The red cell hydrogen peroxide hemolysis test and vitamin E absorption in the differential diagnosis of jaundice in infancy

Studies of red cell hydrogen peroxide hemolysis and intestinal absorption of vitamin E were conducted in 21 infants whose major presenting symptom was jaundice, in order to evaluate the efficacy of these simple laboratory techniques in differentiation of their disease conditions. The peroxide hemolysis test is based upon the assumptions that the intestinal absorption of fat-soluble vitamin E requires adequate amounts of bile salts and that vitamin E deficiency is reflected by abnormal sensitivity of the red cell membrane to hydrogen peroxide. Ultimate diagnoses in the infants studied, 14 of whom underwent open liver biopsy and operative cholangiogram, included biliary atresia, neonatal hepatitis, and primary congenital hemolytic processes. Although a single red cell hydrogen peroxide hemolysis test did not clearly differentiate between the various conditions studied, peroxide hemolysis used in combination with vitamin E absorption curves showed distinctly different patterns for each group of diseases. The information gained thus enabled prediction of the jaundice with accuracy and indicates that these laboratory techniques can be of great value in guiding the decisions regarding the necessity and timing of surgical exploration in jaundiced infants.