What is bilirubin? It is this question that patients ask when a high rate of this substance is found in a blood test. The answer to this question is simple. It is known that bilirubin is a bile pigment that appears during the breakdown of substances such as hemoglobin, myoglobin and cytochrome.
To find out the causes of hyperbilirubinemia, you need to consult a doctor and perform a diagnosis using modern methods of examining the body, as well as follow the treatment prescribed by the doctor.
The process of formation of bilirubin and its effect on the body
After taking a biochemical blood test, the doctor can tell the patient that he has elevated bilirubin. What does it mean? This is a bile pigment. If its indicator is high, then the substance can have a toxic effect on every nerve cell. In addition, it is also the main factor in the development of encephalopathy, nuclear jaundice.
The process of conjugation, that is, the chemical binding of pigments (free type), occurs in the tissues of the liver. The breakdown of red blood cells, which manifests itself in the spleen, is able to ensure the release of a large amount of pigments through the veins with the blood flow passing into the liver itself. Biochemical "binding", a change in bilirubin in liver cells, explains the decrease in the dangerous effects on each organ and tissue.
Different types of bilirubin
Continuing the topic of what bilirubin is, it should be noted that it occurs in different types of bile fractions:
- direct bilirubin;
- indirect bile pigment.
Blood tests may indicate that total bilirubin is elevated. What this means can be understood as follows: during a biochemical study of blood elements, the volume of bile pigment is calculated as a whole for two fractions (total). And with a large volume or presence of indications, a study of the indicators of all fractions (indirect and direct) should be assigned separately from each other.
Indirect bilirubin is always produced: up to 300 milligrams of the substance is released daily during decay. When passing through the bloodstream in the indirect type of liver tissue, bilirubin begins to transform due to biochemical processes. They end with conjugation with acid and the appearance of bilirubin.
Indirect pigment is toxic to tissues and organs. With incomplete penetration into the cells, it begins to conjugate with fats - this leads to a possible disruption of the processes of cell respiration and metabolism. Protein begins to form, potassium ions are transported.
High concentration (indirect form) is considered especially dangerous for brain tissue. Because of this circumstance, it is necessary to consider the norms of bilirubin in different age categories of people.
Normal values of bile pigment in infants
In newborns, bilirubin is important and needs to be controlled. It is clear that the highest levels of this pigment in the blood, which do not accompany any disease and dysfunction, can be seen in young children. This is due to the process of rapid breakdown of red blood cells in the baby's blood.
So what is bilirubin? Continuing to answer this question, it is necessary to note the frequent signs in newborns. The yellowish tint of the skin and eyes in the first week after birth is a consequence of a temporarily elevated bilirubin content in the blood. It is known that its content varies depending on the age category.
The process of releasing a large amount of the bile component begins to end when the child is exactly one month old. After that, the norm of bilirubin is reached, and it corresponds to the value of adults. Moreover, if the normalization of this substance has occurred, then this is not a reason to refuse further examination. It is worth identifying the cause.
Causes of hyperbilirubinemia in infants
The level of total bilirubin in newborns is very different from that in adults. This is due to excess fetal hemoglobin.
For full-term babies, normal bilirubin is 253 mmol/L, and for non-term babies it is about 163-167 mmol/L.
In young children there are disorders that occur in the production of such a substance. There is a high level of bile pigment in the presence of neonatal jaundice, viralhepatitis of different types.
Be sure to note the following reasons for the high content of bilirubin:
- liver pathology;
- Metastasis of a tumor localized in another organ;
- vitamin B deficiency12;
- Dubin-Johnson syndrome - poor excretion of direct bilirubin into the bile duct;
- a syndrome arising from the absence or lack of production of a special substance - the process of combining acids: bilirubin and glucuronic acid is disrupted.
A high content of bile pigments is noted in Gelbert's syndrome at different ages, but much more often in newborns.
Normal tests for different age categories
To find out in detail about the rate of bilirubin, you can consider the following table:
|
Bilirubin fraction In µm |
From 0 to three days | Three to six days | 1 month and older | Adults |
| Straight | 0, 5-10, 1(10, 2 max) | 1-12, 4 | 0 to 5, 1(max) | 0-5, 1(max) |
| General | 24-190 | 28 - 209 (max 210) | 3, 5- max. 20, 4 | 8 - max. 20, 5 |
| Indirect | 23, 4(5) - 180 (Max) | 27-198 (Max) | Max 16, 4-16, 5 | Max 16.5 |
In some congenital diseases, the content of bile pigment in the blood may be higher than the norms of bilirubin indicated in the table.
Main causes of increased bile pigment in adults
A bad blood test, expressed as an excess of the norms of bilirubin of two fractions - unbound and direct, should alert the patient. The pathological threshold of hyperbilirubinemia is the volume of a blood component equal to 34 microns per liter of blood. At this concentration, jaundice begins to actively manifest.
High or low levels of bilirubin in the blood are associated with disease. Often manifested as follows: a large accumulation of bile pigments begins in the proteins of the eyes, the mucous surface. This may result in a corresponding yellow tint.
