Yes it's probably biliverdin, perhaps mixed with mesobiliverdin. Has a
nice absorption peak at 660 nm and the presence of mesobiliverdin
causes a slight red shift.
The production of this pigment is more characteristic of obstructive
jaundice associated with malignancy, in which case the patient's skin
may take on a green-ish colour. You sometimes also come across it in
infectious hepatitis and I don't think it's particularly associated
with neonates.
Nick Miller
London
2009/7/16 TICKNER TREVOR (RM1) Norfolk and Norwich University Hospital
<[log in to unmask]>:
> Although I have not come across it in neonates, biliverdin can be
> produced by spontaneous oxidation of bilirubin and it only takes very small
> amounts to be visible to the eye.
>
> If you look at the history of jaundice you will find that three types were
> described; yellow, green and black. Black was associated with malaria and
> was also used for weil's disease. Green is usually assigned to the presence
> of biliverdin and I have seen one case in an adult with hepatitis where I
> was able to show it had the same reaction characteristics with barbiturate
> under acid conditions as does biliverdin . The rather brown colour one sees
> in severe obstructive jaudice may be a mixture of bilirubin with small
> amounts of biliverdin.
>
> There have been associations with certain drugs and I believe that
> deficiency of the reductase has been described but I doubt there are several
> babies with such inborn errors presenting simultaneously.
>
> Trevor Tickner,
> Norwich
> ________________________________
> From: Clinical biochemistry discussion list
> [mailto:[log in to unmask]] On Behalf Of Smith Natalie (RC9)
> Luton & Dunstable Hospital TR
> Sent: 16 July 2009 13:20
> To: [log in to unmask]
> Subject: Neonates with green/brown serum
>
> Dear Mailbase,
>
> We have recently seen 3 neonates from our NICU with dark green/brown serum,
> previously we have only seen this once about 4 years ago. We have also seen
> in these babies much larger variation between the blood gas analyser
> bilirubin measurement (Radiometer ABL735) and the laboratory bilirubin
> measurement (Beckman DXC) than normally seen, presumably due to spectral
> interference. We have excluded methaemoglobin, rhabdomyolysis and
> haemolysis as causes. It appears that all these babies have been on double
> or triple phototherapy and we were considering the possibility of a
> bilirubin related compound? We have re-read the recent excellent annals
> review of neonatal jaundice and couldn't see any mention of such a
> phenomenon, has anyone else seen this? Could this be Methaemalbumin? Any
> thoughts appreciated.
>
> Kind Regards,
> Natalie
>
> Natalie Smith
> Clinical Biochemist & POCT Supervisor
> Ext 7991 or 2762
> 01582 497991
>
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