What can cause high bilirubin? Manifestations of increased bilirubin. Reasons for increased indirect bilirubin

Bilirubin is a relatively well-known medical term, but few people know what its indicators mean. We are talking about bile pigment, a waste product created by filtering blood from defective red blood cells. Unconjugated bilirubin occurs during the breakdown of hemoglobin. It penetrates hematogenously into the liver, where glucuronic acid acts on it, converting unconjugated bilirubin into conjugated bilirubin.

Sometimes laboratory research show increased bilirubin in the blood and what does this mean in men and women? The reasons for increased unconjugated bilirubin are liver overload. We may be talking about a serious illness - Gilbert's syndrome, but exceeding the norm can also be a short-term indicator that gradually stabilizes. Why are indicators increasing, and what to do about it?

Liver cells contain enzymes whose functions include, among other things, the conversion and elimination of waste substances from the body.

Development mechanism increased bilirubin in the blood(hyperbilirubinemia, Gilbert's syndrome) is based on a lower power of the enzyme (glucuronosyltransferase), leading to a slower excretion of bilirubin into the bile and, therefore, from the body. Specialized medical literature says the problem affects up to 10% of the population.

An increase in blood levels in adults may be due to an increase in the death of red blood cells ( hemolytic anemia).

Hyperbilirubinemia is classified according to the type of bilirubin whose concentration increases:

• unconjugated - the liver does not have time to remove the pigment from the blood when it is excessively formed; if secretion is not increased, the reasons may lie in the lack of sufficient absorption or conjugative capacity of the organ;
• conjugated – most often, the value increases due to obstruction biliary tract;
• mixed - the indicator of unconjugated and conjugated bilirubin increases, mainly when hepatocytes are damaged.

Physiological indicators

Physiological indicators in the blood of men(same as in the blood of women) at the age of 10-110 years are 0.0-5.1 µmol/l (in plasma).

Reasons for the presence of bilirubin in the blood

As already mentioned, there are many reasons for the increase in bile pigment levels. The same as the reasons why the doctor performs lab tests blood to determine levels.

The most common indications for research are the following:

• abdominal pain;
• nausea;
• vomit;
• yellowing of the whites of the eyes;
• yellowing of the skin.

Bilirubin (total) should be monitored in alcoholics, consumers narcotic drugs and people taking medications that have harmful effects on the liver. Rapid weight loss should not be underestimated - in this case it is also advisable to conduct an analysis.

When examining the values ​​of this parameter:

• symptoms of liver damage: jaundice (yellowing of the skin, mucous membranes and whites of the eyes), dark brown urine, nausea, vomiting, abdominal enlargement, weight loss, stomach pain, swelling in right leg, signs of flu, joint or skin lesions;
• history of liver inflammation;
• contact with viruses that infect the liver;
• regular consumption increased amount alcohol;
• family history of hepatogenic diseases;
• taking medications that can damage the liver;
• monitoring of the therapeutic course for liver diseases;
• suspected hemolytic anemia;
• use of narcotic drugs.

Causes of hyperbilirubinemia

An increase in total bilirubin occurs for several reasons:

• increased pigment formation (red blood cell breakdown) due to hemolysis;
• the problem with its elimination is Gilbert's syndrome;
• the combined option is a rarer occurrence.

These conditions usually occur due to hemolytic anemia, hepatogenic diseases or biliary tract diseases (gallbladder disease, gallstones). Causes of elevated levels also include:

• atherosclerosis;
• inflammation;
• autoimmune diseases;
• neurodegenerative diseases;
• hepatitis A, B, C, E;
• Wilson's disease;
• alcohol poisoning;
• drug abuse;
• malaria;
• mononucleosis;
• heart failure;
• liver infections;
• artificial heart valves.

Sometimes causal factors high bilirubin may be:

• genetic influences;
• use of certain medications (chemotherapy, sulfonamides).

Increased value – as an indicator of painful conditions

1st line - the formation of bile pigment may increase due to increased breakdown of red cells:

• anemia due to birth defects development of red blood cells or red blood dye ( sickle cell anemia, thalassemia);
• transfusion of incompatible blood;
• mechanical destruction of red blood cells on artificial heart valves;
• primary hyperbilirubinemia (bilirubin is produced directly from the bone marrow due to impaired hematopoiesis);
• consequences of heart surgery, heart failure (liver congestion with blood);
• absorption of larger blood lesions;
• infections.

