How to test bilirubin. Total bilirubin is increased: what does this mean in an adult. What diseases are accompanied by increased bilirubin levels?

Bilirubin is what is associated with obvious changes in the skin, mucous tissues, and whites of the eyes. It affects the color of urine and feces and signals liver disease. It is worth noting that many experience dysfunction for the first time in the first days after birth, some learn about the problem due to serious pathologies of the organ, and others cannot avoid unfavorable heredity.

The development of the pathological process should be stopped, since the toxicity of the pigment has a detrimental effect on nerve cells.

Bilirubin - what is it?

Bilirubin is a bile pigment, and it tends to appear during the destruction of red blood cells that have completed their vital role. The spleen, having completely destroyed the formed element of blood, transports the substance through the portal veins to the liver, where it is maximally neutralized and becomes less toxic. After all stages of transformation, it tends to be eliminated along with bile through the ducts into the duodenum, while changing its color.

If the conversion process fails, external pathological signs in the patient can be visually noted. Mostly, the manifestation of pathology is the characteristic yellow color of the tissues. If you delve deeper into the clinical picture of all types of jaundice, you can get an idea of ​​the possible causes of the disease.

Types of bilirubin

Every day the human body synthesizes different types of bilirubin. Its volumes reach 300 mg, most of which appears due to the continuous breakdown of old red blood cells.

During a diagnostic study, three types of pigment are determined:

1. The entire volume of the substance in the patient’s plasma is the total fraction.
2. Indirect bilirubin, insoluble in water - indirect or unconjugated. It becomes soluble after entering the liver cells with the blood.
3. Conjugated pigment or direct - synthesis of bilirubin by liver cells from indirect.

The concentration of total, direct and indirect bilirubin can be determined when taking tests. Indicators of indirect pigment are calculated taking into account the figures obtained after studying the material.

In pathologies associated with liver dysfunction, it is important to monitor the balance of substances among themselves, as well as their overall increase. An increased concentration of indirect (free) bilirubin, a signal from the body about the need to neutralize its dangerous, toxic effects.

To protect and eliminate the pigment, it should be converted into soluble forms.

To find out the exact amount of conjugated and indirect bilirubin, blood or urine is taken. During the biochemistry analysis, the pigment and its direct bound form are identified. Knowing just a few values, unbound bilirubin in the blood is calculated. The leading specialist, depending on the symptoms, prescribes one of the above tests, since they are different, the direction should be studied in detail.

The unit of pigment measurement is µmol/liter. Urgent results in case of emergency can be obtained in a couple of hours, but usually laboratory assistants provide data within a day or two.

The equipment of laboratories and new technologies make it possible to find out the concentration of a substance in plasma, down to tenths (micromoles). According to the final data, pathological changes in the liver are detected, even in the absence of clinical signs. When visualizing yellowness in tissues, the study helps to quickly identify the negative factor and ways to eliminate the problem.

A standard urine test can detect pigment. If necessary, the doctor can receive an urgent answer in one to two days.

To obtain reliable results, high-precision analyzers are used, which significantly reduces the likelihood of errors due to the “human factor”.

The outcome of the analysis is not a reason to establish a diagnosis, but it is quite justified for tracking the dynamics of the disease and the patient’s condition.

When is the test scheduled?

Doctors often order an examination if they suspect infections or pathological changes in the liver. Also, a reason for determining the pigment concentration may be:

• preventive control;
• advanced biochemistry;
• patient complaints of spasms in the right hypochondrium;
• suspicion of pathological changes in the liver;
• intoxication, hemolytic anemia;
• yellowness of fabrics;
• cholecystitis, pancreatitis;
• neoplasms in the liver;
• fibrosis, cirrhosis.

General urine tests are additional, clarifying, screening and are usually indicated for the same diseases as a blood test.

Preparatory preparations for analysis

To obtain accurate indicators, the test procedure should be approached with all responsibility.

Blood donation:

1. The study is carried out from samples taken on an empty stomach. “On an empty stomach” - when the interval from food intake to analysis is 8 hours.
2. All drinks except pure water are food, therefore, you will have to limit yourself to water.
3. A couple of days before the tests, you should give up alcohol-containing drinks and junk food.
4. Even heavy smokers need to abstain from tobacco products 30 - 60 minutes before the appointed time.
5. A blood test for bilirubin requires being in a calm physical and psycho-emotional state.
6. Before the study, medications should be discontinued for ten days in advance, in agreement with the doctor.
7. After the x-ray, the diagnostic method must be postponed for some time.
8. To evaluate indicators in the correct form, consistency should be observed when choosing a laboratory.

