BACKGROUND: Total bile acid (TBA) is commonly used in pregnant women as a diagnostic and monitoring marker for intrahepatic cholestasis of pregnancy (ICP). Over 90% of pregnant women suffering from ICP have an increase in serum TBA levels. METHODS: We present the case of a 27-year-old pregnant woman whose TBA level initially reached 152.5 µmol/L, far exceeding the threshold for concern in ICP. However, upon resampling and testing the following day, her TBA levels returned to within the normal reference range (< 10 µmol/L). To investigate this substantial fluctuation over a single day, we performed thorough maintenance and cleaning of the instrument before retesting the serum samples for TBA. Additionally, serum samples from both days were sent to two independent laboratories for reanalysis using different testing systems. RESULTS: Two samples were analyzed using different testing systems, yielding consistent results. The falsely elevated TBA levels were attributed to the patient's non-fasting state and the recent intake of a high-fat meal prior to blood collection. CONCLUSIONS: When TBA levels are unusually elevated in a pregnant woman without symptoms of ICP, a repeat test should be performed under strict fasting conditions. The patient should also be educated on the importance of adhering to fasting protocols for accurate blood testing.
Li et al. (Thu,) studied this question.