Bilirubin

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Bilirubin

Bilirubin

A Marker of Hepatic Dysfunction

Benefits of the Randox Bilirubin Assay

Correlation

Excellent correlation

The Randox bilirubin assay has a correlation coefficient > 0.99% CV when compared to commercially available methods.

Direct-Total

Direct & Total assays available

Randox offer both direct & total bilirubin assays offering choice and flexibility.

Liquid ready-to-use

Liquid ready-to-use

The Randox bilirubin assay is available in a liquid ready-to-use format for convenience and ease-of-use.

Calibrator & Controls

Calibrator and dedicated control available

Calibrator and dedicated control available offering a complete testing package.

Applications available

Applications available detailing instrument-specific settings for the convenient use of the Randox bilirubin assay on a variety of clinical chemistry analysers.

  • Ordering Information
  • Physiological Significance
  • Clinical Significance
  • COVID-19

Direct

Cat NoSizeMethod
BR1234562 x 250 (L)Modified JendrassikEnquireKit Insert RequestMSDSBuy Online
BR3807R1 2 x 30ml (L)
R2 8 x 4ml
JendrassikEnquireKit Insert RequestMSDSBuy Online
(L) Indicates liquid option

Total

Cat NoSizeMethod
BR23612 x 250ml (L)Modified JendrassikEnquireKit Insert RequestMSDSBuy Online
BR3859R1 2 x 50ml (L)
R2 8 x 4ml
JendrassikEnquireKit Insert RequestMSDSBuy Online
(L) Indicates liquid option

Direct & Total

Cat NoSizeMethod
BR411R1. 1 x 50ml (L)
R2. 1 x 10ml
R3. 1 x 100ml
R4. 1 x 100ml
JendrassikEnquireKit Insert RequestMSDSBuy Online

Instrument Specific Applications (ISA’s) are available for a wide range of biochemistry analysers.  Contact us to enquire about your specific analyser.

Bilirubin is a metabolite of haem, derived from haem-containing proteins, including myoglobin, haemoglobin and various P450 enzymes, that serves to coordinate iron in various proteins. Half of it is excreted into bile and the rest contributes to blood bilirubin turnover 1. It is mainly produced in the spleen and liver but can also occur elsewhere in the body by macrophages and renal tubular cells 2. The internal hydrogen bonding causes it to be water-insoluble and so required enzyme-mediated glucuronidation in the liver for biliary excretion. Under normal conditions, it is mostly unconjugated and bound tightly to albumin 3.

Bilirubin is one of the most common diagnostic tests utilised in the diagnosis and monitoring of hepatic dysfunction. It is impaired in cholestatic and parenchymal liver diseases. The most common condition associated with elevated levels is jaundice (a clinical sign of hyperbilirubinaemia), characterised by the yellow colouring of skin, mucous membranes and sclera 3.

Today, it is recognised as being more than just an end-product and considered to be a fundamental substance. Bilirubin is recognised as acting as an antioxidant and anti-inflammatory agent in serum. Evidence exists that states that it can neutralise free radicals, prevent peroxidation of lipids and protects the cardiovascular system, hepatobiliary system, immune system, neuronal system and pulmonary system 4.

It has been established that bilirubin levels are significantly elevated in COVID-19 patients 5. Patients with abnormal liver function tests were at a significantly higher risk of progressing to a severe disease, such as pneumonia. The presence of abnormal liver function tests became more pronounced during hospitalisation within two weeks, with total bilirubin levels elevated 3 times the upper normal limit 6.

Related Products

Clinical Chemistry Calibrator

Bilirubin Elevated Control

Reagents Homepage


Bilirubin (Vanadate Oxidation)

Reagent | Bilirubin (Vanadate Oxidation)

A Superior Method for Paediatric & Lipemic Samples

Benefits of the Randox Vanadate Oxidation Bilirubin Assay

Superior Performance

Superior methodology

The Randox vanadate oxidation bilirubin assay is a superior method for haemolytic and lipaemic samples.

 

Direct-Total

Direct & Total bilirubin assays available

Randox offer both direct & total bilirubin assays offering choice and flexibility.

No Pre-step

No pre-step required

The Randox vanadate oxidation bilirubin assay eliminates the pre-step, increasing testing efficiency.

Liquid ready-to-use

Liquid ready-to-use

The Randox bilirubin assay is available in a liquid ready-to-use format for convenience and ease-of-use.

Calibrator & Controls

Calibrator and dedicated control available

Calibrator and a dedicated bilirubin elevated control available offering a complete testing package.

Applications available

Applications available detailing instrument-specific settings for the convenient use of the Randox vanadate oxidation bilirubin assay on a variety of clinical chemistry analysers.

