Modern analyzes make it possible to determine whether certain organs and systems work correctly, as well as to identify pathologies at an early stage of development. When diagnosing, the level of bilirubin in the blood can be studied. The deviation of this indicator from the norm indicates the development of various pathologies. When it can be considered that bilirubin is elevated, as well as what are the causes of this phenomenon and what are its consequences - all this will be discussed further.
What is bilirubin?
Sometimes at a therapist's appointment you can hear the phrase: "Total bilirubin is increased." What does it mean? Bilirubin is a red-orange pigment with a yellowish tinge. It is formed during the breakdown of red blood cells. This is a normal process that is constantly observed during the metabolic processes of the body. Bilirubin is secreted into bile and then excreted in urine or feces from the body.
Initially, bilirubin is in the form of an indirect (indirect) type. It circulates in the body. In this case, the bile pigment does not dissolve in water. It is a toxic substance that can harmbody.
To remove a dangerous substance from the body, blood albumin reacts with it. It delivers indirect bilirubin to the liver. In this organ, the bile pigment acquires a soluble form. It is called direct bilirubin. In the form associated with albumin, the indirect form of the substance does not penetrate into the cells and does not pass through the filtration department located in the kidneys.
All bilirubin (direct and indirect) is called total. If the level of one of the types of pigment increases, this indicates a failure at one of the stages of metabolism. Direct bilirubin is non-toxic.
Increased bilirubin in the blood is a deviation from the norm. He can talk about the development of serious diseases.
Diagnostic features
During a laboratory examination, it can be established that bilirubin in the blood is elevated. What does it mean? Laboratory diagnostics is an effective method for detecting abnormalities in the functioning of the liver, gallbladder and other organs. Similar analyzes are carried out in combination.
In addition to blood tests for bilirubin levels, other diagnostics are carried out. The doctor may prescribe a blood test for AST and ALT, as well as alkaline phosphatase. This allows you to identify problems in the liver.
Such a diagnosis is indicated for a number of diseases. The first is jaundice. Also, if the patient abuses alcohol or has a serious dependence on it, the doctor prescribes such an examination. If you suspect the use of psychotropic, narcotic drugs is also examinedthe amount of bilirubin in the blood. If it is suspected that a person has been infected with viruses that cause hepatitis, this analysis should also be carried out.
If insufficient red blood cells are found in the blood, anemia will be diagnosed. In this case, the level of bilirubin is also examined. This allows us to draw conclusions about the presence of hemolytic anemia. In this case, additional analyzes are also carried out. These include complete blood count, haptoglobin, reticulocytes, LDH.
There are a number of outside factors that explain why bilirubin is elevated. What the results of the examination mean, the doctor will be able to establish. An incorrect result can be obtained when the patient consumes coffee or other drinks that contain caffeine. They can affect the amount of bilirubin in the blood. Also, prolonged fasting, abstinence from food can lead to an increase in indirect bilirubin. In this case, you will need to re-diagnose.
Norm in adults and children
There are certain regulations. If you go beyond these limits, it can be argued that bilirubin is elevated. What does it mean? When conducting an analysis, the amount of both direct and indirect bilirubin is studied. The indicator is correlated with the age of the patient.
So, for children up to three days of life, this figure is 24-190 µmol/l. In this case, direct bilirubin should be from 0.5 to 10.2 µmol / l, and indirect - 23.5-17.8 µmol / l. Three days after birth, babies normally have a total value of this pigment from 28 to 210 µmol/L.
After the first month, bilirubin in the baby's blood decreases. Now it should be 3.5-20.4 µmol/l. At the same time, decryption is also done. Direct bilirubin in the blood should be 0.5-1 µmol/l, and indirect - up to 16.5 µmol/l.
In an adult, total bilirubin should be 8-20.5 µmol/l. It is this pigment that colors urine and feces. If their color changes, becomes saturated yellow, you need to be examined.
It does not matter what gender the patient is. The values shown are the same for women and men.
Reasons
If bilirubin is elevated, what do these test results mean? Such an indicator can indicate many pathologies. If this situation is observed in an adult, this is a sign of improper breakdown of red blood cells. This, for example, may be a reaction to the intravenous administration of whole blood from a he althy person during a period of illness or other critical condition of the patient.
Also, bilirubin rises with scarring of the liver. Its structure is growing and rebuilding. Its cells are replaced by connective tissue. This situation is observed in fibrosis, cirrhosis of the liver.
Inflammatory processes also affect the amount of hemoglobin in the blood. This happens in the presence of hepatitis type A, B, C. Also, a similar situation is possible when pathogenic viruses or bacteria enter the body.
Another reason why total bilirubin is elevated in an adult is bile duct dysfunction. With the appearance of bileduct stones are clogged. As a result, bilirubin begins to be excreted from the body in a slightly different way, it accumulates. This situation also occurs when malignant tumors appear in the tissues of the pancreas.
Hemolytic jaundice
If bilirubin is elevated in an adult, some diseases explain this condition. One of the common pathologies is hemolytic jaundice. It is worth considering that red blood cells live for about 4 months. They are then broken down and excreted from the body. If, for some reason, red blood cells begin to quickly and massively collapse, the liver does not have time to transform them and remove them from the body. In this case, suprahepatic jaundice occurs.
In this case, during the analysis, it will be found that the total bilirubin will be slightly increased or even normal. In this case, indirect bilirubin will be increased, and direct bilirubin will be normal.
Such a state occurs due to certain reasons. Prehepatic jaundice is caused by hemolytic anemia, sepsis, malaria, Addison-Birmer's disease, rheumatic conditions. Also, severe poisoning, including the waste products of helminths, can lead to a similar phenomenon. In newborns, a similar situation is provoked by hemolytic disease.
