title: Robustness of the Reichert Unistat Bilirubinometer for analysis of hemolyzed samples from neonates.
abstract: OBJECTIVE
  Bilirubin is routinely measured in neonates to avoid the irreversible effects of kernicterus. Grossly hemolyzed samples are routinely rejected under the assumption that bilirubin cannot be accurately measured in hemolyzed samples. The objective of this study was to determine the effect of hemolysis on bilirubin measurement in neonates.
  
  
  METHODS
  Data included 2-years of paired bilirubin results (n=70) where hemolyzed and non-hemolyzed samples were collected and measured within 6h of each other. Bilirubin results were compared by Passing-Bablock linear regression and difference plots. Bilirubin results were also compared using the Bhutani nomogram to determine if hemolysis affected the hyperbilirubinemia risk-category.
  
  
  RESULTS
  Gross hemolysis resulted in a mean negative bias of -5.2μmol/L (95% CI: -30.7 to 20.3μmol/L). Based on the Bhutani nomogram, 1/70 samples would have been classified as Low-intermediate instead of High-intermediate risk and 3/70 would have been classified as Low instead of Low-intermediate risk; 5/70 samples would have been classified as Low-intermediate instead of Low risk.
  
  
  CONCLUSIONS
  Collectively the data support that neonatal bilirubin may be reported from grossly hemolyzed samples measured using the Reichert Unistat Bilirubinometer. This practice has been adopted at our institution where results are reported with comments describing the effects of hemolysis. Implementation of this approach has decreased the number of blood re-collections in neonates.
authors.affiliation: Division of Biochemistry, The Ottawa Hospital, Canada; Dept. of Pathology and Laboratory Medicine, Faculty of Medicine, University of Ottawa, Canada; Eastern Ontario Regional Laboratory Association, 501 Smyth Rd., Ottawa, ONK1H 8L6, Canada. Electronic address: cmccudden@TOH.on.ca.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: McCudden
authors.affiliation: Eastern Ontario Regional Laboratory Association, 501 Smyth Rd., Ottawa, ONK1H 8L6, Canada.
authors.forename: Kathy
authors.initials: K
authors.lastname: Fleming
authors.affiliation: Eastern Ontario Regional Laboratory Association, 501 Smyth Rd., Ottawa, ONK1H 8L6, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Warr
mesh_terms: D001663:Bilirubin / Q000097:blood; D001774:Blood Chemical Analysis / Q000295:instrumentation* / Q000379:methods; D006461:Hemolysis; D006801:Humans; D007231:Infant, Newborn; D015203:Reproducibility of Results
chemical_list: D001663:Bilirubin
keywords: Bilirubin; Hemolysis; Interference; Neonate