The Ektachem clinical chemistry slide for simultaneous determination of unconjugated and sugar-conjugated bilirubin.

Using dual-wavelength spectrometry, we have refined the mordant-based bilirubin slide method (Clin Chem 28:2366-2372, 1982) to co-detect unconjugated bilirubin (Bu) and its sugar conjugates (Bc) in 10 microL of serum. The assay is based on three principles: (a) mono- and diconjugated bilirubins behave spectrally like one fraction (Bc) when bound to the mordant, (b) Bu and Bc are spectrally distinct, and (c) B delta (the bilirubin-albumin complex) is not measured in the film. With known bilirubin mixtures, results by the assay agree with those by nuclear magnetic resonance, by a Jendrassik-Gróf method for total bilirubin, and by a liquid-chromatographic procedure. With patients' sera, the slide correlates with a liquid-chromatography-augmented Jendrassik-Gróf method, according to the following typical regression statistics (in mumol/L): for Bu, slope = 0.992, r = 0.996, intercept = -0.376, Sy X x = 5.08; for Bc, slope = 0.970, r = 0.985, intercept = -0.735, Sy X x = 8.16. The method is precise (for Bu, CV = 5.2% at an average concentration of 16.4 mumol/L, and 4.1% at 66.7 mumol/L; for Bc, CV = 6.5% at 23.4 mumol/L, and 3.8% at 151.7 mumol/L for pools of patients' sera), is relatively interference free, and has potential for extension to further applications.

Diazo-based assay for total bilirubin in a coated thin film evaluated.

We compared results for total bilirubin as measured on a coated thin film and by the Evelyn-Malloy and Jendrassik-Gróf methods. We examined serum samples from patients and studied the effects of protein, hemoglobin, and lipids on bilirubin measurement. Results from the thin-film assay compared favorably with those of the other methods. Total and within-day precision (CV), assessed over a one-year period, were better than 6% and 3%, respectively, at all concentrations. Analytical recovery was 99 +/- 3%. Samples from individuals having a wide range of liver diseases demonstrated, by linear regression, good correlation between the thin-film method and the two wet-chemistry methods (correlation coefficients of 0.990 and 0.994). We conclude that the thin-film method offers a valid alternative assay for total bilirubin.

Estimation of unconjugated, conjugated, and "delta" bilirubin fractions in serum by use of two coated thin films.

We used two coated thin films to measure the concentrations of unconjugated, conjugated, and total bilirubin as well as bilirubin covalently bound to albumin ("delta" bilirubin) in more than 400 serum samples. We measured the unconjugated and conjugated species by determining their reflection densities at two wavelengths (400 and 460 nm) on a coating designed for the enhanced spectral measurement of bilirubin but which does not register the delta form. Total bilirubin was measured by use of a diazo-based thin film (Clin Chem 29: 37-41, 1983). We estimated the concentration of delta bilirubin by subtracting the sum of unconjugated and conjugated bilirubin from the concentration of total bilirubin. All measurements agree well with those by comparative methods, as shown by linear regression. Slopes ranged from 0.92 to 1.02, correlation coefficients from 0.935 and 0.998. Linear combinations of these values can also be used to compute other results; e.g., the sum of conjugated and delta bilirubin can be considered to be an estimate of "direct"-reacting bilirubin.

A diazo-based dry film for determination of total bilirubin in serum.

We have prepared a diazo-based dry film for use in determining total serum bilirubin. On a transparent support are a buffered gelatin layer containing a polymeric quaternary amine (the mordant) and a white, reflective spreading layer that contains all of the components necessary for detection of bilirubin. The method is based on the use of dyphylline and Triton X-100 surfactant to dissociate bilirubin from albumin and subsequent reaction of bilirubin with a diazonium salt [4-(N-carboxymethylsulfamyl)benzenediazonium hexafluorophosphate]. In the dry film, unconjugated, mono- and diconjugated, and strongly protein-linked (delta) bilirubin all react with the diazonium salt to produce azo dyes having absorption maxima at about 520 nm. With reflection densitometry and appropriate mathematical transformation, readings and bilirubin concentrations are linearly related to 260 mg/L. Results correlate well with those by the Jendrassik-Grof (Doumas modification) method (slope 0.994, intercept 1.1, correlation coefficient 0.993, Sy X x 4.0), and the method is precise (CV = 10.0% at Cav = 4.1 mg/L, 2.7% at Cav = 24.5 mg/L, 1.2% at Cav = 102 mg/L for patients' samples) and relatively free of interferences.