2nd line – hepatogenic diseases:

• acute, long-term viral hepatitis;
• autoimmune inflammation of the liver (action immune system directed against one’s own tissues and organs);
• acute inflammation caused by alcohol;
• toxic damage (poisoning with halogenated hydrocarbons, fly agarics);
• steatosis (increase in fat) of the liver;
• cirrhosis;
• insufficient liver circulation with oxygen deficiency in its tissues;
• liver cancer;
• liver failure;
• liver abscess (cavity filled with pus);
• lack of alpha-1-antitrypsin (a protein produced in the liver that protects the body from the effects of enzymes released from white blood cells during an inflammatory response).

3rd line – violation of bilirubin conjugation (compound with glucuronic acid) in the liver:

• Gilbert, Crigler-Najjar syndrome.

4th line – impaired excretion of pigment by the hepatic bile ducts:

• Dubin-Johnson syndrome, Rotor;
• inflammation of the bile ducts;
• stagnation of bile due to estrogen;
• bile duct tumors.

5th line – violation of the outflow of bile in the bile ducts:

• narrowing, blockage with stones;
• gallbladder tumor, bile ducts, pancreas;
• inflammation of the bile ducts, gallbladder and pancreas.

Signs of an elevated level

The most obvious symptoms of increased bilirubin are:

• yellow skin;
• yellow nails;
• yellow eye whites;
• fatigue;
• pressure in right leg;
• nausea;
• itchy skin;
• sudden weight loss;
• flu-like symptoms;
• Combined manifestations may occur.

Less commonly, signs include brown urine.

Toxicity of high bilirubin

The condition, when there is elevated bilirubin in the blood, is especially dangerous for newborns, as it can damage their brain. There is also a danger for adults (see below).

Direct consequences of elevated concentrations

Hyperbilirubinemia more than 43 mmol/l in older children and adults clinically causes jaundice - yellowing of the skin and mucous membranes.

In the case of an increase in conjugated bilirubin with complete obstruction of the biliary tract, the formation of urobilinoids does not occur, because bile pigment is not excreted into gastrointestinal tract with the help of bile. The result of this is an aphoric stool gray. Conjugated bilirubin is filtered in the kidneys, resulting in bilirubinemia.

Unconjugated hyperbilirubinemia (particularly associated with acidosis and lack of free albumin) can lead to the accumulation of bilirubin in the central nervous system and subsequent damage (bilirubin encephalopathy). This means the dissolution of hydrophobic bilirubin in membrane lipids, damage to membrane permeability, membrane transport and affects the neuronal regulatory mechanism. Some sources also point to impaired oxidative phosphorylation in mitochondria.

Late hyperbilirubinemia is prognostic bad sign, because the liver parenchyma retains the ability to secrete pigment until severe damage occurs. Isolated hyperbilirubinemia without clinical signs and increases in other indicators, usually benign.

Scientists have recently published information that adds more importance to bile pigment and negates the existing information that reducing its levels should not be given of great importance. Research has confirmed that this is a significant antioxidant that the body produces on its own. It has been shown that with a slight increase in its level, the risk of developing lung cancer is reduced in both women and men.

Bilirubin is a bile pigment, one of the components of human bile. The substance got its name from the Latin words bilis (bile) and ruber (red).

The formation of bilirubin occurs as a result of a complex and continuous process of breakdown of hemoglobin and breakdown of red blood cells. This is done in internal organs: liver, spleen and bone marrow. The breakdown products are transferred into bile and then removed through the intestines outside the body.

There is little bilirubin in the blood plasma. Its normal level may increase if the flow of bile is disrupted or problems with the liver appear.

To determine the bilirubin content, you need to carry out biochemical research blood.

Types of bilirubin

When studying the composition of the blood, the content of bilirubin is determined:

• general;
• direct (related, conjugated);
• indirect (unbound, free).

Initially, the spleen produces indirect bilirubin, which is very toxic. It does not dissolve in water and cannot be excreted from the body. Indirect bilirubin can easily penetrate the membrane of any cell and disrupt it normal functioning. Its initial target is the brain, then the entire nervous system comes under attack. That is why it is important that the concentration of this type of bilirubin does not leave the established limits.

If the level of free bile pigment is normal, then it enters the liver along with the blood, where it is converted into the direct form of bilirubin.

In this state, the substance is low-toxic, easily dissolves in water, and therefore quickly leaves the body along with feces and urine.

Based on the conducted medical research A hypothesis has been developed that bilirubin is the main cellular antioxidant. And if this is true, then monitoring the level of the substance and not allowing it to go beyond the norm is an important task.

Bilirubin is increased: reasons

The reasons that cause bilirubin to exceed the norm are grouped into the following groups:

• acceleration of the process of destruction of red blood cells;
• failures in the processing of pigment directly in the liver;
• problems in the outflow of bile.

