Detection of Free Bilirubin: A Criterion for Exchange Transfusion

Recent Advances in Paediatric Hepatology

“…From the observation that kernicterus can occur with serum bilirubin concentrations of less than 340 Umolll; (Harris, et a/., 1958) it is assumed that kernicterus occurs when the concentration of bilirubin in plasma exceeds that which can be firmly bound to serum proteins. It is not possible to measure the concentration of free bilirubin or to derive this from methods which measure in vitro binding of albumin and bilirubin, such as that using sephadex (Brodersen, 1976). Only the salicylate saturation index method which measures the reserve capacity of serum proteins to bind bilirubin has received clinical validation as a better indicator of risks of brain damage than the unconjugated bilirubin concentration (Odell et a/., 1970).…”

Determination of the Vacant Amount of High‐Affinity Bilirubin Binding Site on Serum Albumin

“…Furthermore, isomers, bilirubin IX-p, -y, and -6 (Blanckaert et al 1976), possibly also IX-a(E) (Pedersen et al 1977), and their conjugates (Jacobsen et al 1967), are present in small but significant amounts. Suitable methods for determination of free bilirubin in undiluted plasma or serum are not available, (for a review see Brodersen 1976a).…”