A Curious Case of Hyperbilirubinemia

Dutta, Atanu Kumar

doi:10.1007/s12291-011-0160-0

Cited by 2 publications

(1 citation statement)

References 6 publications

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“…IgG and IgM paraproteins have been suggested to interfere with total bilirubin assays, especially on Roche analyzers, by forming precipitants (1)(2)(3)(4)(5). In this case, IgA-and possibly Bence Jones involvement were indicated.…”

Section: What Is Your Guess?mentioning

confidence: 89%

Hyperbilirubinemia in Anicteric Blood?

et al. 2014

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CASE DESCRIPTIONPlasma total bilirubin for a 65-year-old man was high [19.1 mg/dL (326 mol/L)] on a Roche cobas 6000 analyzer. However, the specimen was anicteric and the icteric index was 1 (approximately 1 mg/dL or 17 mol/L). A dilution study demonstrated nonlinear results. Direct bilirubin was measured as normal. The split specimen aliquots were further measured on analyzers from 5 different manufacturers (Table 1). The patient's total protein and albumin were 93 and 34 g/L (reference intervals: 60 -80 and 38 -50 g/L). QUESTIONS 1. What might cause artifactual hyperbilirubinemia in anicteric blood? 2. What strategies can be employed to deal with spurious increased bilirubin results?The answers are below. ANSWERSThe patient's serum IgG, IgM, and IgA concentrations were 3.9, 0.1, and 39.2 g/L, respectively. Protein electrophoresis revealed an IgA-paraprotein (38.3 g/L), a small Bence Jones in serum, and a prominent Bence Jones (27.3 g/day) in urine.

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Section: What Is Your Guess?mentioning

confidence: 89%

Hyperbilirubinemia in Anicteric Blood?

et al. 2014

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Direct Bilirubin Level Greater than Total Bilirubin Level

Yang

Chen

Dai

2022

Journal of Medical Sciences

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Paraproteins have been reported to cause interference in a sort of chemistry assays conducted by current automated chemistry analyzers. However, the nature of interference differs across different methodologies and reactions. Total bilirubin and direct bilirubin assays might yield spurious result when the sample contains excess amounts of paraproteins, which are neither reliable nor reproducible when repeated tests are applied once the interference occurs. Herein, we present the case of a 78-year-old female diagnosed with kappa light chain multiple myeloma with disease progression. On admission, she had acute hepatitis and a bizarre result with direct bilirubin level higher than total bilirubin level was noted. After further investigation, excess amounts of immunoglobulin G (IgG) were the most likely cause which led to the interference of direct bilirubin assay and caused unreliable results. This case highlights the significance of the fact that patients with excess IgG might have unreliable results of direct bilirubin assay which could mislead clinical judgment. Moreover, clinicians should be more careful and should base therapeutic decisions on the patient's clinical condition when faced with patients in a similar condition.

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A Curious Case of Hyperbilirubinemia

Cited by 2 publications

References 6 publications

Hyperbilirubinemia in Anicteric Blood?

Hyperbilirubinemia in Anicteric Blood?

Direct Bilirubin Level Greater than Total Bilirubin Level

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