When red blood cells begin to be rapidly destroyed, both hemoglobin and indirect bilirubin increase sharply.

A shortening of the life cycle of red cells is characteristic of a group of blood diseases under common name hemolytic anemia. It is divided into two subgroups:

• hereditary;
• acquired.

I. Hereditary disease is caused by genetic pathologies:

• membranopathy – damage to the structure of red blood cell membranes;
• fermentopathy - a decrease in the intensity of those enzymes that are important for the life of red blood cells;
• hemoglobinopathy - the structure of hemoglobin is disrupted.

The most commonly observed hereditary hemolytic anemias are:

• Sickle cell – associated with the production of “incorrect” hemoglobin. The structure of its protein is disrupted, and it acquires a crystalline non-standard structure. The shape of the red blood cells becomes sickle-shaped.
• Cooley's anemia, or thalassemia. The disease is characterized by a decrease in hemoglobin production.

II. Acquired hemolytic anemia is characterized by the fact that the body begins to produce antibodies hostile to its own red blood cells. The disease also appears as a result of exposure to toxic substances.

Materials harmful to red blood cells include:

• arsenous hydrogen, or arsine, is formed in some industrial processes and enters the body by air;
• phenylhydrazine is the basis for the production of medicines and azo dyes;
• Hyperiz (benzoyl peroxide) is a component in the production of rubbers, acetone, and fiberglass.

No promotion direct bilirubin can also be called:

• Vitamin deficiency, especially B12 (cyanocobalamin). This is the only water-soluble vitamin that can accumulate in the body - it accumulates in the liver, spleen, lungs and kidneys.
• Infectious diseases, namely sepsis, malaria, typhoid fever.
• Syphilis in the second and third stages.
• Syndromes Lucy - Driscoll, Gilbert or Crigler - Nayyar.

Such medicines, like aspirin, chloramphenicol, insulin, in their arsenal side effects have increased bilirubin. Therefore, they should be taken with caution.

IN metabolic processes bilirubin plays an important role in the liver. If it happens pathological processes, then it is not able to completely neutralize the toxic yellow pigment. The result may be ailments that are accompanied by an increase in the concentration of direct bilirubin:

• Viral hepatitis of all types, including drug-induced and alcohol-related.
• Cirrhosis of the liver.
• Hereditary jaundice: Rotor and Dabin-Johnson syndromes.

The level of direct bilirubin can increase cholelithiasis associated with problems with bile flow.

Another factor in the increase in direct bilirubin concentration is helminthic infestation. The penetration of worms into the body is a common phenomenon and should not be underestimated.

Symptoms of elevated bilirubin

When the concentration of bilirubin increases, the color of the skin and sclera of the eyes first changes. They acquire a characteristic yellow color. This is especially noticeable on the palms and lower surface of the tongue. This is where jaundice appears first.

When the process of bile outflow from the gallbladder is disrupted, the amount of direct bilirubin increases sharply. In addition to jaundice, hepatic colic appears - attacks acute pain under the right rib.

Elevated bilirubin can be irritating nerve endings skin, causing quite severe itching.

Additional symptoms are:

• abnormal stool: feces are almost discolored, resemble white clay;
• bloated stomach, constipation gives way to diarrhea;
• nausea and “bitter” belching, bouts of vomiting;
• lack of appetite;
• urine darkens.

Often, the accumulation of excess bilirubin only causes severe discomfort in the liver area. It is especially noticeable after physical activity, even minor ones.

If the cause of increased bilirubin is hemolytic anemia, then the symptoms are as follows:

• a feeling of discomfort under the left rib, caused by an enlarged spleen;
• temperature rises;
• urine becomes dark, possibly dark brown, and even black - this indicates that red blood cells are being destroyed inside the vessels;
• feeling very tired;
• frequent headaches;
• weakness throughout the body;
• painful sensations in the area of ​​the heart.

If you have such symptoms, you cannot do without consulting a doctor and carrying out appropriate tests. And this needs to be done immediately.

Features of increased bilirubin in newborns

For children, the same bilirubin norm is established as for adults.

But newly born babies have some peculiarities.

In infants, increased bilirubin is common. This occurs due to the active breakdown of fruit hemoglobin, which is different from that produced after birth. Bilirubin levels rise and the baby develops physiological jaundice.

The baby’s liver is not yet fully functioning, so an increase in the amount of pigment causes yellowness of the skin and mucous membranes. This is especially pronounced on the third day of life.

Over the course of a week, bilirubin returns to normal, as the baby’s body and its enzyme systems fully adapt to the outside world and begin to function fully. Physiological jaundice in a healthy baby does not harm the body.