  • Ordering Information
  • Physiological Significance
  • Clinical Significance
  • V.O vs Diazo
  • COVID-19

Direct Vanadate Oxidation Bilirubin

Cat NoSize
BR9765R1 4 x 14ml
R2 4 x 6ml
EnquireKit Insert RequestMSDSBuy Online
BR8133R1 4 x 52.2
R2 4 x 20ml
EnquireKit Insert RequestMSDSBuy Online
BR4060R1 4 x 20ml
R2 4 x 20ml
EnquireKit Insert RequestMSDSBuy Online
BR8308R1 4 x 20ml
R2 4 x 8ml
EnquireKit Insert RequestMSDSBuy Online
BR8376R1 4 x 20ml
R2 4 x 8ml
EnquireKit Insert RequestMSDSBuy Online

Total Vanadate Oxidation Bilirubin

Cat NoSize
BR9766R1 4 x 68ml
R2 4 x 25ml
EnquireKit Insert RequestMSDSBuy Online
BR4061R1 4 x 20ml
R2 4 x 8ml
EnquireKit Insert RequestMSDSBuy Online
BR8132R1 4 x 52.2ml
R2 4 x 20ml
EnquireKit Insert RequestMSDSBuy Online
BR8377R1 4 x 20ml
R2 4 x 8ml
EnquireKit Insert RequestMSDSBuy Online

Instrument Specific Applications (ISA’s) are available for a wide range of biochemistry analysers.  Contact us to enquire about your specific analyser.

Bilirubin is a metabolite of haem, derived from haem-containing proteins, including myoglobin, haemoglobin and various P450 enzymes, that serves to coordinate iron in various proteins. Half of this bilirubin is excreted into bile and the rest contributes to blood bilirubin turnover 1. The production of bilirubin mainly occurs in the spleen and liver but can also occur elsewhere in the body by macrophages and renal tubular cells 2. The internal hydrogen bonding causes bilirubin to be water-insoluble and so required enzyme-mediated glucuronidation in the liver for biliary excretion. Under normal conditions, bilirubin in mostly unconjugated and bound tightly to albumin 3.

Bilirubin is one of the most common tests to diagnose and monitor hepatic dysfunction. Bilirubin is impaired in cholestatic and parenchymal liver diseases. The most common condition associated with elevated bilirubin levels is jaundice (a clinical sign of hyperbilirubinaemia), characterised by the yellow colouring of skin, mucous membranes and sclera 3.

Today, bilirubin is recognised as being more than just an end-product and considered to be a fundamental substance. Bilirubin is recognised as acting as an antioxidant and anti-inflammatory agent in serum. Evidence exists that states that bilirubin can neutralise free radicals, prevent peroxidation of lipids and protects the cardiovascular system, hepatobiliary system, immune system, neuronal system and pulmonary system 4.

The main advantage of the vanadate oxidation method over the diazo method is that the V.O method is a superior method for haemolytic and lipemic samples. The advantages are particularly evident in neonatal and infant populations where haemolysis is common. Moreover, the V.O method offers a wider analytical measurement range 5.

It has been established that bilirubin levels are significantly elevated in COVID-19 patients 6. Patients with abnormal liver function tests were at a significantly higher risk of progressing to a severe disease, such as pneumonia. The presence of abnormal liver function tests became more pronounced during hospitalisation within two weeks, with total bilirubin levels elevated 3 times the upper normal limit 7.

Related Products

Clinical Chemistry Calibrator

Bilirubin Elevated Control

Reagents Homepage


Neonatal health testing from Randox: what to expect after birth

It’s been almost a month since the Duke and Duchess of Cambridge welcomed Prince Louis into the Royal Family, and as reported it was a natural birth with no complications.

But caring for a newborn baby in the first few hours of its life isn’t quite as simple as it may have seemed in the picture-perfect media coverage of Kate and William introducing their third child to the world for the first time.

Behind the doors of the hospital maternity ward, doctors and nurses are busy carrying out a wealth of tests to ensure the health of the neonates in their care. Because the time immediately following a baby’s birth is crucial for their development in the coming months.

Newborn babies are particularly at risk for some diseases because their immune systems aren’t yet developed enough to fight bacteria, viruses and parasites. Just a few minutes after a baby’s arrival, they will be poked, pricked, measured, tested, examined, cleaned and swaddled – all in the name of making sure they are – and importantly, remain – healthy.

