Indian Journal of Medical Biochemistry

Register      Login

VOLUME 26 , ISSUE 1 ( January-April, 2022 ) > List of Articles

ORIGINAL RESEARCH ARTICLE

Understanding the Difference in Various Fractions of Serum Bilirubin while Estimated by Wet Chemistry and Dry Chemistry Method and its Importance in Neonatal Jaundice

Kaushal Kishor Singh, Kalpana Singh, Mala Kumar

Keywords : Conjugated bilirubin, Dry chemistry, Hyperbilirubinemia, Serum bilirubin, Unconjugated bilirubin, Wet chemistry

Citation Information : Singh KK, Singh K, Kumar M. Understanding the Difference in Various Fractions of Serum Bilirubin while Estimated by Wet Chemistry and Dry Chemistry Method and its Importance in Neonatal Jaundice. Indian J Med Biochem 2022; 26 (1):9-14.

DOI: 10.5005/jp-journals-10054-0200

License: CC BY-NC 4.0

Published Online: 03-01-2023

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Aim: The aim of this study is to find out the percentage of variation of bilirubin values in neonates by two different techniques: Dry chemistry versus wet chemistry method, and also to establish that unconjugated bilirubin ≠ indirect bilirubin and conjugated bilirubin ≠ direct bilirubin. Materials and methods: This comparative study was conducted over a period of 6 months from October 2019 to March 2020. Ethical approval was taken from Institutional Ethical Committee. Informed and written consent were taken from the parents of the enrolled neonates. A total of 195 blood samples were randomly collected from neonates (<14 days) admitted with neonatal hyperbilirubinemia in Department of Pediatrics for estimation of serum bilirubin fractions by two techniques, i.e., traditional wet chemistry and dry chemistry. The statistical analysis of data was performed by using software package SPSS version 16 and Microsoft Excel 2019. Results: In our study, mean total bilirubin measured by dry chemistry method Total bilirubin (TBild), neonatal bilirubin (BuBc/NBil) estimated by dry chemistry method, and total bilirubin estimated by wet chemistry method (TBilw) were 12.42 mg/dL, 12.21 mg/dL, and 11.72 mg/dL, respectively. Conclusion: Total bilirubin estimated by dry and wet chemistry methods differ due to difference in the principle of methods by which they are estimated in laboratories. Neonatal bilirubin (BuBc/NBil) may be preferred over total bilirubin estimated by wet chemistry as dry chemistry is estimating unconjugated and conjugated fractions of bilirubin, while in wet chemistry, direct bilirubin is estimated and indirect bilirubin is calculated. Hence, the term unconjugated bilirubin cannot be interchanged with indirect bilirubin and conjugated bilirubin as direct bilirubin. Clinical significance: Measurement of serum bilirubin among neonates with hyperbilirubinemia is an essential part for diagnosis and monitoring of neonatal jaundice. Both dry and wet chemistry methods correlated well, any method can be used for measurement of bilirubin, but switching the method while monitoring serum bilirubin levels during treatment must be discouraged.


HTML PDF Share
  1. Kuenzle CC, Maeir C, Rutter JR. The nature of four bilirubin fractions from serum and of three bilirubin fractions from bile. J Lab Clin Med 1966;67:294–306. PMID: 5902890.
  2. Kaplan M, Muraca M, Hammerman C, et al. Imbalance between production and conjugation of bilirubin: A fundamental concept in the mechanism of neonatal jaundice. Pediatrics 2002;110(4):e47. DOI: 10.1542/peds.110.4.e47.
  3. Kramer LI. Advancement of dermal icterus in jaundiced newborn. Am J Dis Child 1969;118(3):454–458. DOI: 10.1001/archpedi.1969. 02100040456007.
  4. Dennery PA, Seidmar DS, Stevenson DK. Neonatal hyperbilirubinemia. N Engl J Med 2001;344(8):581–590. DOI: 10.1056/NEJM 200102223440807.
  5. Manning D. American Academy of Pediatrics guidelines for detecting neonatal hyperbilirubinemia and preventing kernicterus. Arch Dis Child Fetal Neonatal Ed 2005;90(6):F450–F451. DOI: 10.1136/adc.2004.070375.
  6. Puppalwar PV, Goswami K, Dhok A. Review on evolution of methods of bilirubin estimation. IOSR J Dent Med Sci 2012;1(3):17–28. DOI: 10.9790/0853-0131728.
  7. Gourley GR, Bhutani V, Johnson L, et al. Measurement of serum bilirubin in newborn infants: Common clinical laboratory method versus high performance liquid chromatography (HPLC). Pediatr Res 1999;45:283(A). DOI: 10.1203/00006450-199904020-01683.
  8. Sherwin JE, Thompson C. Liver function. In: Kaplan LA, Pesce AJ, Kazmierczak SC (eds). Clinical Chemistry: Theory, Analysis, Correlation, 4th ed., Mosby Inc.: St. Louis, USA; 2004.
  9. Vitros Chemistry Products TBil slides. Instructions for Use: Technical Document. Version 13 Pub. No. MP2-39_EN.
  10. Berska J, Bugajska J, Sztefka K. Newborns bilirubin concentration determined by different methods in relation to hematocrit and albumin level. J Med Biochem 2020;39(2):171–177. DOI: 10.2478/jomb-2019-0030.
  11. Kishore KR, Haridas C, Arshiya A, et al. Serum bilirubin – which method of estimation is more accurate? J Neo Res Pediatr Care 2018;1(1):1–5.
  12. Padmanabhan P, Hotkar KN, Nagarkar VD, et al. Estimation of various fractions of bilirubin in cases of neonatal jaundice. Int J Clin Biochem Res 2016;3(2):194–200. DOI: 10.5958/2394-6377.2016.00039.3.
  13. Lo SF, Doumas BT, Ashwood ER. Performance of bilirubin determinations in US laboratories-revisited. Clin Chem 2004;50(1): 190–194. DOI: 10.1373/clinchem.2003.019216.
  14. Davis AR, Rosenthal P, Escorbar GJ, et al. Interpreting conjugated bilirubin levels in newborns. J Pediatr 2011;158(4):562–565.e1. DOI: 10.1016/j.jpeds.2010.09.061.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.