But bilirubin does not always return to normal. Newborns may develop pathological jaundice, in which the level of pigment increases significantly. This happens when there is:

• hepatitis of all types - acute viral, bacterial, toxic, chronic.
• severe intestinal obstruction;
• intensive destruction of red blood cells caused by genetic factors;
• constitutional liver dysfunction or Gilbert's syndrome;

Infants should be under constant supervision of pediatricians in order to diagnose any problems in a timely manner. possible pathologies and take therapeutic measures.

Increased bilirubin in pregnant women

In women who are pregnant, the bilirubin level should be within normal limits.

The exception is the third trimester. During this period, many pregnant women experience an increase in the content of bile pigment.

The main reason for this phenomenon is the appearance of intrahepatic cholestasis in pregnancy. In most cases, the disease goes away after childbirth.

How to bring bilirubin back to normal

In order to reduce bilirubin, it is first necessary to determine the cause of its increase.

There are certain treatment methods that only a doctor can prescribe.

These include:

• Infusion therapy. Glucose and detoxification medications are infused intravenously. With their help, the body is cleansed not only of excess bile pigment, but also of other breakdown products. This method is effective. They resort to it in case serious condition patient.
• Phototherapy, or phototherapy, - the patient is exposed to light emanating from artificial sources: lasers, light-emitting diodes, fluorescent and dichroic lamps. Under their influence, toxic bilirubin transforms into its direct form and leaves the body.

  This method has been successfully used to treat jaundice in newborns.

• Drug treatment– necessary when the cause of the increase in bilirubin is a violation of the outflow of bile. A list is being determined pharmacological drugs, the intake of which should normalize the condition of the body and regulate the level of bile pigment.
• Correction of the daily diet. To reduce the load on the liver, you need to avoid eating fried, fatty, peppery foods, soda, flour and sweets. No alcoholic drinks. Strong coffee and tea are also prohibited. The daily diet should consist of steamed or oven-cooked dishes.

Additionally, cleansing medications may be prescribed, in particular Activated carbon and gels that remove toxins.

When hepatitis is the cause of the increase in bilirubin, treatment is aimed at neutralizing the virus that caused the disease. The doctor prescribes medications that should protect the liver. Thanks to successful treatment hepatitis, the level of bile pigment is normalized.

For some liver diseases and Gilbert's syndrome, it is possible to prescribe drugs such as zixorine and phenobarbital. A patient taking these medications should be under the supervision of a doctor to monitor and prevent possible complications and side effects.

Reducing bilirubin: folk remedies

Decoctions made from herbs will help reduce the level of bilirubin in the blood and reduce the load on the liver.

You can normalize bile pigment by drinking tea, which contains:

• chamomile and mint;
• St. John's wort and motherwort;
• corn silk.

You need to measure out two dessert spoons of the herbal mixture and pour a glass of boiling water. The infusion should stand covered for about an hour.

The dose of the drink is one glass per day. Half should be drunk on an empty stomach about twenty minutes before breakfast. The rest is taken before bedtime.

A tincture of birch leaves is effective. First, young birch leaves are dried and then crushed. A tablespoon is poured into one glass of boiling water and left for a day. The drug is taken before bedtime.

It’s a good idea to cleanse the liver with milk thistle fruit extract. The sprouted seeds of this plant are effective in the treatment of hepatitis. A tablespoon a day will help improve the liver and reduce elevated bilirubin.

Proper nutrition and moderate physical activity will also help improve the body’s condition and normalize the level of bile pigment.

It is important to avoid stress on nervous system, that is, to avoid breakdowns and stress.

Diseases that cause increased bilirubin must be treated comprehensively and all doctor’s instructions must be followed.

When receiving the results of a biochemical analysis, some patients may learn that the direct fraction of bilirubin in their body is increased. Not everyone knows about the presence of this substance and its role, and the phrase itself “ high level"immediately makes you think about the presence of some disease. What does it mean if direct bilirubin is elevated, what are the causes of this condition and how to deal with it, is discussed in the article.

The bile pigment bilirubin is a substance formed in the human body after the destruction of red shaped elements blood (erythrocytes). This is an absolutely normal physiological process that accompanies the destruction of old cells and the appearance of new ones.

A substance can exist in two forms:

• direct fraction (conjugated, bound form);
• indirect fraction (unbound, free).

After red blood cells are destroyed, hemoglobin is released from their composition. It is from this that bilirubin is formed. The process occurs in liver cells, bone marrow and spleen. This pigment is indirect, it does not dissolve in water and is toxic to the human body, so during chemical reactions it is converted into a bound form, which is considered low-toxic and ready for excretion.