The first test to be conducted is usually an Apgar score – a simple assessment of how a baby is doing at birth, to help determine whether they are ready to meet the world without additional medical assistance.   Based on heart rate, colour, reflex response, activity, muscle tone and breathing, the Apgar score ranges from zero to ten, with anything above seven or above being considered a healthy score. Babies with a score below seven will have their issues addressed – it could be something as simple as moving them to a warmer room until they are able to maintain their own body temperature, or clearing their nose and mouth for more efficient breathing.

The baby is then weighed and measured, and may be given antibiotic eye ointment to prevent infections, and vitamin K to prevent clotting problems.

They will also have their pulse, abdomen, genitals, fingers and toes examined, and their Ballard score taken. This takes into account head circumference, chest circumference and length, to confirm gestational age.

A paediatrician will then assess risk factors for infection and ensure that the baby is feeding well. They will also check for jaundice, which causes yellowish skin when bilirubin, a compound formed by the liver, isn’t being broken down properly.

Neonatal jaundice is extremely common, because during the first week of their life nearly every newborn develops a somewhat elevated bilirubin level, which could potentially lead to jaundice. And the good news is, that if diagnosed early, jaundice can easily be eradicated, by exposure to a specialist light that can help break down bilirubin.

At Randox, we offer a test for bilirubin to diagnose and monitor newborn jaundice, which, in rare cases if left untreated, can lead to brain damage. Early, accurate diagnosis is therefore imperative and so to ensure the precision of the bilirubin tests, Randox also offers Acusera Bilirubin Elevated Quality Control.

The baby will also have their heel pricked for a variety of metabolic conditions including sickle cell anaemia, which causes red blood cell destruction. The Randox test for haptoglobin, a protein found in blood plasma, can help to diagnose sickle cell anaemia.

Or if the baby is premature, they will remain in the hospital nursery. Depending on how premature the baby is there will be different types of tests and treatment given, but they will have their temperature, heart rate and respiratory rate closely monitored. These vital signs will be checked regularly for the first few hours of the baby’s life.

So as you can see, within just a few short hours newborn babies are kept incredibly busy. Procedures may vary from one hospital to the other, but one thing is for sure: neonatal tests are vital in determining and protecting the health of babies.

Randox is committed to saving and improving lives – at any age and any stage of life.

Our innovative diagnostic technologies are versatile and easily adapted for use in the paediatric setting – keeping your baby healthy now and into the future.

 

For more information on neonatal health tests available from Randox, please email randoxpr@randox.com or phone 028 9442 2413

 

 

 


Neonatal health testing from Randox: keeping your baby healthy now and into the future

Most newborns enter the world healthy. But sometimes, infants develop conditions that require medical tests and treatment. Newborns are particularly at risk for some diseases, and in particular infections, because their immune systems aren’t developed enough to fight bacteria, viruses, and parasites.

At Randox we offer a number of accurate and reliable tests capable of detecting illnesses in newborn babies, enabling early medical intervention to allow for the best possible outcome for the baby.

Testing for Jaundice with Randox Bilirubin

In the routine care of newborns, a test for bilirubin is commonly conducted.

Bilirubin is formed by the breakdown of haemoglobin in the spleen, liver and bone marrow. It travels to the liver where it is secreted into the bile ducts as bile, and stored in the gallbladder where it is later released into the small intestines for digestion.

Increased levels of bilirubin within the body are associated with a condition called jaundice, which occurs in toxic or infectious diseases of the liver. The most common symptom of jaundice is a yellow pigmentation of the skin.

Elevated levels of bilirubin may also arise as a result of an obstruction in the bile duct or gall bladder, as a result of haemolysis (the destruction of red blood cells), or by the liver not actively treating the haemoglobin it is receiving.

Therefore the Randox Bilirubin test is essential in the screening, monitoring and diagnosis of hepatic (liver function) disorders and jaundice in newborn babies.

Neonatal jaundice, otherwise known as hyperbilirubinemia, is extremely common in babies, because nearly every newborn develops a somewhat elevated bilirubin level during the first week of life.

Side effects may include excess sleepiness or poor feeding, but in some more extreme cases babies may experience seizures, cerebral palsy, delayed intellectual development, or physical abnormalities.

Early and accurate detection is therefore extremely important – making bilirubin testing fundamental. To ensure the precision of the bilirubin tests conducted in paediatric testing, Randox also offers Acusera Bilirubin Elevated Quality Control.

Monitoring the destruction of red blood cells with Randox G-6-PDH

Glucose-6-Phosphate Dehydrogenase (G-6-PDH) is an enzyme located on the X-chromosome, and so is found in every bodily cell as soon as a baby is born.

