2mg/dL in neonates above 15 days of age. Estimation of total bilirubin is preferred in the routine analyses for NHB compared to measurement of direct bilirubin. If certain conditions like sepsis, hepatic infections and other liver diseasesare present it may be prudent to use direct bilirubin measurement. Yet contrary to the usual assumption of pathology, there are several lines of evidence supporting an adaptive role for neonatal hyperbilirubinemia. First, experimental and clinical evidence indicate that neonatal enzyme systems are not yet mature at birth; bilirubin has been demonstrated toscavenge potentially toxic oxygen free radicals that in later life are removed by the mature antioxidant enzyme system. Second, presence of bilirubin in mammals, similar patterns of expression of neonatal hyperbilirubinemia in nonhuman primates, and significant interpopulation variation in newborn serum bilirubin levels among humans all suggest that bilirubin production, metabolism, and excretion are under genetic control. Therefore bilirubin metabolism and its understanding may help improve its diagnosis and prognosis.