Contents
What is bilirubin?
Bilirubin is a unique bile pigment of a rather bright red-brown color. It is an important product of hemoglobin catabolism. It is known that the main part of the bilirubin itself is always formed in the liver. Of great diagnostic value is its excessive accumulation in the blood or a significant appearance in the urine in humans. These conditions are called hyperbilirubinemia and bilirubinuria.
The small molecule of bilirubin contains four simple pyrrole rings that are connected linearly to each other. The determined molecular weight of bilirubin is 548,68. Ordinary pure bilirubin can be characterized as a crystalline substance. It is always difficultly soluble in water, glycerin, ether, and also slightly soluble in alcohol, while it is slightly better in chlorobenzene, chloroform and various diluted alkali solutions.
Since bilirubin is a special breakdown product of red blood cells, it is continuously produced in the body. In the tissues and in the blood, only an indirect type of bilirubin is initially formed, in other words, a toxic substance. It practically does not dissolve in water, and therefore is not excreted from the human body at all. It is believed that normally this indirect bilirubin always enters the liver with blood immediately, where its direct form is formed.
This resulting substance is further soluble in water, due to which it is easily excreted from the human body along with feces or urine. It should be mentioned that it is the substance bilirubin that gives human feces such a characteristic brown color.
Type of bilirubin | Children 1-3 days of age | Children 3-6 days of age | Children after a month | Adults |
General | 24 to 190 µmol/l | 28 to 210 µmol/l | 3,5 to 20,4 µmol/l | 8 to 20,5 µmol/l |
Straight | 0,5-10,2 | 1-12,4 | 0-5,1 | 0-5,1 |
Indirect | 23,5-179,8 | 27-197,6 | Until 16,5 | Until 16,5 |
Causes of elevated bilirubin
A significant increase in the content of bilirubin in human blood is due to such reasons as an increase in the intensity of hemolysis of erythrocytes, a serious damage to the liver parenchyma with the inevitable violation of its important bilirubin excretory function, a significant violation of the outflow of bile from all biliary tracts into the human intestine, a strong loss of an enzyme link, which always provides the necessary biosynthesis of bilirubin glucuronides.
In addition, an increase in bilirubin can provoke a serious violation of the hepatic secretion of direct conjugated bilirubin into bile, a significant increase in the intensity of hemolysis, which is observed in various hemolytic anemias. You should know that hemolysis can often be increased in malaria, B12-deficiency anemia, massive hemorrhages in various tissues of the body, crush syndrome, otherwise called unconjugated hyperbilirubinemia, and dangerous pulmonary infarcts.
With a fairly strong increase in a certain concentration of bilirubin in the blood of a person, first of all, a slightly yellowish characteristic shade of the skin and sclera of the eyes often appears, while the urine becomes darker in color. Since at a highly elevated concentration, bilirubin always seeps into the tissues of the human body, which leads to tissue staining in a yellowish-gray hue.
In most cases, the accumulation of bilirubin is often accompanied by severe discomfort after various physical exertion in the right hypochondrium. Fatigue, high fever, and weakness may also occur. If these specific symptoms occur, it is advisable to go to the hospital to have an analysis of the level of bilirubin itself.
Moreover, if the rate of this substance is greatly increased, then the next step should be to immediately find out the causes of this condition, followed by the appointment of the necessary treatment.
In tiny newborns, blood for analysis is always taken from the heel, and in adults, a sample is taken from a vein. It is recommended to do such an analysis in the morning and on an empty stomach. To get the correct objective results, you should not drink for 4 hours before donating blood.
A significant increase in bilirubin in the blood is caused by conditions and diseases of the liver and blood, such as anemia, problems with the gallbladder, impaired formation of bilirubin in the liver, helminthic invasion and vitamin B12 deficiency.
Congenital or acquired anemia often leads to a significant acceleration of the process of direct destruction of red blood cells in humans, due to which the level of bilirubin rises. At the same time, all other links of the chain in this case are not violated at all. Such anemia is characterized by an increase in the indirect form of bilirubin. Due to autoimmune and many other diseases like malaria, acquired hemolytic anemia can develop.
