Bilirubin

Question 1

Bilirubin was called

Answer 1

Hematoidin

Question 2

Bilirubin is the product of what catabolism

Answer 2

Heme catabolism

Question 3

Who coined the term bilirubin and in what year

Answer 3

Stadeler in 1864

Question 4

Who discovered bilirubin, what substance in the body, and in what year

Answer 4

Virchow, blood, 1849

Question 5

This is the “unconjugated” or “indirect” bilirubin

Answer 5

B1

Question 6

What are the characteristics of B1 bilirubin

FWRB

Answer 6

Found in plasma
Water insoluble
Reacts to Diazo reagent with accelerator
Bound to albumin

Question 7

This is the “conjugated” or “direct” or “bilirubin diglucu ronide”

Answer 7

B2

Question 8

Characteristics of B2 bilirubin

Answer 8

Water soluble
Reacts with Diazo reagent and without and accelerator

Question 9

What bilirubin methods: bilirubin in serum reacts with a diazo reagent forming red-purple azobilirubin at 560nm

Answer 9

Malloy-Evelyn method

Question 10

At what pH does Malloy-Evelyn method performed

Answer 10

pH of 1.2

Question 11

Accelerator used in Malloy-Evelyn method

Answer 11

50% methanol

Question 12

Aliquots used in Jendrassik-Grof method

Answer 12

Aliquot 1- reacted with diazo reagent
Aliquot 2- reacted with diazo reagent and an accelerator

Question 13

Accelerator used in aliquot 2 in Jendrassik-Grof method

Answer 13

Caffeine-benzoate

Question 14

Purpose of ascorbic acid in Jendrassik-Grof method

Answer 14

Stops the reaction of the diazo reagent (removes excess diazo reagent)

Question 15

Components of aliquot 2 of Jendrassik-Grof method

CAA

Answer 15

Caffeine-benzoate (accelerator)
Ascorbic acid (stops diazo reaction)
Alkaline tartrate solution (alkalinizes the solution)

Question 16

Purpose of alkaline tartrate solution in Jendrassik-Grof method

Answer 16

Alkalinize the solution to shift the absorbance spectrum to lessen or remove interfering substances turning the color to intense blue

Question 17

At what nm is Jendrassik-Grof method (aliquot 2) measured

Answer 17

598-600nm

Question 18

Principle of Jendrassik-Grof method

Answer 18

Bilirubin in serum reacts with a diazo reagent forming a purple azobilirubin

Question 19

Diazo regaent used in Jendrassik-Grof method

Answer 19

Sulfanilic acid in hydrochloric acid and Sodium nitrite

Question 20

Advantages of Jendrassik-Grof method

NIMMN

Answer 20

Not affected by pH changes
Insensitive to a 50-fold variation in protein concentration of the sample
Maintains optical sensitivity even at low bilirubin concentrations
Minimal turbidity
Not affected by hemoglobin up to 750mg/dL

Question 21

Enumerate the other liver function tests

liver and serum proteins

Answer 21

Liver enzymes
- Transaminases (alanine aminotransferase and aspartate aminotransferase)
- Alkaline phosphatase
- Y-glutamyl transferase
- 5’-nucleotidase

Serum proteins
PT and aPTT

Question 22

Specimen collection and storage of bilirubin

Answer 22

Serum or plasma
Avoid hemolysis
Protect from light

Question 23

List of pathophysiologies of liver

Answer 23

Jaundice (icterus)
Pre-hepatic hyperbilirubinemia
Hepatic jaundice
Post-hepatic jaundice

Question 24

Describe jaundice (icterus)

Answer 24

Characterized by increased bilirubin in the blood (hyperbilirubinemia) and deposition in the skin, mucous membranes, and sclera

Question 25

Describe pre-hepatic hyperbilirubinemia

IDNBN

Answer 25

Increase bilirubin presented to the liver
Due to acute or chronic hemolytic anemia or malaria
Not water soluble
Bound to albumin
Not seen in urine

Question 26

What are the two types of hepatic jaundice and differentiate them

Answer 26

1. Unconjugated hyperbilirubinemia
   Gilbert syndrome
   Crigler-Najjar syndrome
   Lucey-Discroll syndrome
2. Conjugated hyperbilirubinemia
   Dubin-Johnson syndrome
   Rotor syndrome

Question 27

Describe post-hepatic jaundice

Answer 27

“Obstructive”
Biliary obstruction disease
Increased B2