Total Bilirubin in the Blood

Total bilirubin in the blood, direct, indirect Increased bilirubin – a source of dangerous intoxication of the brain. Bilirubin – the pigment saturated yellow-brown color, is produced in many organs and tissues and is the end product of the breakdown of hemoglobin and other proteins heme-containing in the cells of the liver, bone marrow and spleen.

The physiological role of bilirubin is not completely understood, but according to recent research, it is necessary not only for the disposal of hemoglobin, as previously thought, but is also a powerful natural antioxidant that gives great promise for the discovery of new treatments for cancer, cardiology and many other diseases.

Bilirubin direct, indirect and total

In the human body bilirubin is present in two forms – direct (related) and indirect (Free). Total bilirubin in its pure form does not exist, and is defined as the sum of direct and indirect, and, normally, direct bilirubin should be 75% of the total. Every day, the body is made of about 250 – 350 mg of bilirubin, wherein, about 80% erythrocytes formed during decomposition (1 gram of hemoglobin – about 36 grams bilirubin).

It is known that human blood is a rapidly renewing connective tissue composed of plasma cells and uniform elements: erythrocytes (provide tissues with oxygen), white blood cells (responsible for the immune system and fight infections) and platelets (responsible for blood clotting).

The erythrocytes, or red blood cells – the most numerous of the blood cells. They live in an average of about 120 days, after which decompose, releasing the hemoglobin contained in them. Hemoglobin, after complex chemical reactions, originally converted into a free or indirect bilirubin is insoluble in water and is extremely poisonous. It is concentrated in the liver by gripping it from the blood of liver cells.

Unconjugated bilirubin in the liver as a “neutralized” – under the influence of special enzymes, it connects to the glucuronide and get involved. Due to the effect of glucuronic acid, direct bilirubin, in contrast to indirect becomes soluble and less toxic – easily soluble in bile, it falls along with it in the intestine and then removed from the body naturally with faeces, giving it a brown color.

Increased bilirubin in the blood causes and symptoms

In the normal metabolism of bilirubin in the blood gets very little direct bilirubin. However, under pathological failure, it can significantly increase the concentration in blood (hyperbilirubinemia) and urine (bilirubinuria) penetrating into the surrounding tissue and causing yellowing of the skin, sclera eyes and mucous membranes. In addition, frequent signs of the disease – nausea, weakness, vomiting, bitter belching, heaviness in the right upper quadrant, bleached almost white feces, urine, beer color and itchy skin.

Primary cause of bilirubin metabolism:

Diseases of the blood in which there is a sharp increase in the number of non-viable red blood cells (anemia), the immune aggression toward normal red blood cells (hemolytic disease of the newborn rhesus – conflict with the child’s mother), and exposure to toxic chemicals and blood cells.

Liver disease (viral, bacterial, autoimmune, toxic and drug hepatitis, jaundice), striking or destroy liver cells. When severe jaundice yellowing not only the skin and the sclera eyes, but also saliva, sweat, tears, breast milk, and all the internal organs.

Violation of the free passage of bile on biliary pathways – gallstones, gallbladder dyskinesia, pakreatit, the presence of tumors, scars or enlarged lymph nodes in close proximity to bile ways.

Poisoning by alcohol, chemicals and medicines. A lack of vitamin B12. Hereditary lack of liver enzyme – Gilbert’s syndrome. Physiological neonatal jaundice.

Normal bilirubin in children and adults

Determining the level of bilirubin in the blood is an important tool for the diagnosis of many diseases, especially of the liver, biliary tract and the hematopoietic system, and is one of the key indicators of the biochemical analysis of blood. Refferentnye values ​​of normal levels of total, direct and indirect bilirubin levels for adults and children are shown in the table below

In adults and children older than 1 month

Birth 51-60 mmol/l, with 2 days to the end of the first week may increase to 256 mmol/l by indirect (preterm and 170 pmol/l).

3 By the end of the week approaches the indicator for vzroslyhNepryamoydo 15.4 mmol/l (75% of the total) in the peak period of not less than 90% of the obschegoPryamoydo 5.1 mmol/l (25% of the total) in the peak period of not more than 10%.

