Test ID: BFBL
Bilirubin, Body Fluid
NY State Approved 
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
May aid in the distinction between a transudative and an exudative body fluid, when used in conjunction with other testing including serum bilirubin analysis, body fluid; serum protein ratio, body fluids; serum lactate dehydrogenase ratio, and serum lactate dehydrogenase
Method Name A short description of the method used to perform the test
Photometric, Diazonium Salt
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Collection Container/Tube: Body fluid container
Submission Container/Tube: Opaque, amber vial (Supply T192)
Specimen Volume: 1 mL
Collection Instructions:
1. Centrifuge, separate supernatant, and send both supernatant and sediment.
2. Protect specimen from light.
3. Label specimens as sediment and supernatant.
Additional Information: Indicate specimen source.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK; Gross OK |
| Lipemia | Mild OK; Gross OK |
| Icterus | Mild OK; Gross OK |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Body Fluid | Frozen (preferred) | 70 days |
| Refrigerated | 14 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Assessing whether a body fluid specimen is exudative or transudative in nature is the initial step in determining the etiology of the fluid. Transudative fluids result from hemodynamic aberrations or oncotic changes and are associated with ultrafiltration of serum across pleural membranes. Transudates most commonly occur in association with clinically apparent conditions such as heart failure and cirrhosis. Exudative fluids tend to develop as a consequence of inflammation or malignant disorders such as tuberculosis, pneumonia, or cancer, in which capillary permeability is increased, allowing large-molecular-weight compounds to be released into the accumulating fluid. If the fluid is transudate, further diagnostic procedures are often not necessary, however the presence of an exudative fluid often triggers additional testing that may be invasive in nature.
Determination of body fluid bilirubin concentration can aid in the distinction between a transudative and an exudative fluid. Bilirubin values tend to be higher in exudates than in transudates, although there is some overlap between groups. However, a ratio of body fluids to serum bilirubin has been reported to identify exudative body fluids with sensitivity, specifically, positive predictive accuracy, and absolute accuracy equivalent to that obtained using Light's criteria for an exudative pleural fluid (pleural/serum protein ratio >0.5, pleural/serum lactate dehydrogenase ratio >0.6, and serum lactate dehydrogenase >200 U/L).
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Not applicable
The reference range has not been established for bilirubin in body fluids. The test result should be integrated into the clinical context for interpretation.
Interpretation Provides information to assist in interpretation of the test results
Elevated body fluid bilirubin is suggestive of an exudative fluid. This testing should be performed in conjunction with other testing including serum bilirubin analysis, body fluid:serum protein ratio, body fluids:serum lactate dehydrogenase ratio, and serum lactate dehydrogenase.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Bilirubin is photosensitive. Failure to protect from light may cause decreased results.
Contamination by blood may cause altered results in either direction.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Elis A, Meisel S, Tishler T, et al: Ascitic fluid to serum bilirubin concentration ratio for the classification of transudates or exudates. Am J Gastroenterol 1998 Mar;93(3):401-403
2. Runyon BA: Ascitic fluid bilirubin concentration as a key to choleperitoneum. J Clin Gastroenterol 1987 Oct;9(5):543-545
3. Darwin P, Goldberg E, Uradomo L: Jackson Pratt drain fluid-to-serum bilirubin concentration ratio for the diagnosis of bile leaks. Gastrointest Endosc 2010 Jan;71(1):99-104 Epub 2009, Nov 27
4. Burgess LJ: Biochemical analysis of pleural, peritoneal and pericardial effusions. Clin Chim Acta 2004 May;343(1-2):61-84
5. Clinical and Laboratory Standards Institute: Analysis of Body Fluids in Clinical Chemistry; Approved Guideline. Clinical and Laboratory Standards Institute, Wayne, PA, 2007, CLSI document C49-A (ISBN 1-56238-638-7)
Method Description Describes how the test is performed and provides a method-specific reference
Total bilirubin, in the presence of a suitable solubilizing agent, is coupled with a diazonium ion in a strongly acidic medium (pH 1-2) to produce azobilirubin. The intensity of the color of the azobilirubin produced is proportional to the total bilirubin concentration and is measured at 546/600 nm.(Package insert: Roche Bilirubin reagent, Roche Diagnostic Corp., Indianapolis, IN, October 2010)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Saturday; Continuously
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
82247
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| BRNBF | Bilirubin (BF) | N/A |
| FLD14 | Fluid Type: | 14725-6 |
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