Chemical transformations occur in liver hepatocytes, where bilirubin binds to glucuronic acid. Now it takes on the appearance of a direct faction. This type of substance enters the bile, and from it into the intestines. Part of the pigment is excreted from the human body through urine, the rest through feces.

There is also a collective concept - common bilirubin. This is the total amount of all pigment that is in the body (direct + indirect fractions). As a rule, this indicator is indicated by laboratory technicians when conducting diagnostic studies.

However, there are times when the attending physician suspects the presence of a certain disease in a patient, so he needs to find out the level of the direct pigment fraction. U healthy person direct bilirubin in the blood is approximately 20-23% of total number substances. Normal numbers are less than 3.4 µmol/l.

Reasons for the increase in indicators

There are a number of pathological conditions that may cause increased direct bilirubin (hyperbilirubinemia). Next, about each of the factors.

Liver lesions

This etiological factor considered the most common, since liver diseases are infectious and non-infectious disrupt not only the process of bile outflow, but also the mechanism of its formation.

Laboratory signs that direct bilirubin is increased due to liver pathology:

• discoloration of stool is partial or complete;
• the figures for the indirect fraction of bilirubin are normal or slightly increased;
• the direct fraction of the pigment is significantly increased;
• transaminase level, alkaline phosphatase above normal;
• thymol test +;
• direct bilirubin in urine;
• urobilinogen levels in urine are sharply higher than normal, however, they can be equal to zero with intrahepatic cholestasis.

Liver diseases, against the background of which the direct fraction of pigment is higher than normal:

1. Acute hepatitis of viral origin:
   • hepatitis A;
   • Hepatitis B;
   • inflammation caused by infectious mononucleosis.
2. Chronic hepatitis C.
3. Inflammation of the liver of bacterial origin:
   • hepatitis caused by Leptospira;
   • hepatitis due to infection with Brucella.
4. Inflammation of a toxic or medicinal nature - caused by the effects of alcohol, medicines(antituberculosis, antitumor, hormones, oral contraceptives, psychotropic drugs).
5. Autoimmune liver damage - the body produces antibodies to its own hepatocytes.

Other reasons why the level of direct pigment may increase are associated with jaundice in pregnancy, primary biliary cirrhosis, and tumor processes.

There are also hereditary causes. Examples are Dubin-Johnson syndrome and Rotor syndrome. Dubin-Johnson syndrome occurs due to gene mutations in the structure of a protein that is ion channel. As a result, there is a violation of the removal of pigment from the body.

Rotor syndrome resembles the first pathological condition, but the degree of impairment of bilirubin excretion is less pronounced. Enzyme activity liver is preserved, but changes occur in the process of transporting bilirubin from gland cells against the background of the inability to normally capture the substance by the sinusoidal pole of hepatocytes.

Impaired patency of the extrahepatic bile ducts

Laboratory signs of this condition:

• discoloration of stool;
• the indirect fraction of the pigment is normal, the direct fraction is sharply increased;
• alkaline phosphatase increased;
• transaminases are normal;
• thymol test -;
• direct bilirubin in urine;
• There is no urobilinogen in the urine.

The reasons that bilirubin is elevated are associated with compression of the bile ducts externally and internally. External compression occurs due to inflammatory processes of the pancreas of an acute or chronic nature, hepatic echinococcus, duodenal diverticulum, hepatic artery aneurysm, tumor processes nearby organs.

From the inside, the patency of the biliary tract can be disrupted by stones, cholangitis (with inflammatory processes swelling and narrowing of the lumen) or neoplasm occurs.

Symptoms of pathology

The following manifestations may indicate high levels of direct bilirubin:

• yellow tint skin, mucous membranes;
• hyperthermia (not always);
• an increase in the size of the spleen, which is manifested by a feeling of heaviness in the left hypochondrium and is diagnosed by a doctor upon palpation;
• brown urine;
• white or light-colored stool;
• weakness, decreased performance;
• pain in the chest, lower back;
• attacks of nausea and vomiting;
• belching, bloating;
• feeling of heaviness, discomfort or pain on the right side under the ribs.

A set of symptoms that represent a specific clinical picture, may vary depending on the cause of the increase in direct bilirubin levels.

Increased direct fraction in pregnant women

This condition when carrying a child can occur in a woman against the background of intrahepatic cholestasis or fatty liver disease liver. If hyperbilirubinemia occurs against the background of cholestasis, pregnant women complain of attacks of nausea, heartburn, and itching of the skin. Jaundice is not pronounced and may occur periodically.