There are several more factors why bilirubin in the blood is elevated. The reasons for the appearance of this condition may be due to the intake of certain medications. Many antibiotics, aspirin, insulin and other drugs cause this situation.
Symptoms of this disease can be chills and fever, the rapid development of the disease. In this case, the skin becomes yellow. There are signs of anemia. These include pallor, decreased hemoglobin, weakness. On examination, the doctor may notice that the spleen is enlarged. In this case, the liver either remains the same size or is slightly enlarged.
Hepatocellular (parenchymal) jaundice
There is another disease that can affect the amount of bilirubin in the blood. This is hepatocellular jaundice. The metabolism of bilirubin in this case is disturbed at the stage of conversion from an unbound to a bound state. In this case, it can be said that the liver cells are damaged.
In this case, indirect bilirubin will remain normal. However, his diseased liver will not be able to convert to a bound form. In this case, the level of direct bilirubin may also increase. This is due to violations of the process of formation and outflow of bile through the internal channels of the liver. The analysis will also show that the total bilirubin is elevated.
The reason for the development of such a disease are all types of hepatitis, cancer, and cirrhosis. Icterohemorrhagic leptospirosis leads to this condition. Also, the cause may be poisoning with special types of poisons, sepsis, Dubin-Johnson, Rotor, Gilbert, Lucy-Driscoll, and Crigler-Najjar syndromes.
Also, certain drugs cause a similar situation. These can be birth control pills with estradiol, "Morphine",Paracetamol, Rifadin. Hepatocellular jaundice is often caused by excessive alcohol consumption.
The symptom of this condition is the gradual development of the disease. The patient begins to feel periodic nausea, loss of appetite. His skin color turns yellow. Over time, the shade may even become greenish. The stool becomes either completely or partially discolored.
You may also experience slight itching. Urine darkens. There may be fever, pain in the right side, and vomiting. In this case, the liver is always enlarged. The spleen may be of normal size.
Mechanical jaundice
The cause of increased bilirubin in the blood can be mechanical (subhepatic) jaundice. In children, this disease is extremely rare. It usually develops in adulthood or old age. In this case, unbound bilirubin is determined in a normal amount. It is transformed in the liver into a bound substance. However, it is not excreted in the required amount due to problems with the biliary tract.
A blood test in this case shows that total bilirubin will be elevated. In this case, its indirect type will be normal. The amount of direct bilirubin increases. There are several reasons for the appearance of such a disease. It can be caused by stones or narrowing of the bile ducts. Also, swelling or cyst of the pancreas can lead to similar consequences.
Mechanical jaundice is also provoked by acute or chronic pancreatitis, portal biliopathy, syndromeMirizi, as well as oncological neoplasms of the stomach, bile ducts, pancreas, liver.
In infants, this condition may be due to a rare congenital disease. In this case, the bile ducts are either poorly developed or absent altogether. This situation requires surgical intervention.
If tumors are the cause of the disease, the deterioration is rather slow. In other cases, the disease develops quickly. The skin becomes yellow-green. The stool becomes discolored and the urine darkens. The skin is very itchy, nausea and vomiting appear. There is severe pain in the right side. The gallbladder may be enlarged. However, the liver and spleen are usually not enlarged.
Jaundice in newborns
There may be increased bilirubin in the blood of a newborn. In this case, physiological jaundice is diagnosed. This is one of the most common causes of increased bilirubin in newborns.
In a small child who is not yet a week old, the level of hemoglobin is much higher than in an adult. With the breakdown of red blood cells, liver enzymes are not yet able to qualitatively cope with a high amount of bilirubin. In this case, the baby's skin may turn yellow. It is quite normal if this situation continues for 2-3 weeks after the birth of the baby. This process is called physiological neonatal jaundice.
According to various sources, this situation occurs in 25-50% of newborns.
And the skin turns yellow, starting from the head. The lower this one goesshade, the more bilirubin is determined in the blood of the baby.
It is also worth noting that physiological jaundice appears more often in children who are breastfed. Mother's milk somewhat dulls the production of liver enzymes of the child. Because of this, there are characteristic signs of an increase in bilirubin.
This situation requires examination. If various diseases that can cause such a phenomenon are excluded, the yellowness of the baby's skin should not cause concern in the first months after childbirth. At the same time, the level of bilirubin should decrease in dynamics.
Nuclear jaundice
Bilirubin is often elevated in newborns. This is quite normal, but requires monitoring by doctors. In some cases, the level of bilirubin becomes critically high. In this case, kernicterus is diagnosed. This is a severe form of the disease, which is not normal and dangerous for the he alth of the baby.
In this case, the amount of unbound bilirubin in the blood of the newborn increases. It has an extremely negative effect on the central nervous system of the baby. Brain cells begin to break down. If the child was born full-term, the critical threshold for bilirubin in the blood is 324 µmol/L. If the baby is premature, this figure drops to 150-200 µmol/L.
Factors for the development of kernicterus
If bilirubin is high in a newborn, there are a number of pathologies that provoke this condition. The development of nuclear jaundice is promoted by hemolytic disease of newborns, as well as their prematurity. Lead to similarpathological pathological hemolysis, hemolytic anemia, Hirschsprung's disease, pyloric stenosis. Also carry a serious risk of hemorrhage, endocrine disorders, fermentopathy, intrauterine infections or sepsis.
If it is determined that bilirubin is elevated, you need to consult an experienced doctor. He will conduct a comprehensive diagnosis, establish the cause of this condition. After that, the correct treatment can be started.
