Hello all~! Yan Ling here~! Sry for the late post. ><
Can u believe? We had finished 16 wks of sip le~! 1 more mth to go~! xD
Okay for this post, which should be my last post already, I'm going talk about neonatal bilirubin testing. I'm was sent of a medical center somewhere in sg where they do neonatal bilirubin testing as there are nurseries there. Believe everyone should still remember abt the incompability of mother-fetal bld group, which result in hemolysis of fetal's RBC by mother's IgG.
When the fetal's RBC are broken down, bilirubin as the by-product was produced and is to be removed by the fetal's liver. However, when the amounf of bilirubin exceeds the theshold of the liver to remove the bilirubin, it will remain in the body, and thus resulting in neonatal jaundice. And to treat the neonatal jaundice is by giving phototherapy so the light, usually blue in colour, will break down the bilirubin.
And so, measuring the amount of bilirubin in the baby's serum is important so to see if he/she requires any treatment or able to go home with his/her mummy.
First, the collection of baby's blood is using heel prick where the phlebotomist will use a lancet to prick the either side of the baby's heel and using a capilliary tube to collect the blood. After that, the tube is spin down to get the serum. The centrifuge used is different from the normal ones we see/uses in the lab, its especially for spining down capillary tube, however, using the normal centrifuge is also possible but it requires longer spining time compare to the special centrifuge which usually requires abt 3-4 mins to spin down.
So after the tube is been spun down, it will be separated into serum and RBC. Then, the serum part will be used to read for the neonatal bilirubin. The analyser used in my lab is reichert, which
uses a curvette to read the amount of bilirubin.
The principle of this test is spectrophotometer which measures the colour of the serum. The machine measures at 460nm and 55onm. At 460nm, the machine will measure the bilirubin and oxyhemoglobin and at 550nm, the machine will only measure the oxyhemoglobin. And thus the difference of 460nm and 550nm concentation will be the total bilirubin. Since oxyhemoglobin is measured, hemolysed specimens will not affect the result since the hemoglobin is measured.
The values of the bilirubin are then faxed to the clinics/nurseries where the doctors will decide whether to continue the treatment or not.
The values of the bilirubin are then faxed to the clinics/nurseries where the doctors will decide whether to continue the treatment or not.
Here are some pics to show you about the machine. xD
The Reichert machine with curvette, and the syringe-looking thing is to add the serum into the curvette.
Capillary tubes with babies' blood after spun down.Thats all. xD Feel free to ask me any questions. Will try to answer wor. ><
yaNLing xD
Hello Yanling!!!
ReplyDeleteThere are some questions i would like to ask you! =D
1) How much blood is drawn from each baby? Is there a standard amount required for the machine to be able to detect clearly?
2)For the amount of bilirubin concentration, how do you determine whether the baby is having mild jaundice or those serious jaundice? And how do you determine the baby is not having jaundice? (What is the normal range for bilirubin concentration in blood?)
Thks!
Zhang'e
0704086H
TG02
Hello Yanling! :D
ReplyDeleteomg, the capillary tubes looks so fragile! anyways, do you guys keep the serum after use? for how long?
THANK YOU THANK YOU!
Joanna Yeo!
0702054H
hello yanling!
ReplyDeleteyou mentioned that haemolysis samples do not affect bilirubin conc.can i know what are the factors that may affect the bilirubin concentration?
siti shahimah
0702717J
:)
to zhang'e: hello~ okay so for your first qn, the nurse usually takes 2 capillary tubes if possible, if not around half of a capillary tube will do. The machine requires 20ul of serum, but if there is not enough serum, the staff will call the doc/nurse to get another one, or else the staff will go take the blood herself.
ReplyDeleteand for second qn, the condition of jaundice is decided by the doctor, i had seen the results slip where they will write if the concentration is less than 12 umol/L the baby can go home, sometimes is 8 umol/L. So there is not really any referance range, but then for the lab, its around 3.5 to 6 umol/L. But any results will be faxed to the clinic.
to joanna: hello~! well, if there is any extra capillary tubes, they will keep for a day in case the doc request for a retest.
to siti: hello~ to what i know, lipemic serum will affect the reading, and also, the part near the RBC should not be pipette into the curvette as it contains might contains WBC and platelets etc, and so those will give a false high results.
hope the answers help~! xD
yaNLing xD
Hi
ReplyDeleteMay i know how does phototherapy breaks down the bilirubin? And typically what is the duration of the phototherapy before the infant is healthy again?
Liyana
0703827F
Hi Yanling,
ReplyDeleteQuestions on your comments.
How does the presence of WBC and platelets lead to a false high results ? Also, how does lipemic serum affect the reading ?
Thanks and take care =)
Ng Tze Yang Justin
0703747F
hello liyana and justin.. sorry for the late reply..
ReplyDeleteto liyana: the phototherapy breaks down bilirubin into water soluble isomers, so it can be excreted out from the baby without going through the liver, as i think that the liver breaks down the water insoluble bilirubin to water insoluble products to be excreted out. and also, for the duration, it should be according to the neonatal bilirubin level, as if the concentration is high, the baby will need a longer duration of phototherapy, but usually it takes about 1-2 days for the baby's bilirubin to reduce to normal level.
to justin: the presence of WBC and platelets and lipemic serum will give a false high result as the components will cause the serum to be more opaque. and since the prinicple of this test is by spectrophotometer, it depends on how much light can pass through the capillary tube, so a more opaque serum will cause lesser light to pass through the tube, and thus result in higher result.
hope i answered your questions. xD
yaNLing xD
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ReplyDelete