G-6-PDH is involved in the normal processing of carbohydrates and plays a critical role in red blood cells, protecting them from damage and destruction. Depleted levels of G-6-PDH can therefore cause red blood cells to become particularly vulnerable to haemolysis. G-6-PDH deficiency, which causes rapid heart rate, shortness of breath, excess tiredness, and mild to severe jaundice in new-borns, affects more than 400 million people globally.

During a baby’s new-born screening, a test for the G-6-PDH enzyme will be conducted to check for this deficiency disorder. Early diagnosis is imperative, as untreated haemolysis can result in haemolytic anaemia.

Genetic Disease Screening with Randox Copper

Copper is an essential mineral in human nutrition, and is mainly found in the brain, liver, kidneys, heart and skeletal muscle.

It aids in some of the key bodily functions including the production of red blood cells, the maintenance of nerve cells and the immune system, and the formation of bone and connective tissue. A deficiency in this mineral can therefore result in bone abnormalities or fractures in premature babies.

Copper deficiency can also be caused by an inherited disorder called Menkes Disease. Affecting approximately 1 in 100,000 children worldwide, this condition is characterised by sparse, kinky hair; failure to gain weight and grow at the expected rate, and deterioration of the nervous system.

The first signs of Menkes Disease – curly, sparse, coarse, dull, and discoloured hair – usually first develop at 2-3 months of age and therefore monitoring copper levels in babies is a way to catch this rare condition at the earliest possible opportunity.

Testing for Lupus with Randox Complement C4 and Complement C3

Another condition which can affect newborn babies is neonatal lupus, which occurs when the mother’s antibodies affect the foetus. A rare condition, it is an autoimmune disease caused by the body’s immune system attacking its own tissues and organs.

The Complement C4 and Complement C3 proteins, which play an important role in eliminating certain infections, can be used as biomarkers in the diagnosis and monitoring of lupus. Complement C4 deficiency is commonly associated with lupus, as the protein is required to clear damaged cells, promote inflammation, and attack pathogens.

Although there is no cure for lupus at present, the condition is very treatable and usually responds well to a number of different types of medication – especially when treatment is started in the early stages of the disease.

Early diagnosis is therefore imperative, and the Randox Complement C4 and Complement C3 tests can help to diagnose babies with lupus at the earliest possible stage. Randox also offer Acusera Immunology controls.

Monitoring a baby’s anti-infection defences with Randox IgA

IgA (immunoglobulin A) is an antibody present in the cells of the immune system, and plays a crucial role in the immune function of mucous membranes including tears, saliva, and sweat. It is also present in colostrum, often referred to as ‘liquid gold’, which is the first secretion from the mammary glands after giving birth.

It’s the IgA in colostrum and milk that is important in neonatal protection against infection and it is therefore imperative to monitor the levels of this antibody to make sure your baby is receiving the anti-infection defences he or she requires.

Testing for allergic reactions with Randox IgE

IgE (immunoglobulin E) is an antibody released by the immune system as a defence mechanism when it believes the body is at risk. IgE determinations are therefore used as an aid in the diagnosis of allergic diseases.

In babies, an allergen-specific IgE test may be done to look for some kinds of allergies, including food, animal dander, pollen, mould, medicine, dust mites, or insect venom.

Increased concentrations of IgE will confirm that an allergic response has occurred, facilitating further investigation as to the specific allergy present.

Testing for bacterial infection with Randox CRP

C-reactive protein (CRP) is an acute phase protein found in blood plasma and produced by the liver. The concentration levels of CRP increase in response to cytokines which are produced by white blood cells during inflammation, infection and tissue injury.

Testing for this protein can therefore be used in the detection of bacterial infections in neonates – enabling antibiotic prescription and a speedy recovery. If infection is identified, CRP can also be used to monitor treatment response or identify neonatal septicaemia.

Randox is committed to saving and improving lives – at any age and any stage of life.

Our innovative diagnostic technologies are versatile and easily adapted for use in the paediatric setting – keeping your baby healthy now and into the future.

 

For more information on neonatal health tests available from Randox click here or email randoxpr@randox.com or phone 028 9442 2413

 

 

 

 


Liver Cirrhosis is a Global Health Burden

#LoveYourLiver this January.  This month, we are taking a closer look at Liver Cirrhosis.

 

Liver cirrhosis occurs when the healthy tissue of the liver is replaced with scar tissue (fibrosis) due to long-term liver damage.  Liver cirrhosis can result in liver failure which can be fatal.

