Bilirubin Babies

Every day that I work in the lab, I usually end up drawing blood from a newborn or a child under 10 years old. The children are pretty easy if they are over 1 year old, since you only have to hold them down screaming and finish it fast. If you work quickly and confidently, the parents can handle it pretty well. Of course, I realized today that now when I see children ages 1-10, I feel guilty/apologetic because I am used to thinking that I am about to inflict pain upon them and see that terrified, betrayed look in their eyes. I'm talking about when I am not even in the laboratory - just seeing a cute five-year old girl in an elevator makes me feel bad because I "know" that in a couple seconds those curious, happy little eyes will change. I'm pretty desensitized in the lab, but out of the lab when I attempt to look at a child happily, I feel like I am a wolf in sheep's clothing.

At any rate, I also draw blood from newborns. 95% of the time, the purpose for the blood draw is that it is a bili baby. A bili baby is a newborn with elevated levels of bilirubin (hyperbilirubinemia). The most obvious symptoms are jaundice, or yellowing of the skin and the whites of the eyes. Prolonged exposure to such high levels of bilirubin can cause brain damage, hearing loss, eye muscle problems, physical abnormalities, liver damage, and death. There are two reasons a baby may have hyperbilirubinemia. One is increased destruction of blood cells, usually caused by antibodies from the mother if the baby and mother have different blood types. The other is accumulation of bilirubin because the newborn's system is not excreting as much as it produces - primarily because the liver is immature and unable to process the bilirubin. For this reason, preterm babies are more likely to suffer hyperbilirubinemia: their liver is not as developed.

Treatment for hyperbilirubinemia is phototherapy. Light is absorbed through the skin and helps convert the excess bilirubin into a more excretable form for the infant. In extreme cases, blood transfusions are necessary. For babies under 7 days old, the average acceptable level of bilirubin in the blood is 10 mg/dL, 6 mg/dL for babies less than 24 hours old.

Circumstances

Today at work I encountered a woman who was getting tested for various things, and her entire hand was inflamed from a bee sting. She told me how she had been stung once before and had not had a reaction to it, but this second time it was progressing up her arm. I recalled that years ago I had been stung in a pool, and because my skin was so cold from being in the water, as was the bee's venom gland, I did not have any lasting reaction from the sting. I suspect it is because the fluid was not warm enough to diffuse into my skin, my skin was taut from being cold, and my flesh was cold so the venom that did get into my skin did not permeate very far.

With that in mind, I asked her about the circumstances of her first sting, since a lot of people get stung in or around pools. Sure enough, her first sting was in a pool. After a little research, I found that there are a lot of factors that affect a person's allergic reaction to something like a bee sting, including temperature and a person's emotional state (panic can cause a chain reaction that makes the patient worse). Another thing to consider is that the first time a person is exposed, she may not react at all, but after that point the body may build antibodies and recognize the allergen when exposed a second time. It is very possible to develop allergies after previous exposures, such as health workers developing an allergy to latex. The second time this woman was stung, she was riding a motorcycle with her significant other, on a hot day, and panicked because they were on a freeway and couldn't stop for her to examine the situation. I imagine that tiny details such as these can make huge differences when evaluating a patient history.

Teenage Breast Cancer

Today at work, I came across a teenage girl, about sixteen years old, getting tested for BRCA genes (Breast Cancer genes, 1 and 2). She told me that she had actually had a lump biopsied and it had come back positive for breast cancer, and that she had to insist on the biopsy for the physician to perform it. Teenage breast cancer has been likened to winning the lottery - a condition almost unheard of without strong genetic predisposition and other relatives with early onset breast cancer. I can understand from a statistical and biological standpoint why a physician would not order a biopsy of every lump in a girl with developing breasts, but at the same time I would hate to misdiagnose breast cancer simply because I played the odds.

When I shadowed a breast cancer physician, we did actually see a teenage girl, probably 14 or 15, come in with a lump and he did a biopsy on a lump in her breast. A that age when the breast is developing, it is common for a duct in the breast to become blocked and form a temporary cyst, or for a benign tumor, a fibroadenoma, to form. He suspected she had a fibroadenoma. For the guys out there who don't know what those would feel like, they resemble grapes in the breast, and they generally go away as a girl gets used to hormones and the breasts develop. If I were a guy learning about feminine health, I would probably be very surprised at how much happens. I may be biased, but I think female development is a lot more complicated than male development, on account of girls having breasts, a uterus, and ovaries to worry about, instead of a single, localized sperm-delivery system. Also girls seem to have more hormones to regulate the reproductive system, whereas men mainly have testosterone.