Acute fatty hepatosis usually occurs in those women who have their first pregnancy. The anicteric stage lasts up to 2 months. Patients complain about severe weakness, malaise, heartburn, dyspeptic symptoms, abdominal pain. Body weight decreases, itching of the skin occurs.

The second stage of the pathology is characterized by pronounced jaundice, a pathological decrease in the amount of urine excreted, edema lower limbs, ascites, bleeding various localizations, intrauterine fetal death.

Laboratory signs indicate a slight increase in ALT, AST, alkaline phosphatase, high levels of bilirubin due to the direct fraction (indirect form of pigment is normal), low protein levels.

Help for a pregnant woman

Therapeutic measures:

1. Nutrition correction.
2. Prescription of herbal choleretic drugs, products based on fatty acids.
3. Infusion therapy, use of hepatoprotectors.
4. For blood purification - plasmapheresis.
5. A decision is made about urgent delivery.

Methods for reducing direct bilirubin

Those specialists who are interested in unconventional methods therapy, they claim that it is possible to reduce pigment levels in the blood of patients with the help of nutritional correction, physical therapy And homeopathic remedies. However, representatives traditional medicine do not agree with this opinion.

The fact is that high bilirubin numbers are not separate disease, but are considered a manifestation of cumulative symptoms of several pathologies that require adequate diagnosis and treatment.

Detoxification measures are one of the stages of helping patients. For this purpose in inpatient conditions carry out infusion therapy. It is necessary in order to speed up the process of removing the direct fraction of pigment, changing the volume of circulating blood and its composition, inter- and intracellular fluid. As a rule, specialists prescribe a solution of glucose, a suspension of amino acids, saline, Reopoliglyukin.

Phototherapy can also be an effective treatment method. This is the use of ultraviolet light with therapeutic purpose. To relieve intoxication, enterosorbents (Smecta, activated or white coal, Enterosgel).

It is imperative to determine the etiological factor that caused the development of the pathological condition. When it is eliminated, the bilirubin level will decrease and restore general state body:

• viral hepatitis – antiviral drugs, enzymes, vitamin complexes, immunostimulants;
• liver cirrhosis – hepatoprotectors, vitamins, antioxidants;
• stones – surgery, lithotripsy procedure, the use of drugs based on ursodeoxycholic acid and agents that normalize the outflow of bile;
• tumor processes - surgery, chemotherapy, radiation therapy;
• helminthiasis – anthelmintic drugs.

It is important to remember that painkillers, choleretic drugs should not be taken if the cause of the pathology is a neoplasm or blockage of the bile ducts with stones.

Self-medication is not allowed. Only compliance with the recommendations of a qualified nutrition correction specialist, compliance the right image life and drug treatment is the key to a favorable outcome for the patient.

One of the key complexes of biochemical blood analysis is the study of pigment metabolism. It can be assessed using indicators of total bilirubin and its individual fractions.

What is bilirubin

It is a pigmented substance that is formed in human body and circulates through only one metabolic pathway. Its direction includes several successive parts of the bilirubin cycle.

Among them are:

1. Bilirubin formation. Occurs in the spleen when red blood cells are destroyed life cycle. Total bilirubin is formed during the breakdown of hemoglobin. By splenic vein it is sent to the systemic circulation. By portal vein it is brought to the liver, where it is neutralized.
2. Conjugation. This process is based on the combination of bilirubin with glucuronic acid that occurs in the liver. This is necessary to neutralize bilirubin in the blood, since the substance is very toxic.
3. Excretion. Bilirubin bound (conjugated) in the liver is less toxic and can therefore be quickly eliminated from the body. This occurs through its release along with bile from the liver into the duodenum. Most of it is excreted in the form of stercobilin in the feces. The part sucked into small intestine, is excreted in the form of urobilin by the kidneys along with urine.

Types of bilirubin

The substance bilirubin is presented in the body in the form of several fractions:

1. Indirect fraction- bile pigment. The indirect fraction is insoluble in water and can penetrate through cell membrane. This property explains toxic effect. This fraction is synthesized in the reticuloendothelial system as a result of the enzymatic transformation of heme, formed during the breakdown of hemoglobin. The substance then binds to proteins, usually albumin, and ends up in the liver.
2. Straight (free) the fraction is formed in the liver by combining with glucuronic acid. This reaction allows the pigment to acquire water-soluble properties and also enter the duodenum along with bile. Further changes bilirubin undergoes in the gastrointestinal tract. A small part of it goes back into the blood, after which it is excreted in the urine, having been filtered in the kidneys. Basically, as a result, it is transformed into stercobilin, which is part of the feces and gives it its characteristic color.
3. Total bilirubin in a biochemical blood test - the result of adding the concentration of free and indirect fractions. The value of this indicator is the main guideline in assessing bilirubin metabolism; it helps to establish the feasibility of determining the indicators of individual fractions. If total bilirubin is normal, further research bilirubin fractions is inappropriate. If this indicator is elevated, there is a need to carefully study individual fractions of the substance in order to determine the reasons for the increase in bilirubin levels.

