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PEDIATRICS Vol. 111 No. 4 April 2003, pp. 919-920

Measuring Bilirubin Through the Skin?

The first 20% of the full text of this article appears below.

To the Editor.—

We commend Engle et al for their study of a large Dallas Hispanic population with elevated bilirubin levels.1 Visual assessment of jaundice is particularly challenging in this population. Before all differences between cutaneous bilirubin and total serum bilirubin (TSB) are ascribed as errors in transcutaneous (TcB) measurement, we must acknowledge TSB measurement is also susceptible to errors of similar magnitude in a clinical laboratory.2

Quality control of their TSB measurements (using the College of American Pathologists’ guidelines) was limited to a few samples sent to an independent laboratory for high-performance liquid chromatography (HPLC) analysis (gold standard). Differences between clinical method and HPLC analysis were reported as usually <1.0 mg/dL, but 27% of the time (7/26) the differences were between 1 and 1.9 mg/dL. Though clinically acceptable, its importance should not be underestimated. Blood sample collection and handling are additional sources of error in any laboratory measurement, even by experienced clinicians. These types of error in the TSB assay would not be detected by sending the serum samples to 2 separate laboratories, but it would introduce a difference between TcB and TSB measurements.

We agree with the authors’ statement that "... a TSB value >10 mg/dL certainly would be cause for concern in a 24- to 36-hour-old infant being discharged from the hospital, whereas the higher value (>15 mg/dL) might be of . . . [Full Text of this Article]




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