Contrary to popular belief, hepatitis A, caused by hyperbilirubinemia, is not specifically related to hepatitis B, although it can occur as a symptom of this disease. A high content of a substance, especially when a large excess of the norm, is considered a sign that poses a danger to the life of the patient.
It should be noted that there are two fractions of bilirubin in the blood - free and bound. Diseases accompanied by a high level of bile pigment of the direct type should be considered:
- acute viral hepatitis A, B,
- mononucleosis, like secondary hepatitis;
- protracted form of hepatitis C;
- hepatitis of a bacterial nature in conditions such as leptospirosis;
- complication after food poisoning, medicines: non-steroidal anti-inflammatory drugs, hormonal contraceptives and so on;
- gestational jaundice in women during pregnancy;
- tumor formations in liver tissues.
Deviation from the norm of this component in the blood can be the cause of a genetic abnormality and a syndrome that is a factor in jaundice.
Signs of hyperbilirubinemia
If there are violations of liver function that prevent conjugation, the production of bile pigments in the body and the outflow of bile, an increase in bilirubin occurs. One of the signs of an increased value of this substance, which is detected during the analysis, is considered a violation in the system.
Yellow hue from bile pigment appears on the whites of the eyes, and then on the oral mucosa. After that, it begins to appear on the front, on the surfaces of the palms and on the soles. This also covers other parts of the body. A very common symptom that accompanies jaundice during hyperbilirubinemia is pruritus.
The presence of jaundice is not mandatory with elevated bilirubin. A similar feature of skin pigmentation can manifest itself with a large accumulation of substances - carotenes, for example, with excessive consumption of carrots, tomatoes. The yellow color of the skin is a symptom of diabetes mellitus, hypothyroidism. A special sign of this condition is the normal color of the sclera of the eyes.
Tall unbound and straightbilirubin: the main causes
The high content of such fractions is a consequence of factors (diseases) that are considered the root causes of hyperbilirubinemia. Consider this point in more detail:
- exceeding the content of such blood components as eritrocit, accelerating the processes of their destruction;
- excretion of bile (non-free type);
- violations in the processing and removal of pigments.
- a large number of blood cells and their destruction.
The main thing to understand is that if direct bilirubin is elevated, then you should immediately consult a doctor. The high rate of breakdown of blood cells (erythrocytes) can cause the development of such a type of jaundice as hemolytic. It is accompanied by the production of large amounts of indirect bilirubin. A similar condition manifests itself in many pathologies, including a hereditary defect in red blood cells and severe hemorrhage (hematoma, pulmonary infarction). A violation may occur if there are such problems:
- infectious pathologies;
- malignant tumors;
- poisoning.
If there are discrepancies in such important components as the blood type of the donor and the recipient, then jaundice appears. At the same time, the following symptoms are noted:
- Bright yellow tint to the whites of the eyes, mucous membranes and skin.
- Pale skin due to anemia.
- Sufficiently large volume of some organs - the spleen. There is pain in the left hypochondrium.
- The black color of secretions such as urine and feces is due tohigh content of urobilin.
Deterioration of well-being is associated with poor oxygenation - pain in the head, fast heart rate, high fatigue, as well as an increase in body temperature to subfebrile values.
Nervous system and brain damage
Bad analysis may indicate possible damage to the nervous system and organs. This condition refers to kernicterus. In an adult, a deviation from the norm in the analysis may indicate pathologies such as:
- cholecystitis;
- hereditary disorders of bilirubin metabolism;
- hepatitis;
- mononucleosis;
- cirrhosis of the liver;
- tumors in the liver;
- toxic hemolysis;
- hemolytic anemia;
- tumors in the pancreas;
- incompatibility of plasma groups during transfusion;
- bad reaction to used bactericides, contraceptives and other medicines.
Low content of bile pigment in the blood is diagnosed very rarely. It is usually associated with long-term use of vitamin C, phenobarbital.
Gastrointestinal problems
Poor outflow of contents from the gallbladder can cause hyperbilirubinemia. In the presence of such a problem, the bile component does not leave the body and is sent to the general bloodstream. For this reason, jaundice develops. Very common causes that cause outflow disruption include the following:
- the appearance of any narrowing of the ducts that remove bile, andalso the presence of gallstones in them, formation, pathologies in tissues, parasites;
- injury;
- tissue disease in the biliary tract of an inflammatory nature, which provokes sclerosis of the ducts.
Occurs in poor blood count and bile duct pathology from birth.
Gilbert's syndrome
Always increased bilirubin in the blood? So it's a congenital liver disease? This option is also quite acceptable, and the main manifestation of this disease is benign hyperbilirubinemia. There are signs of jaundice, accumulation of lipofuscins in hepatocytes.
Gilbert's syndrome was described as early as 1900 - it is called simple familial cholemia, that is, benign familial non-hemolytic hyperbilirubinemia.
The disease is rare. For this reason, benign hyperbilirubinemia should be included in the diagnostic screening for patients with high blood pigment values.
Clinical picture: symptoms
In Gilbert's syndrome, bilirubin begins to rise as a result of disorders such as:
- capture;
- transportation;
- conjugation in cells.
