Measurement of Unbound Bilirubin by the Peroxidase Test Using Zone Fluidics

Background: Measuring plasma unbound bilirubin concentration by the peroxidase test is useful in the management of jaundiced newborns. However, the commercially available peroxidase technology is manual, and the unbound bilirubin may be seriously underestimated at the 42-fold sample dilution and single peroxidase concentration used. We investigated improving the test by adapting it to Zone Fluidics, which is a system for automating reactant handling that requires small sample volumes and dilution.

Methods: A computer-directed Zone Fluidics system was constructed using small diameter tubing to connect in series a water-surfactant reservoir, a bi-directional pump, a multiport selection valve to which peroxidase test reactants (45 mul of sample) are attached with one port open to air, and a spectrophotometer flow cell. Test reactants and air are sequentially aspirated through the valve into the tubing connecting the pump and valve to form a reactant "zone" surrounded by air. The zone is advanced to the spectrophotometer flow cell where total and unbound bilirubin are determined (37 degrees C) from the absorbance at 460 nm at a 2-fold sample dilution and 4 peroxidase concentrations. Imprecision was assessed in artificial controls and newborn plasma. Plasma results were compared with those obtained using the commercial method.

Results: The CV for unbound bilirubin in the various controls ranged from 11% to 38% (within day) and 12% to 27% (between days). Triplicate CV measurements for newborn plasma measurements ranged from 0.6% to 31% (mean 11%, n=47). Mean unbound bilirubin by Zone Fluidics was 5-fold higher than that by the commercial method.

Conclusion: Zone Fluidics can be used to automate the peroxidase test and overcome many of the limitations of the commercially available peroxidase technology.