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Clinical Chemistry 50: 190-194, 2004. First published November 18, 2003; 10.1373/clinchem.2003.019216
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(Clinical Chemistry. 2004;50:190-194.)
© 2004 American Association for Clinical Chemistry, Inc.

General Clinical Chemistry

Performance of Bilirubin Determinations in US Laboratories—Revisited

Stanley F. Lo1,2,a, Basil T. Doumas1,2 and Edward R. Ashwood3

1 Reference Standards Laboratory, Department of Pathology and Laboratory Medicine, Children’s Hospital of Wisconsin, Milwaukee, WI.
2 Department of Pathology, Medical College of Wisconsin, Milwaukee, WI.
3 ARUP Laboratories, Department of Pathology, University of Utah, Salt Lake City, UT.

aAddress correspondence to this author at: Reference Standards Laboratory, Children’s Hospital of Wisconsin, 9000 W. Wisconsin Ave., Milwaukee, WI 53226. Fax 414-266-2779; e-mail slo{at}mail.mcw.edu.

Background: The diagnosis and management of hyperbilirubinemia in the newborn requires accurate and precise bilirubin determinations. We evaluated the current status of bilirubin measurements in US laboratories by examining data submitted by laboratories participating in the College of American Pathologists (CAP) Neonatal Bilirubin (NB) and Chemistry (C) Surveys.

Methods: We analyzed specimens from the CAP NB and C Surveys by the reference method for total bilirubin in three laboratories. The reference method bilirubin values were compared with bilirubin values reported by Survey participants.

Results: The imprecision (CV) for all instruments combined (CAP-All Instruments) ranged from 4.7% to 5.6% at the bilirubin concentrations tested. The CVs of the four most commonly used instruments were smaller, ranging from 1.9% to 4.5%. Differences between bilirubin values by the reference method and mean values from the four most common instruments ranged from -21.6% to 10.9%. When the same specimens from the NB Surveys were used in the C Surveys, the Vitros values were strikingly different from those of the NB Surveys. The use of different methods in the NB and C Surveys coupled with the presence of a nonhuman protein base and ditaurobilirubin (DTB) in the Survey specimens accounted for the discrepant results.

Conclusions: The evaluation of accuracy is impossible from the CAP Surveys because the specimens consist of bovine serum containing a mixture of unconjugated bilirubin and DTB. For the evaluation of accuracy, we recommend that Survey specimens consist of human serum enriched with unconjugated bilirubin.




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