This condition occurs due to an enzyme defect. Due to the poor activity of this enzyme, the liver can completely lose such a function as neutralization. Given the pathogenesis of the disease, it should be noted that it is associated with impaired transport function of proteins that deliver bilirubin (total) to microsomes.
Most oftenthe disease begins to manifest itself in children at the age of 14 by chance and accompanies a person all his life. About 30% of people do not complain about their he alth. It takes a very long time in a state of remission, and at the same time there are no changes in the shade of the skin and eyes that relatives notice. Most often, such a syndrome is an accident that becomes noticeable during the examination of the patient.
Usually, the disease has a whole bunch of symptoms:
- Intermittent type of jaundice - associated with an excess of unconjugated bilirubin.
- Asthenoneurotic symptoms.
- The presence of pain and disturbances in the work of the stomach. There is a slight hysteria of the sclera.
In the development of Gilbert's syndrome, bilirubin in adults exceeds 21 mmol/l.
Hyperbilirubinemia in pregnant women
The increase in this indicator in this category of people has various reasons, but there are the most common of them. For example, during pregnancy, there may be a slight increase in the content of a substance associated with the large size of the fetus. Because the changes are small and physiological, they are not visible in blood screening.
With significant excess of bilirubin in the blood in women, the possibility of a dangerous disease or poor functioning of the bile secretion organs is of particular importance in this condition.
There are several diseases and conditions that cause changes in the performance of this pigment. They are dangerous, which is why it is so important to see a doctor in a timely manner.
The increase in the volume of bilirubin in the blood does not occuronly in case of illness, but also for a physiological reason related to pregnancy:
- stagnation of bile - their cause is the growth of the fetus and the organ, which puts pressure on the woman's insides;
- the presence of such a condition as early toxicosis is noted in many women in the first trimester of pregnancy;
- pregnancy cholestasis (intrahepatic) - manifests itself later, and begins to pass during childbirth without the need for medical intervention.
Dystrophy of the liver of pregnant women is also a fairly rare pathology that develops in the initial stages in pregnant women who bear a child for the first time.
Anemia hemolytic - the cause of early birth or death of a child in the womb. The second cause of the disease is hepatitis. Poor development of the placenta is also possible, which leads to a delay in the development of the fetus. It is also possible for a fetus to become infected from a condition such as hepatitis E in the womb.
A disease such as cholecystitis can cause the development of preeclampsia in the later stages. It is dangerous for the mother and the newborn with the following symptoms: edema, high blood pressure, leading to intrauterine growth retardation.
High bilirubin leads to dangerous childbirth and consequences, but before panicking, it is necessary to repeat biochemical screening, since another reason may be improper preparation of a woman for analysis. It is worthwhile to carefully approach issues related to the delivery of tests.
There are cases when during the screening, it was revealed thattotal bilirubin in the blood is quite low. Sometimes this is due not only to prolonged renal failure, but also to other reasons.
What causes low bile pigment?
Provoking factors can be diseases such as:
- acute leukemia;
- tuberculosis;
- aplastic anemia;
- bad preparation.
Leukemia is the cause of low bilirubin in the blood. It is still possible that intoxication from tuberculosis leads to poor analysis. These diseases are considered dangerous, and timely examinations and treatment can avoid a dangerous complication.
Aplastic anemia
Poor performance is due to this form of anemia, which is a rare and complex disease that requires timely medical attention and treatment.
So what is bilirubin? Returning to this problem, in the context of aplastic anemia, it should be noted that with this disease there is a decrease in the content of red blood cells and, accordingly, there is a tendency to their destruction and to a decrease in the content of bilirubin.
Ischemic heart disease
It also causes disruption of the gastrointestinal tract and, as a result, poor tests.
Speaking of patients who have reached the age of more than 60 years, it should be noted that a decrease in the number of bile pigments is characteristic of IHD (coronary heart disease) of various typesintensity. Clinically, this disease occurs with symptoms of low bilirubin.
It is worth noting that improper preparation for donating blood for research can also be the cause.
Tips for Successful Testing
It is recommended that you familiarize yourself with certain expert advice that should be followed immediately before taking blood for biochemical analysis:
- Do not eat 12 hours before screening.
- High physical activity is prohibited. This may affect the result of the analysis.
- Don't drink drinks containing caffeine or alcohol.
- It is proposed to stop drugs that affect bilirubin.
Before performing the test, it is recommended to avoid heavy physical exertion, as the results may be incorrect with them.
Recommendations for dealing with high bilirubin
You should follow all the advice from the doctor with a bad analysis, because if you do not take the prescribed funds and do not contact specialists with this problem, you can provoke the development of serious complications.
The main goal of treating diseases and other causes of hyperbilirubinemia is to achieve a normal or acceptable level of this substance. It is determined by the doctor and it does not have to be within 21 mmol / l - higher values \u200b\u200bare possible in the presence of certain diseases. In any case, the condition is dangerous when bilirubin in the blood is elevated. Reasons for this violationneed to be detected and treated in a timely manner.
