Hyperbilirubinemia in Anicteric Blood?
Bibliographic record
Abstract
Plasma total bilirubin for a 65-year-old man was high [19.1 mg/dL (326 μmol/L)] on a Roche cobas 6000 analyzer. However, the specimen was anicteric and the icteric index was 1 (approximately 1 mg/dL or 17 μmol/L). A dilution study demonstrated nonlinear results. Direct bilirubin was measured as normal. The split specimen aliquots were further measured on analyzers from 5 different manufacturers (Table 1). The patient's total protein and albumin were 93 and 34 g/L (reference intervals: 60–80 and 38–50 g/L). What might cause artifactual hyperbilirubinemia in anicteric blood? What strategies can be employed to deal with spurious increased bilirubin results? The answers are below. The patient's serum IgG, IgM, and IgA concentrations were 3.9, 0.1, and 39.2 g/L, respectively. Protein electrophoresis revealed an IgA-λ paraprotein (38.3 g/L), a small Bence Jones λ in serum, and a prominent Bence Jones λ (27.3 g/day) in urine. IgG and IgM paraproteins have been suggested to interfere with total bilirubin assays, especially on Roche analyzers, by forming precipitants (1–5). In this case, IgA-λ and possibly Bence Jones λ involvement were indicated. To deal with pseudo-hyperbilirubinemia, naked eye examinations, spectrophotometric indices, different analytical measurements, and the clinical picture will be helpful (1).
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".