Clinical relevance of the plasma reserve albumin binding capacity for bilirubin (RABC) and "free" bilirubin concentration.

An analysis of 55 plasma samples from 46 jaundiced newborn infants showed that endogenous "free" bilirubin levels bear no significant correlation to reserve albumin binding capacities for bilirubin as determined by both the Sephadex G-25 gel filtration and the enzymatic peroxidation technique (r = 0.14, p less than 0.05). This contrasts with the significant correlation between the "free" bilirubin concentrations and the bilirubin/albumin molar ratios in the same plasma samples (r = 0.75, p less than 0.001). The results of this study suggest that if "free" bilirubin is the "driving force" in the pathogenesis of bilirubin encephalopathy then the use of the reserve albumin binding capacity for bilirubin as the only guide in predicting the risk of kernicterus may not be adequate.