In a child, surgery was done for biliary stricture with hepatojejunal anastomosis. Postoperative bilirubin level after 2 weeks was 6 mg/dL from a preoperative level 12mg/dL. The reason for this could be:
Normal lowering of bilirubin takes time
Anastomotic stricture
Delta bilirubin
Mistake in lab technique
Ans: C. Delta bilirubin(Ref Harrison 19/e p280, 18/e p325)Delta Bilirubin:Albumin-linked bilirubin fraction (delta fraction/biliprotein)Is pa of direct-reacting bilirubin fraction including conjugated bilirubin, covalently linked to albumin.Represents an impoant fraction of total serum bilirubin in patients with cholestasis & hepatobiliary disorders.Clearance rate of albumin-bound bilirubin from serum approximates half-life of albumin (12-14 days) rather than sho half-life of bilirubin (4 hours).Due to tight albumin bonding.