Significant violation of the formation of direct bilirubin in the liver is considered the second most important possible cause of the disease. These include all types of cancer, hepatitis and cirrhosis. Along with this, hereditary diseases, Gilbert’s syndrome, are also characteristic of an increase in the level of bilirubin, when the correct production of liver enzymes is severely impaired. To find out the cause, it is necessary to do specific additional tests.
Gallbladder problems can also trigger this condition. With a serious violation of the outflow of bile from the gallbladder itself, an increased level of direct bilirubin is often observed. Among other things, in rather rare cases, it can be said that taking certain medications due to their side effects can change the level of this bile pigment in the blood.
Do not underestimate the prevalence of dangerous infection with worms. Numerous types of parasites in the human body can often give, in addition to the main symptoms of infection, an increase in the level of bilirubin. A significant deficiency of vitamin B12 can also trigger the disease.
Symptoms of elevated bilirubin
The main symptoms of elevated bilirubin include headache, nausea, dizziness, itching, fatigue, as well as noticeable yellowness of the skin and mucous membranes. Since bilirubin, which is formed outside the liver, is always associated with serum albumin, it is transported by the blood and is necessarily taken up by the liver.
It should be noted that a significant part of it, approximately 75% in the liver, binds to the important glucuronic acid, with the formation of a paired compound of bilirubin-glucuronate, or, in other words, bilirubin glucuronide. Approximately 15% of bilirubin then forms a typical pairing with sulfuric acid. This form is called bilirubin sulfate.
Diagnosis of elevated bilirubin
To accurately determine the amount of bilirubin in the urine, the Garrison test is always used, which is a qualitative reaction based on the oxidation of bilirubin when it interacts with Fouche’s reagent to biliverdin. It is necessary to combine trichloroacetic acid in a mandatory certain proportion with ferric chloride. In addition, the Garrison test is also considered a sensitive qualitative test (sensitivity varies from 0,5 to 1,7 mg / 100 ml).
Treatment for elevated bilirubin
To know how to quickly lower the level of bilirubin in the blood of a person, you first need to find out the specific reason for its increase. Only a doctor can prescribe the optimal method of treatment, since each of them has its own specific indications.
Infusion therapy is the main method of reducing bilirubin in the blood. It involves the intravenous infusion of detoxifying drugs and glucose, which helps to remove bilirubin and its decay products from the patient’s body. Modern specialists usually resort to this effective measure in case of serious serious conditions.
Another technique is phototherapy, which is the irradiation of the patient with special harmless lamps. Toxic indirect bilirubin is destroyed under their influence, turning into its direct simple form, and then easily excreted from the body. As a rule, such phototherapy is often resorted to if it is necessary to quickly reduce the level of bilirubin in infants. For them, this measure is the most effective.
When the reason for the increase in bilirubin is precisely in serious violations of the excretion of bile, then in most cases certain pharmaceutical preparations are prescribed that help normalize this process. Another way is to change your daily diet.
It is recommended, in addition to cleansing preparations, to use activated charcoal and special gels that remove toxins. It is necessary to reduce the load on the liver, which means the exclusion from the diet of fried and spicy foods, as well as sugary carbonated drinks.
If the increase in bilirubin is caused by hepatitis, then, first of all, drugs are prescribed that can fully protect the patient’s liver. Direct treatment of hepatitis itself stimulates a decrease in bilirubin.
With improper treatment, the risk of complications is very high. For example, the dangerous Gilbert’s syndrome and many other serious liver diseases are in most cases successfully treated with Phenobarbital. If all links of such a chain work in normal mode, then the removal of bilirubin from the body does not cause any difficulties.
This cleansing process also rids the patient of waste products and renews the tissues. With an excessive concentration of bilirubin in the blood, the symptoms of the disease should not be ignored, timely treatment will allow a person to recover quickly.