Biliary acids is a critical laboratory value in pregnant women: a case report as an opportunity to improve the quality of care


  • Anna Lisa Montemari Clinical Laboratory Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
  • Michaela Carletti Clinical Laboratory Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
  • Susanna Ferrero Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
  • Rosa Carmela Cristofaro Clinical Laboratory Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
  • Giovina Di Felice Clinical Laboratory Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
  • Cinzia Anna Maria Callà Department of Scienze Biotecnologiche di base, Cliniche Intensivologiche e perioperatorie, Università Cattolica del Sacro Cuore, Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del S. Cuore, Rome, Italy
  • Ottavia Porzio Clinical Laboratory Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy; Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy



BA, Laboratory critical values, Pregnancy complications, Fetal loss, Critical communications, Cholestasis


Biliary acids (BA) levels were found greatly increased to 72.1 µM/l in a pregnant woman. Bambino Gesù Children’s Hospital had not established critical alarm values for BA, so communication of the result was overpassed. After 30 hours, the patient referred to the emergency room of another hospital for the assessment of the pregnancy course and BA re-evaluation, which in turn resulted normal. BA levels in our sample were re-analyzed in both laboratories and high levels were confirmed. We utilized an enzymatic cycling colorimetric method measuring primary, secondary and tertiary BA. The patient was on therapy with ursodeoxycholic acid (UDCA) explaining total BA results difference reported in the two different blood samples. BA accumulation maybe leads to fetal complications or loss and a quick communication of the result to clinician could potentially be life-saving for the baby. We implemented corrective actions to avoid adverse events by the introduction of a note on the report, warning of UDCA therapy interference in BA dosage and recommending the suspension of therapy 24 hours before blood sampling; furthermore, in order to provide high level of health care, we introduced an alarm value for fertile women in our critical values list.


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How to Cite

Montemari, A. L., Carletti, M., Ferrero, S., Cristofaro, R. C., Di Felice, G., Callà, C. A. M., & Porzio, O. (2023). Biliary acids is a critical laboratory value in pregnant women: a case report as an opportunity to improve the quality of care. International Journal of Research in Medical Sciences, 11(12), 4507–4512.



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