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October 11, 1971, Vol 218, No. 2 >
ARTICLE | October 11, 1971

Interpretation of Plasma on Studies With FREE

Joseph R. Bloomer, MD; Paul D. Berk, MD; Robert B. Howe, MD; Nathaniel I. Berlin, MD
[+] Author Affiliations

Reprint requests to 4N117 Bldg 10, National Institutes of Health, Bethesda, Md 20014 (Dr. Bloomer).


JAMA. 1971;218(2):216-220. doi:10.1001/jama.1971.03190150036007
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References

The plasma unconjugated bilirubin concentration (Br) is related to the bilirubin production rate (BRP) and hepatic bilirubin clearance (CBr) in the following manner: Br = BRP ÷ CBr. The distribution for Br in the normal population was calculated from this relationship, using normal values of BRP and CBr measured with labeled bilirubin. The results indicate that any individual with a Br exceeding 1.0 mg/100 ml (99% level) should be suspected of having abnormal hepatic function or bilirubin overproduction or both. A Br greater than 3.5 mg/100 ml usually indicates abnormal hepatic function, regardless of the BRP. A change in Br means that either bilirubin production or hepatic function has been altered, even if Br remains within the normal range.

REFERENCES

1 +
Barrett PVD, Berk PD, Menken M, et al:  Bilirubin turnover studies in normal and pathologic states using bilirubin-14C . Ann Intern Med 68:355-357, 1968;.
2 +
Berk PD, Howe RB, Bloomer JR, et al:  Studies of bilirubin kinetics in normal adults . J Clin Invest 48:2176-2190, 1969;.
3 +
Schmid R, Hammaker L:  Metabolism and disposition of C14-bilirubin in congenital nonhemolytic jaundice . J Clin Invest 42:1720-1734, 1963;.
4 +
Crigler JF Jr, Gold NI:  Effect of sodium phenobarbital on metabolism in an infant with congenital, nonhemolytic unconjugated hyperbilirubinemia, and kernicterus . J Clin Invest 48:42-55, 1969;.
5 +
Powell LW, Billing BH, Williams HS:  An assessment of red cell survival in idiopathic unconjugated hyperbilirubinemia (Gilbert's syndrome) by the use of radioactive diisopropylfluorophosphate and chromium . Aust Ann Med 16:221-225, 1967;.
6 +
Weber AP, Schalm L:  Quantitative separation and determination of bilirubin and conjugated bilirubin in human serum . Clin Chim Acta 7:805-810, 1962;.
7 +
Ducci H, Watson CJ:  The quantitative determination of the serum bilirubin with special reference to the prompt-reacting and the chloroform-soluble types . J Lab Clin Invest 30:293-300, 1945;.
8 +
Perelli WV, Watson CJ:  Comparison of the Weber-Schalm method with the Ducci-Watson modification of the Malloy-Evelyn method for serum bilirubin determination . Clin Chem 16:239-246, 1970;.
9 +
Jendrassik L, Grof P:  Vereinfacte photometrische Methodern zur Bestimmung des Blutbilirubins . Biochem Z 297:81-89, 1938;.
10 +
Coburn RF, Blakemore WS, Forster RE:  Endogenous carbon monoxide production in man . J Clin Invest 42:1172-1178, 1963;.
11 +
Coltman CA, Dudley GM:  The relationship between endogenous carbon monoxide production and total heme mass in normal and abnormal subjects . Amer J Med Sci 258:374-384, 1969;.
12 +
Butt HR, Anderson VE, Foulk WT, et al:  Studies of chronic idiopathic jaundice (Dubin-Johnson syndrome): II. Evaluation of a large family with the trait . Gastroenterology 51:619-630, 1966;.
13 +
Zieve L, Hill E, Hanson M, et al:  Normal and abnormal variations and clinical significance of the one-minute and total serum bilirubin determinations . J Lab Clin Med 38:446-449, 1951;.
14 +
Aitchison J, Brown JAC: The Lognormal Distribution . Cambridge, England, The University Press, 1957;.
