Theoretical constraints in the measurement of serum bilirubin binding capacity

The large majority of methods for measuring serum unoccupied bilirubin binding capacity involve adding an exogenous ligand to a diluted serum sample. If the added ligand binds specifically to bilirubin binding sites, the extrapolation is made that the amount of ligand which becomes bound represents the previously unoccupied bilirubin binding capacity of the original sample. This simple theory ignores the labile nature of the equilibrium reactions between bilirubin binding sites and the ligands with which they interact. The present theoretical and experimental study of these equilibrium reactions shows that (a) sample dilution alone results in changes in the proportional occupancy of bilirubin binding sites by bilirubin and other endogenous ligands, so that the extent of vacancy of those binding sites becomes exaggerated; (b) addition of an exogenous ligand to the diluted sample results is further displacement of native bilirubin and other endogenous ligands from bilirubin binding sites. The amount of added ligand which becomes bound is thus likely to represent a greater extent of vacancy of bilirubin binding sites than was present in the original sample. Results from such methods can therefore only overestimate the unoccupied bilirubin binding capacity of blood plasma in vivo. In order to avoid these analytical problems, current methods must be redesigned. It is suggested from this work that the ability of a serum to sequester safety additional bilirubin may best be assessed from measurement of its bilirubin buffering capacity. This parameter is different from the total or unoccupied binding capacity currently attempted, and its measurement is within the capability of published methods for measuring free (= unbound) bilirubin, modified to analyse minimally diluted samples.