The Kodak Ektachem clinical chemistry slide for measurement of bilirubin in newborns: principles and performance.

In this slide, unconjugated bilirubin and its sugar conjugates interact with a cationic polymeric mordant to form spectrally enhanced complexes having similar absorptivities at approximately 400 nm. With reflection densitometry and appropriate mathematical transformation, readings at this wavelength are linearly related to bilirubin concentrations up to 260 mg/L. The slide requires 10 microL of serum, is precise (total CV less than 2% determined over 20 days for the analyte range 39-184 mg/L), gives results that correlate well with the Doumas et al. modification of the Jendrassik-Gróf method (slope 0.95, intercept 0.3, Sy . x 3.4, r = 0.991), and is relatively interference free. Also, the slide measures less loss of bilirubin after in vitro illumination of serum specimens than do diazo tests. An intermediate layer in the slide minimizes the spectral interference from hemoglobin and prevents the detection of the strongly protein-linked ("delta") bilirubin found in many jaundiced adults. The method is recommended for newborns (less than or equal to 14 days), in whom the incidence of delta bilirubin is negligible.

Dry film for the enzymic determination of total cholesterol in serum.

We have prepared a dry film for the enzymic determination of total serum cholesterol. It consists of a transparent support bearing a buffered gelatin layer, and a white reflective spreading layer that contains all of the necessary components for the detection of cholesterol. The method is based on (a) hydrolysis of cholesterol esters to cholesterol by cholesterol ester hydrolase (EC 3.1.1.13), (b) oxidation of cholesterol to cholest-4-en-4-one and hydrogen peroxide by cholesterol oxidase (EC 1.1.3.6), and (c) oxidation of a triarylimidazole leuco dye with hydrogen peroxide in the presence of peroxidase (EC 1.11.1.7) to produce a dye with maximum absorption at about 650 nm. For use over a wider range of concentration, the dye density is read at 540 nm. With reflection densitometry and appropriate mathematical transformation, readings and cholesterol concentrations are linearly related to 5500 mg/L. Results correlate well with those by the Abell-Kendall comparison method (slope 0.97, intercept 92.5, correlation coefficient 0.974, Sy.x = 250.7), and the method is precise (CV of 1.2-2.3% for a control fluid and patients' samples) and relatively free of interferences.

Multilayer film elements for clinical analysis: applications to representative chemical determinations.

Using the general concept of a dry multilayer analytical element, we can change chemical procedures and configurations to assay several blood components. In the assay of serum urea nitrogen, urease in the reagent layer catalyzes the hydrolysis of urea. A semipermeable membrane excludes aqueous base, but allows ammonia to diffuse to an underlying indicator layer. For the amylase determination, the enzyme hydrolyzes a dyed-starch substrate coated on top of the spreading layer; this produces small fragments, which diffuse to a registration layer. The increase of absorbance at 540 nm is correlated with amylase activity. Bilirubin complexes with a cationic polymer at the interface between the spreading and reagent layers. The direct reading at 460 nm allows determination of total bilirubin in the range 1 to 500 mg/liter. Tirglycerides are hydrolyzed in the spreading layer, and the resulting soluble glycerol readily diffuses into the reagent layer, where it is phosphorylated and subsequently oxidized by glycerophosphate oxidase to yield dihydroxyacetone phosphate and hydrogen peroxide. Peroxidase catalyzes production of a color commensurate with the hydrogen peroxide produced.

Multilayer film elements for clinical analysis: general concepts.

Dry, thin films containing all necessary reagents for clinical analysis by colorimetry have been designed. Reagents in a matrix of hydrophilic polymer are coated on top of a transparent plastic base. A white isotropically porous polymer spreading layer, 80% void volume, is coated over the reagent layer(s). In the analysis, a drop (typically 10 microliter) of undiluted serum or other fluid is touched to the spreading layer. The fluid spreads rapidly and uniformly through the pore structure, filling a void volume corresponding to the drop volume. Water and low-molecular-weight components diffuse from the spreading layer into the reagent layer(s), initiating the reaction sequence. The spreading layer acts also as a white optical diffuser for reflection densitometry. Optical reflection density is linearized through use of the function developed by Williams and Clapper [J. Opt. Soc. Am. 43, 595 (1953)] to convert reflection to transmission density. A wide variety of chemical assays are compatible with this format. As an example, for the glucose film we found coefficients of variation of 1.5% in predicting glucose concentrations in control sera during 20 days. Results for glucose concentrations in several hundred patients' sera by the present method were very cose to those obtained with the Center for Disease Control's hexokinase reference method.