How to give urine correctly:

1. Urine is collected in a special, sterile container.
2. The test is not taken during menstruation.
3. It is first necessary to exclude vegetables and fruits that change the color of urine.
4. Before collecting material, perform genital hygiene.
5. An initial portion of urine is released into the toilet, after which 50 ml is collected in a reservoir.

The reliability of the analysis may be affected by:

• pregnancy;
• diet;
• prolonged hunger.

When taking tests, no bacteria should get into the research material.

Bilirubin norms in adults

The reference value of total bilirubin in an adult without pathological changes in the blood plasma varies from 8 to 20.5 µmol/l according to Jendrasik. In this case, indirect makes up 75% of the total, direct – no more than 25%.

The limits of normal bilirubin in men and women do not differ.

Bilirubin in pregnant women

The level of bilirubin in the blood of women during pregnancy may increase or decrease - not correspond to the reference values, which is the norm. The concentration of pigment may increase with increasing period and growth of the fetus.

If bilirubin in the blood deviates from the norm, in any direction within insignificant limits, we are not talking about a threat to the fetus and mother, but with significant growth rates of the substance, it is worth taking the problem seriously. The cause of pathological values ​​may be cholecystitis, hepatitis, anemia.

Bilirubin in newborns

The norm of bilirubin in newborns is somewhat different from the values ​​of an adult, healthy person.

In the first year of life, tests for bilirubin in children should be carried out once every couple of months. The decision on the frequency of testing is made by the pediatrician. Determination of the substance content per year is mandatory.

Negative factors affecting the increase or decrease of pigment

High bilirubin is a consequence of a pathological process in the body and it is worth considering the negative factors in more detail. The level of pigment in the plasma increases upward when the outflow of bile is blocked, which subsequently stops the flow of the substance into the intestines. It is worth studying the causes of dysfunction in more detail.

Liver diseases

Doctors carefully monitor pigment levels in cases of quite serious liver pathologies:

• A, B - hepatitis, mononucleosis;
• leptospirosis, brucellosis;
• hepatitis of an autoimmune nature;
• toxic hepatitis;
• cholelithiasis;
• slow autoimmune biliary cirrhosis;
• Rotor, Dubin-Jones syndrome.

Values ​​when bilirubin is higher than normal are explained by inadequate outflow of bile.

Hemolytic anemia

Disorders affecting the increase in indirect pigment:

• Gilbert's syndrome, Driscol;
• sepsis, malaria;
• hemolytic anemia (congenital etiology);
• snake bites, chemical intoxication,
• medicines;
• systemic, autoimmune hemolytic anemia.

There are many reasons for increased bilirubin, and they are all caused by excessive destruction of red blood cells.

Jaundice

Increased bilirubinemia is a pathological change that occurs when there is an excess of a substance in the blood plasma. Due to the chemical bond with proteins, yellow compounds are synthesized, which subsequently colors the tissues in a rich, yellow color. Since the protein coat of the eyeball includes a lot of elastin, which is essentially related to bilirubin, with jaundice, it is the sclera that first of all changes color to yellow. Only after a period of time does the skin tone change.

Heredity

Yellowness of tissues and an increase in free pigment in the serum may be explained by Gilbert's syndrome, a rare hereditary disease. The disease gains strength due to a decrease in the activity of the liver enzyme uridine diphosphate-glucuronyl transferase. In carriers of homozygous mutations, a high initial level of pigment with characteristic clinical changes is detected. It is worth noting that in heterozygous forms, the disease occurs in a latent form.

Cholestasis

High bilirubin in women, a common occurrence in late pregnancy is cholestasis. Under fetal pressure, bile secretion slows down or completely stops. The problem is difficult to diagnose.

Decreased bilirubin

Low bilirubin is a rare occurrence. The reasons may be pathological factors or incorrect testing. The result is also influenced by the quality of a person’s diet or the course of drug therapy. Typically, low bilirubin is explained by a frivolous attitude towards testing requirements.

Increased bilirubin

When deciphering the discharge data, it is important to determine exactly which bilirubin is elevated in the blood. Indirect pigment increases with accelerated destruction of hemoglobin. The reason for this phenomenon is most often Rh conflict, intoxication of the body, pathological changes in the structure of the blood.

Direct bilirubin increases when the circulation of bile is disrupted for any reason (stones, swelling, spasms).

If cirrhosis or a disease that destroys liver cells is diagnosed, an increase in all indicators is noted.

A bilirubin level above 30 µmol/liter leads to the manifestation of obvious clinical signs - the color of the skin and mucous tissues changes.

