Abstract
We devised a paper chromatoelectrophoresis technique to measure serum BBC which compares favorably with results from Sephadex G25 chromatography. We measured serum BBC and total protein (TP) concentration in 27 infants of various gestational ages who required no special care (normal) and 51 infants with various problems who received treatment beyond routine(abnormal). The mean ± 1 SD of the BBC/TP ratio is 3.92 ± 0.47 (range 3.20-5.40) and 3.59 ± 0.74 (range 1.50-5.29) respectively for the normal and abnormal infants (p<0.05). If normal and abnormal infants are grouped together, the mean of the ratio is 3.75, which is similar to the derived value of 3.7 presented in some textbooks of neonatology. Many use that value together with a patient's serum TP in grams/dl to calculate an artificial BBC which then becomes the serum bilirubin concentration in mg/dl used to determine the need for exchange transfusion. If that process were applied to our subjects, 27% of normal and 18% of abnormal infants would receive an unnecessary exchange transfusion and the risk of bilirubin encephalopathy would be increased in 22% of normal and 51% of abnormal infants because they would not have received an exchange transfusion before the primary protein binding sites for bilirubin were saturated. It is clear that measuring the BBC of each infant's serum is imperative for accurate and reliable information. A calculated value based on a fixed ratio such as 3.7 appears to be unsafe.
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Kierney, C., Ainbender, E., Brown, E. et al. COMPARISON OF MEASURED AND CALCUIATED SERUM BILIRUBIN BINDING CAPACITY (BBC)-A DANGER EXPOSED. Pediatr Res 11, 536 (1977). https://doi.org/10.1203/00006450-197704000-00995
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DOI: https://doi.org/10.1203/00006450-197704000-00995