The chart below compares the monthly total bilirubin mean of Laboratory A to the

Question

The chart below compares the monthly total bilirubin mean of Laboratory A to the monthly mean of Laboratory B which uses the same control materials, analyzer and method. Both laboratories perform controls at the beginning of each shift using commercially prepared liquid QC control serum stored at 20 degrees C. After reviewing the results, what conditions would explain the differences in the results between the two laboratories?

Level I Control

Level 2 control

Mean

CV

Mean

CV

Lab A

1.1 mg/dL

2.1%

6.7 mg/dL

3.2%

Lab B

1.4 mg/dL

2.2%

7.0 mg/dL

3.6%

2

.In the following chart, indicate whether the listed enzymes are increased, decreased, or normal in the conditions stated. If increased designate markedly, moderate or slightly increased.

Enzyme

Acute Hepatitis

Cirrhosis

Obstructive Disease

AST

ALT

ALP

GGT

LD

5’-Nucleotidase

3

For each of the disorders of direct and indirect increases in bilirubin, list the mechanism by which the defect occurs in bilirubin metabolism.

Disorder

Defect in Bilirubin Metabolism

Unconjugated Hyperbilirubinemia

Hemolysis

Ineffective erythropoiesis

Neonatal physiologic jaundice

Crigler-Naijar syndrome Type I

Conjugated Hyperbilirubinemia

Dubin-Johnson syndrome

Rotor’s syndrome

Extrahepatic cholestasis

Hepatocellular injury

Level I Control

Level 2 control

Mean

CV

Mean

CV

Lab A

1.1 mg/dL

2.1%

6.7 mg/dL

3.2%

Lab B

1.4 mg/dL

2.2%

7.0 mg/dL

3.6%

Explanation / Answer

Lab 1 and Lab 2 variation in billirubin resilts is mostly caused by the difference in the assigned value of caliberator used.Bilirubin calibrator is designed for use as a calibrator in the determination of direct and total bilirubin assays and serum based materials.The difference in the example due to constant rather than proportional erroror the true molar absorptivity of bilirubin is unknown.when billirubin caliberatote error is found the  molar absorptivity of bilirubin should be measured.Lab 1 resulted loss of billirubin due to photodegradation. Photodegradation generally results in greater loss of billirubin at higher temperature and also conributee to random error.

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