Blood test for bilirubin

Biochemical analysis is performed on an empty stomach, the sample is taken from a vein. To obtain reliable results, you should give up alcohol and fatty foods at least 24 hours in advance.

The result is also affected by:

• Pregnancy;
• Some drugs that affect the coagulation system (Heparin, Warfarin, Aspirin);
• Overeating or strict diet;
• Choleretic herbs;
• Caffeinated drinks.

Typically, a blood test to determine bilirubin is done in the following cases:

• If symptoms of jaundice occur (this also applies to newborns);
• For the purpose of diagnosing liver function in cirrhosis, tumors, hepatitis;
• In the presence of pancreatitis or cholelithiasis;
• In case of poisoning and various toxic effects;
• With the development of hemolytic disease;
• As a control of the effectiveness of therapy.

It is possible to assess the state of bilirubin metabolism biochemical analysis. It determines the indicators of general, direct (free) and indirect bilirubin.

Generally accepted standards for bilirubin metabolism

What is dangerous about high bilirubin levels?

Bilirubin is extremely toxic substance, which causes intoxication and disruption of the functioning of the body’s organs. Brain tissue is the most sensitive in this regard. The remaining systems (liver, kidneys, heart) are more resistant to the effects and are able to function for a long time under increased content bilirubin. The duration of such functioning is determined by hyperbilirubinemia - the severity of the increase.

Patterns and degrees of increase in bilirubin

Symptoms of increased hyperbilirubinemia

With increased bilirubin, the following manifestations may occur:

• Yellowness of the sclera of the eyes and skin. It manifests itself when the concentration of the substance exceeds 50 µmol/l. The intensity and nature of the manifestation are determined by the degree of increase in the concentration of the substance and the causes of the pathology;
• General weakness;
• Bitterness in the mouth;
• Itchy skin;
• White color of stool;
• Darkening of urine;
• Violation intellectual abilities and memory;
• Increased liver size and a feeling of heaviness in the right hypochondrium.

Reasons for increased bilirubin levels

The main diseases that can increase bilirubin levels:

How to treat hyperbilirubinemia

An increase in bilirubin levels is not a separate pathological condition requiring specific treatment. This phenomenon should be considered only as a symptom of a number of diseases. And it is necessary to correctly identify the disease that caused changes in the test results, since without its treatment it is impossible to normalize bilirubin.

There is only one condition when minor hyperbilirubinemia can be corrected through a special diet or other means - these are genetic disorders of bilirubin metabolism enzymes in the liver. In other cases, it makes no sense to act directly on bilirubin; it is necessary to undergo examination to identify the disease as early as possible, since it may be necessary complex treatment and even a complex operation.

To reduce the toxic effects of bilirubin, detoxification methods are used (including the introduction of glucose solutions, hemodez, protein).

Diagnostic significance high rate bilirubin levels increase to the maximum early definition and correct assessment of deviations from the norm.

Reasons for decreased bilirubin levels

A decrease in bilirubin levels is quite rare. This is usually caused by ischemic heart damage. However, this is not a specific sign and is not used in diagnosing the disease. Also, a decrease in bilirubin concentration can occur as a result of taking certain medications ( Ascorbic acid, Phenobarbital, Theophylline).

Often reduced level substances are detected as a result of erroneous analysis results, so that similar cases It is advisable to conduct a repeat study.

Results

Bilirubin is formed from destroyed red blood cells through the processing of hemoglobin. Bilirubin content is one of the indicators of the functioning of metabolism, liver and spleen.

Video - liver health: bilirubin test

Bilirubin is a breakdown product of red blood cells and is constantly produced in the body. Initially appears in the blood indirect view bilirubin, a toxic substance that cannot dissolve in water and be excreted from the body. What to do if bilirubin in the blood is increased, what are the reasons, and what should be the treatment?