15 +
Barrett P:  Effects of fasting and dietary composition on serum bilirubin levels . Clin Res 18:127, 1970;.
16 +
Felsher BF, Richard D, Redeker AG:  The reciprocal relation between caloric intake and the degree of hyperbilirubinemia in Gilbert's syndrome . New Eng J Med 283:170-172, 1970;.
17 +
Black M:  The use of phenobarbitone to investigate the pathogenesis of unconjugated hyperbilirubinaemia . Brit J Pharm 39:203, 1970;.
18 +
Black M, Sherlock S:  Treatment of Gilbert's syndrome with phenobarbitone . Lancet 1:1359-1362, 1970;.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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1 +
Barrett PVD, Berk PD, Menken M, et al:  Bilirubin turnover studies in normal and pathologic states using bilirubin-14C . Ann Intern Med 68:355-357, 1968;.
2 +
Berk PD, Howe RB, Bloomer JR, et al:  Studies of bilirubin kinetics in normal adults . J Clin Invest 48:2176-2190, 1969;.
3 +
Schmid R, Hammaker L:  Metabolism and disposition of C14-bilirubin in congenital nonhemolytic jaundice . J Clin Invest 42:1720-1734, 1963;.
4 +
Crigler JF Jr, Gold NI:  Effect of sodium phenobarbital on metabolism in an infant with congenital, nonhemolytic unconjugated hyperbilirubinemia, and kernicterus . J Clin Invest 48:42-55, 1969;.
5 +
Powell LW, Billing BH, Williams HS:  An assessment of red cell survival in idiopathic unconjugated hyperbilirubinemia (Gilbert's syndrome) by the use of radioactive diisopropylfluorophosphate and chromium . Aust Ann Med 16:221-225, 1967;.
6 +
Weber AP, Schalm L:  Quantitative separation and determination of bilirubin and conjugated bilirubin in human serum . Clin Chim Acta 7:805-810, 1962;.
7 +
Ducci H, Watson CJ:  The quantitative determination of the serum bilirubin with special reference to the prompt-reacting and the chloroform-soluble types . J Lab Clin Invest 30:293-300, 1945;.
8 +
Perelli WV, Watson CJ:  Comparison of the Weber-Schalm method with the Ducci-Watson modification of the Malloy-Evelyn method for serum bilirubin determination . Clin Chem 16:239-246, 1970;.
9 +
Jendrassik L, Grof P:  Vereinfacte photometrische Methodern zur Bestimmung des Blutbilirubins . Biochem Z 297:81-89, 1938;.
10 +
Coburn RF, Blakemore WS, Forster RE:  Endogenous carbon monoxide production in man . J Clin Invest 42:1172-1178, 1963;.
11 +
Coltman CA, Dudley GM:  The relationship between endogenous carbon monoxide production and total heme mass in normal and abnormal subjects . Amer J Med Sci 258:374-384, 1969;.
12 +
Butt HR, Anderson VE, Foulk WT, et al:  Studies of chronic idiopathic jaundice (Dubin-Johnson syndrome): II. Evaluation of a large family with the trait . Gastroenterology 51:619-630, 1966;.
13 +
Zieve L, Hill E, Hanson M, et al:  Normal and abnormal variations and clinical significance of the one-minute and total serum bilirubin determinations . J Lab Clin Med 38:446-449, 1951;.
14 +
Aitchison J, Brown JAC: The Lognormal Distribution . Cambridge, England, The University Press, 1957;.
15 +
Barrett P:  Effects of fasting and dietary composition on serum bilirubin levels . Clin Res 18:127, 1970;.
16 +
Felsher BF, Richard D, Redeker AG:  The reciprocal relation between caloric intake and the degree of hyperbilirubinemia in Gilbert's syndrome . New Eng J Med 283:170-172, 1970;.
17 +
Black M:  The use of phenobarbitone to investigate the pathogenesis of unconjugated hyperbilirubinaemia . Brit J Pharm 39:203, 1970;.
18 +
Black M, Sherlock S:  Treatment of Gilbert's syndrome with phenobarbitone . Lancet 1:1359-1362, 1970;.

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