I think total bilrubin is always greater than direct bilrubin.

Hi Ifeoluwa,

i think you made an error during your experiments. Total bilirubin represents the sum of direct and indirect bilirubin...and can not be lower than any of these two. If you are doing your own experiments (manually) the places for mistakes are numerous...wrong measurement of sample, dim sample and thus lousy spectrophotometry, wrong calibration, miscalculation ect. I suggest you rerun your experiments once again with great care or ask for help from someone.

All best

Nikola

Unconjugated bilirubin comes from red blood cell destruction and is transported to the liver to be conjugated and excreted into the bile. Unconjugated plus conjugated bilirubin usually consitute total bilirubin. I cannot explain your results.

Agreed with Nikola and Enzo, the total Bilirubin is always high as it consists of two direct and indirect.

I think total bilrubin is always greater than direct bilrubin.

Agree with previous answers, if the method of analysis is the same T-bil will be greater than D-bil.

hi bro 

Total bilirubin equal to direct bilirubin + indirect bilirubin therefore i think its impossible to consider that direct bilirubin higher than total bilirubin 

Yes, it is correct what Dara Aziz is said.

It is always due to the inaccuracy of the measurement method used

I have never encountered such. Meanwhile check your reagents and try to do external QC. That might resolve the problem.

Thank you everyone, I will check my protocol and reagents again and rerun the experiment. Thanks for your suggestions.

Could be due to a interference. you can run serum indexes for discard interference for hemolysis, lipemia an icterus. Another possibilities can be problems with unclean reaction cuvettes, drugs, detergents.

Hi Ifeoluwa, 

I have just seen your answer. Without knowing  whether you are still curious about the problem, I am going to share my experience. 

We have the same problem with human samples in clinical laboratory setting. It is very rare problem but it happens time to time. If each step of the analysis including preanalytical, analytical and postanalytical phase is well-defined and executed, it might depend on the fact that this phenomenon may be observed when nearly all reacting bilirubin is direct bilirubin. 

I hope this may help.

even we got like that in serum sample wat to do

Though very rare,we found the same problem . Difficult to explain even if all the reacting bilirubin is direct bilirubin.

This sort of unexplainable values is encountered in labs inspite of all QC measures in place. If we know the clinical setting we can explain it because high immunoglobulin levels, lipemic serum and hemolysis can raise the direct value and give a falsely elevated value above the Total.

Sometimes the presence of monoclonal immunoglobulin may falsely increase the direct bilirubin

A phenomenon where a normal total bilirubin with direct bilirubin higher than the total bilirubin was noted in patients with plasma cell dyscrasias. This could be due to interference with the bilirubin assays. Further studies are needed to see if this phenomenon may have clinical implications in the future, where physicians may be alerted to the presence of a possible paraprotienemia if they note this phenomenon on a patient's lab tests.

A phenomenon where a normal total bilirubin with direct bilirubin higher than the total bilirubin was noted in patients with plasma cell dyscrasias. This could be due to interference with the bilirubin assays. Further studies are needed to see if this phenomenon may have clinical implications in the future, where physicians may be alerted to the presence of a possible paraprotienemia if they note this phenomenon on a patient's lab tests.