When a sensitive method for measuring direct serum bilirubin (DB) was used, a third of the patients with liver or biliary tract disease had elevated DB levels, but normal levels of total serum bilirubin (TB). The correlation of DB and sulfobromophthalein (BSP) retention was studied because DB and BSP are cleared through the same hepatic pathway. Our findings support the clinical and chemical validity of DB measurements as an index of occult liver disease.
Gambino SR, Other A, Burns W. Direct Serum Bilirubin and the Sulfobromophthalein Test in Occult Liver Disease. JAMA. 1967;201(13):1047–1049. doi:10.1001/jama.1967.03130130073022
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