Physiological neonatal jaundice

Increased bilirubin in neonates is not a disease and in most cases takes place independently and does not require treatment. This phenomenon is called physiologic jaundice (jaundice) in infants and children is associated with the adaptation of the organism to changing environmental conditions.

Fact that blood first days of life of children comprises a so-called fetal hemoglobin (formed in utero) which differs in composition from adult human hemoglobin and is active replacement for the first month of life.

Due to the fact that the replacement of a significant amount of released hemoglobin degradation products of erythrocytes, and the liver and biliary system infant has not yet fully operational, approximately 3 – 4 days of age his skin and mucous membranes may be colored yellow. Afraid of this state do not have to – as soon as the enzyme system of the child is fully working, skin color changes to pale – pink, this is usually a 7 – 8 day of life.

A slightly longer and expression can occur in rhesus jaundice – conflict (Rh negative mother and an infant positive) or in the presence of mothers in the first group of blood, and the child’s second (sometimes third). At the same time children become overly drowsy and need to wake up for feedings.

To reduce the toxicity effects of high levels of bilirubin and accelerate its excretion in feces and urine, modern medicine is widely used method of light therapy (phototherapy). Infant is placed under a special lamp, close your eyes and cover the bandage, if possible, on both sides. Typically, after the 4 – day fotolecheniya, jaundice symptoms completely disappear.

The positive effect of the treatment has zheltushki breastfeeding and earlier attachment baby to the breast – it promotes more rapid discharge of meconium and reduces the likelihood of complications. In more severe cases, with severe jaundice may require donor blood transfusion, allowing the nervous system and save a child’s life from the toxic effects.

How to lower bilirubin?

To reduce the bilirubin in the blood, it is first necessary to establish the root cause of its increase. Otherwise, it will continue to rise since hyperbilirubinemia is not a separate disease but a symptom of a disease.

In particular, if the fault stagnation of bile, sufficient to remove the obstacle, for example, remove the stone in the gall bladder or a course of treatment with drugs that improve bile secretion. In viral hepatitis need antiviral treatment, hemolytic anemia – a means to warn increased breakdown of red blood cells. If the reason is due to intoxication of the body, will help welcome the adsorbents bind toxic substances and getaprotektorov, which serve to protect the liver.

In addition, to reduce the rate of the enzyme in blood, it is necessary to unload the liver and gallbladder, changing his diet toward healthy diet. From the menu to exclude acute, smoked and fried foods, carbonated drinks, alcohol, strong tea, sweets. Choose more fresh, boiled and baked foods, especially vegetables – this will help to eliminate the causes of constipation, restore useful microflora and provide quick removal of toxins from the intestines.

In order not to disturb the functioning of the digestive tract, eat often, but little by little, do not overeat and avoid long breaks between meals. In addition, during the acute banned starvation diets for weight loss, showing compliance with therapeutic diet for gallstones.

For the correct diagnosis needs to know how to properly prepare for the tests. Blood is drawn from a vein in the morning on an empty stomach is not recommended to eat and drink coffee (caffeine reduces bilirubin levels) for 8 hours before the procedure, otherwise the results may be unreliable.

In previous blood donation day give up fatty foods (not to overload the liver) and from excessive exercise, provoking pain in the right upper quadrant. To obtain accurate figures, sometimes requires the prior cancellation (within 2 weeks), certain drugs, in particular vitamin C and anti-epileptic drugs.

If the research is carried out correctly and showed enzyme levels significantly below normal, it also should be alerted. Causes of low bilirubin insufficiently studied, because, more often than not, people are suffering from high enzyme content, not low. However, according to some medical studies, a direct link between between its reduced level of disease and coronary heart disease, that is, the risk of heart attack and stroke is much lower at high bilirubin than at low.

Finally, we note that high levels of bilirubin requires careful and rigorous, as it is highly toxic to the central nervous system and causes a variety of ailments – persistent headaches, fatigue, slowing of heart rate (bradycardia). Therefore, the best way to avoid poisoning the brain and body – at the first symptoms to seek medical attention.

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