Norm of bilirubin

Based on the characteristics of metabolism, we can distinguish direct and indirect bilirubin. In order to understand whether there is increased bilirubin in the blood or not, first of all you need to know its norms in healthy people:

• indirect (free, unconjugated, unbound) bilirubin is a breakdown product of heme substances and is toxic. Indirect bilirubin should not exceed 16.2 µmol/l;
• direct (bound, conjugated), occurs in the liver upon binding with glucuronic acid. It is neutralized by the liver, which means it is not dangerous. Normal direct bilirubin is 0–4.3 µmol/l;
• total bilirubin should range from 0.5–20.5 µmol/l.

In unfavorable conditions, indirect and direct bilirubin may increase in women and men. Let's find out what to do if indirect or direct bilirubin is increased, what are the reasons for this phenomenon, and what should be the treatment.

Symptoms of the disease

Symptoms of increased bilirubin in women and men appear as a yellow tint to the skin, sclera of the eyes, and urine becomes dark in color. This happens due to the substance seeping into the tissues of the body, coloring them yellow-gray. Increased bilirubin is often accompanied by a feeling of discomfort in the left hypochondrium after physical activity, weakness, increased fatigue, and high fever.

If an adult develops such symptoms, then it is necessary to urgently consult a doctor in order to get tested for bilirubin levels and begin timely treatment. Blood for bilirubin levels in an adult is taken from a vein, and in a newborn from the heel. It is best to do the test on an empty stomach, in the morning. Before donating blood to check the level of this substance, it is not recommended to drink for 4 hours, this will allow you to get the most objective results.

Reasons for increased bilirubin

Many people wonder why bilirubin levels in women and men can be elevated? Exist following reasons such a phenomenon:

Unlike adults, increased total bilirubin in newborns - common occurrence. This occurs as a result of the destruction of fetal hemoglobin, which has some differences in its structure with that which is formed after birth. This means that fetal hemoglobin is actively destroyed, thereby increasing the level of bilirubin. It should be noted that treatment in this case is rarely required, even the most severe jaundice goes away on its own, in some cases phototherapy may be required.

If the baby was born premature, it means that he may have problems with the liver - it may be underdeveloped. Almost always birth ahead of schedule and the symptoms of increased bilirubin go hand in hand with each other. In this case, appropriate treatment is necessary.

An increased level of bilirubin in newborns, the norm on days 3–4 after birth is 256 µmol/l for full-term infants, 171 µmol/l for premature infants, requires medical supervision. He may talk about the same disorders, which can be suspected with a similar increase in the substance in adults. In the case of newborns, it is necessary to start treatment even faster, even if symptoms are not pronounced, since the likelihood of developing dangerous condition much higher.

Except simple diseases, which can increase bilirubin levels, young children often develop hemolytic disease newborns. It may be caused by incompatibility of mother and child in antigens and Rhesus. In this case, the rate of destruction of red blood cells increases, and therefore the level of bilirubin increases. Treatment in this case should be immediate.

How to lower bilirubin levels?

This phenomenon can be treated only by determining the cause of its increase. Each technique has its own indications, so only a specialist can prescribe the optimal treatment. Here are the main ways to treat elevated bilirubin:

• infusion therapy - treatment consists of internal infusion of detoxification medications and glucose, thereby cleansing the body of bilirubin and other breakdown products. This effective method, which is used for severe conditions;
• phototherapy - irradiation of the patient using certain lamps, under the influence of which indirect toxic bilirubin is converted into a direct form and is easily eliminated from the body. Treatment is often started in this way when it is necessary to reduce the level of a substance in newborns; in most cases, the method is very effective;
• in case the reason higher level bilirubin is found to impair the excretion of bile from the body, then drugs are prescribed that normalize these processes;
• Another way to reduce bilirubin in the blood is special diet. Along with it, cleansing preparations, gels that remove toxins from the body and activated carbon are also prescribed. It is imperative to reduce the load on the liver, remove all peppered, fried, and sweet carbonated drinks from the diet;
• If the cause of increased bilirubin in the blood is hepatitis, then the main measures should be aimed at combating the virus. At the same time, the patient is prescribed medications that protect the liver. If the treatment of hepatitis itself is successful, then soon the bilirubin level will return to normal on its own;
• Gilbert's syndrome and some other liver diseases are treated with Phenobarbital. It should be noted that only a competent doctor should prescribe this or any other drug, since otherwise the likelihood of complications will increase.

The level of bilirubin directly depends on how well all links in the chain of binding and removing bilirubin from the body work. This is normal natural process cleansing and getting rid of decay products, one of the elements of the tissue renewal process constantly occurring in our body.

If a failure occurs at any stage, a timely analysis and detected increase in bilirubin levels can help to make a timely diagnosis and begin effective treatment. It is for this reason that it is not recommended to ignore the symptoms of excessive bilirubin concentration, and if they are present, consult a doctor immediately.