 

Liver complications such as liver disease and cirrhosis can be detrimental if it is not treated or monitored.  Liver disease is the only major cause of death still increasing year-on-year.  Globally, deaths due to liver cirrhosis have increased from 676,000 in 1980 to over 1 million in 2010 (NCBI, 2014).   Cirrhosis and other chronic liver diseases have increased by 12.4% from 2006-2016 and was the cause of 1,256,900 deaths in 2016 (Global Burden of Disease, 2016).

There are a few factors that increase the risk of liver cirrhosis.  The three main factors are heavy alcohol consumption, an undiagnosed hepatitis infection, particularly hepatitis C, and non-alcoholic steatohepatitis (a more severe form of non-alcoholic fatty liver disease) due to obesity.

 

There are numerous symptoms associated with liver cirrhosis.  Some of the more severe symptoms include:

  • Jaundice – yellowing of the skin and whites of the eyes
  • Personality changes, confusion, difficulty concentrating, memory loss, or hallucinations
  • A tendency to bleed or bruise easily
  • In women, abnormal periods
  • In men, enlarged breasts, a swollen scrotum (the loose sac of skin that contains the testicles) or shrunken testicles
  • Vomiting
  • Diarrhea
  • Stomach pain – swollen or bloated stomach

Liver cirrhosis cannot be cured, but the aim of treatment is to manage the symptoms and complications, and to stop the condition getting worse.

#LoveYourLiver and prevent or reduce the symptoms of liver cirrhosis through: moderating alcohol consumption, not sharing needles to inject drugs, using a condom during sex, taking medications as prescribed, and maintaining a healthy weight.

 

The early stages of liver cirrhosis usually does not present any symptoms and is often first detected using routine blood tests.  Liver cirrhosis can be diagnosed and monitored through the following routine blood tests:

Alanine Aminotransferase (ALT)

ALT is one of the enzymes within the aminotransferases group and are among the most sensitive liver enzymes. The normal concentration levels of ALT in the blood are low, however, when the liver is damaged, such as liver cirrhosis, the levels of ALT increase.  During the diagnosis of liver cirrhosis, the root cause of the damage can be established, such as disease, drug or injury.  ALT is commonly measured alongside AST as part of the hepatic panel.

Aspartate Aminotransferase (AST)

AST is an enzyme found throughout the body. Elevated concentration levels of AST in the blood is directly correlated to the severity of the tissue damage.  AST also allows for the root cause of the damage to be diagnosed.  Excessive levels are indicative of damage due to acetaminophen overdose or acute viral hepatitis.  Moderately high levels are indicative of alcohol abuse.  Slightly high levels are indicative of cirrhosis.

AST is commonly measured alongside ALT as part of the hepatic panel, although ALT levels are higher in most types of liver damage.

Albumin

Albumin is a special protein made in the liver and provides the body with the proteins it requires to grow and repair tissue. The body requires a proper balance of albumin to prevent fluid from seeping out of blood vessels.  Decreased concentrations levels of this protein in the blood is an indicator of liver cirrhosis.

 

Randox supply a range of third party clinical diagnostic hepatic reagents to aid in the diagnosis and managing the complications of liver cirrhosis.  All reagents are available for use on a range of third party biochemistry analysers.  Randox offer the following hepatic reagents to diagnose liver cirrhosis:

Alanine Aminotransferase (ALT)

Aspartate Aminotransferase (AST)

Albumin

Randox also offer the following high performance and unique tests to diagnose liver cirrhosis:

5th Generation Bile Acids

Vanadate Oxidation Bilirubin

 

Why choose Randox reagents?

  • Randox offers the largest range of chemistries
  • Liquid ready-to-use reagents available
  • Automated applications for a wide range of clinical analysers
  • Excellent correlation to reference methods
  • Wide measuring ranges
  • Flexible pack sizes
  • Official accreditation to national and international standards including UKAS, ISO 13485:2003, and FDA.
  • Easy fit reagents
  • Easy read reagents

 

To request an application for your specific analyser, contact reagents@randox.com

 

For more information on liver function or to view our hepatic panel, visit https://www.randox.com/liverfunction/


Bilirubin Elevated Quality Control

Therapeutic Drug Quality Control

The Randox Acusera Bilirubin Elevated control is designed to monitor the accuracy and precision of bilirubin assays used in paediatric testing. Assayed method specific target values are provided for both Total and Direct Bilirubin.

Features & Benefits

  • Lyophilised for enhanced stability
  • Bovine based serum
  • Assayed target values provided for Total and Direct Bilirubin
  • Stable to expiry date at 2°C – 8°C
  • Reconstituted stability of 5 days at 2°C – 8°C
DescriptionSizeAnalytesCat No
Bilirubin Elevated Control10 x 3ml2BE454

Analytes

  • Direct Bilirubin
  • Total Bilirubin

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