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Lab Manual for UCSF Clinical Laboratories

Lab Manual for SFGH

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Item Value
Available Stat? Yes
Test code Bilirubin, Total: TBIL
Bilirubin, Direct : DBIL
Performed by? Chemistry
Sendout? no
Price range $
In House Availability Total: Routine: 7 days.
Direct: Routine: 7 days.
STAT: 24 Hours/7 days.
Principle Bilirubin is oxidized by vanadate at about pH 3 to produce biliverdin. In the presence of a detergent and vanadate, either conjugated (direct) or both conjugated (direct) and unconjugated bilirubin are oxidized. The decrease in optical density at 451 nm is proportional to the total bilirubin concentration in the sample. The concentration is measured as an endpoint reaction.
Interpretation 1. Major elevation of Indirect Bilirubin: Hemolytic anemia, hepatitis, Crigler-Najjar syndrome, Gilbert's disease.

2. Major elevation of Direct Bilirubin: Obstructive jaundice, Dubin Johnson and Rotor Syndrome.

Clinical jaundice appears at levels above 3 mg/dL (51.3 mcmol/L) serum bilirubin. Bilirubin may be followed in the urine with a reagent strip. Trace bilirubin in the urine is abnormal.
Special instructions Avoid exposure to direct light. Avoid hemolysis. Exposure to light will decrease serum bilirubin. Hemolysis (in vitro) will increase bilirubin levels. Grossly hemolyzed samples will not be assayed.

Fasting or post-absorptive state. A 48-hr fast can produce an increase of 200-240%.
Normal range Total Bilirubin
Age mg/dL mcmol/L
> 5 days– 60 years 0.1-1.2 1.71-20.5
60 – 90 years 0.1-1.1 1.71-18.8
> 90 years 0.1-0.9 1.71-15.4

0 - 1 days 1.4-8.7 23.9-148.8
1 - 3 days 3.4-11.5 58.1-196.7
3 - 5 days 1.5-12.0 25.7-205.2

Direct Bilirubin (all ages): 0.1-0.3 mg/dL (1.71-5.1 mcmol/L)

In infants, pathologic significance is ascribed in individual cases based on the magnitude and the rate of rise. Contact the Pediatric Nursery Resident for more information.

Critical values All values greater than 19.9 mg/dL (> 340 mmol/L) for neonates less than 30 days old are called to the physician or patient care unit immediately.
Synonyms Liver Panel (ALB, ALT, AST, ALKP, TP, TBIL, DBIL);Metabolic Comprehensive Panel (METC): METB, TBIL, TP, ALB, ALT, AST, ALKP;
Stability Photosensitive, may decrease by 50% within 1-2 hr. For optimal stability, darkness and low temperatures are necessary. Stable 3 days at 4°C in the dark; 3 months at -70°C.
References Total and Direct
1. Rosenthal P, et al.: Total and Direct-Reacting Bilirubin values by Automated Methods Compared with Liquid Chromatography and with Manual Methods for Determining Delta Bilirubin. Clin Chem. 1990. 36: 755-91.

2. Bayer(TM) Clinical Methods Direct Bili; Total Bili. Advia 1650 Operator's Guide. PN 073-5001-09. Siemens Medical Solutions Diagnostics, Malvern, PA.

3. Westwood A: The Analysis of Bilirubin in Serum. Ann Clin Biochem. 1991. 28:119-30.

4. Young, DS. Effects of Drugs on Clinical Laboratory Tests. Ed. 4. Washington, D.C.: AACC Press; 1995.

5. Tietz, N.W. Textbook of Clinical Chemistry and Molecular Diagnosis, ed. 4. St. Louis, MO: Elsevier Saunders, 1193-1201; 2006.

6. Soldin, SJ, et al. Pediatric Reference Ranges 3rd ed. AACC Press 1999. Washington DC, pg. 45.
CPT coding 82010, 82248

Last Updated 7/1/2015 1:18:09 PM
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