How to lower bilirubin?

If there is high bilirubin in the blood, then there are quite serious reasons for this. To reduce the indicators, it is necessary to eliminate the negative factor, since the concentration of pigment is a consequence of pathology.

To reduce the concentration to normal limits it is necessary:

• take medications for hepatitis or hemolytic anemia;
• make efforts to normalize liver function (hepatoprotectors);
• stimulate the synthesis of bile, removing it from the body without delay;
• correct food habits, follow a diet, give up alcohol;
• cleanse the gastrointestinal tract and bile ducts.

Today, alternative treatment methods are especially popular. With medicinal preparations and homemade tinctures, you can effectively support the body’s “filter,” adjust the digestive function, and facilitate the functional activity of the gallbladder. In alternative medicine, herbal teas are widely used to reduce bilirubin at home. Homeopathic compositions are made based on milk thistle, and a decoction of birch leaves has also proven itself to be excellent.

When diagnosing jaundice in newborns, in order to quickly reduce bilirubin, the baby is placed in a special chamber under a lamp. Under the influence of rays, the substance is modified and eliminated from the body. It is worth noting that an increase in the concentration of bilirubin can negatively affect the nervous system and the quality of hearing of the newborn, therefore, measures to correct the situation should be taken without delay.

Conclusion

Having received test results with bilirubin levels in your blood, you should not panic and diagnose yourself. The best solution would be to visit a doctor, clarify the real situation and develop a joint treatment strategy if necessary. Only a specialist can prescribe adequate treatment taking into account the characteristics of the case.

Bilirubin is a yellow-brown chemical element and dye that is the result of the processing of red blood cells - red blood cells containing hemoglobin.

The process of producing this dye occurs in the gallbladder and liver. The normal value of bilirubin in women varies slightly due to age (except in newborns). Below in the article there will be a table showing the norms of bilirubin in accordance with the age category.

The analyzes take into account not only the overall indicator of the pigment, but also its fractions - direct and indirect. Exceeding the total concentration may indicate intoxication in the body, cirrhosis, viral hepatitis, malignant neoplasms in the liver or genetic disorders.

An increase in concentration is due to dysfunction of the gallbladder and biliary tract, or indicates a malfunction of the pancreas.

An increase in the level of indirect pigment can be explained by the presence of Gilbert's syndrome, past infections, hemolytic anemia, and spleen dysfunction. The value of this chemical element is indicative for recognizing anemia and jaundice in newly born children.

What test should be taken for bilirubin?

Most often, a biochemical blood test is performed to determine the concentration of bilirubin. Analysis will help determine the overall meaning of the dye and its associated species. And the indirect view is simply calculated from these two values.

Bilirubin is measured in micromoles per liter with very high accuracy, making it possible to detect problems in the body even before painful symptoms appear. Most often, the result of the study is ready the next day, but it is possible to conduct an urgent analysis, in which all indicators will be known within a few hours.

Indications for testing

Due to improper functioning of the liver and biliary tract, bilirubin is not completely eliminated from the body, toxicity occurs, and the tissues of the internal organs acquire a characteristic icteric color. This does not necessarily mean that the person has hepatitis.

A study is prescribed to determine the level of pigment if:

Preparing for the test

Bilirubin - the norm for women by age (table below) - indicates the proper functioning of organs such as the spleen, liver and bile ducts. But sometimes research results can be distorted. This occurs due to violation of certain conditions before taking the test.

Reasons that may affect the results of the study:

• abuse of coffee, alcohol, fatty foods before analysis;
• long exposure to the sun;
• taking hormonal medications and contraceptives;
• taking diuretics;
• taking medications containing codeine, caffeine, alcohol;
• taking sedatives containing barbiturates;
• heavy physical activity or a strict diet before taking the test;
• taking the test after completing a course of chemotherapy or after the last dose of antibiotics (at least 14 days must pass).

Blood is donated from a vein in the morning before breakfast. If it is not possible to refuse food for any reason, it is given 4–5 hours after the morning meal.

The rules for passing urine for bilirubin are no different from the usual ones applied to passing a general analysis. Before the examination, you must take a bath or shower. The initial portion of urine is passed, and the next one is collected in a sterile container.

Types of bilirubin

Red blood cells, whose “lifespan” (approximately 90 days) ends, begin to decompose. The main task of bilirubin is to remove the waste protein component of hemoglobin from the body. Initially, an indirect type of bilirubin is formed, which cannot leave the body on its own and is toxic to it.

The indirect species then travels through the bloodstream to the liver, where, after its further breakdown is complete, it combines with readily soluble glucuronic acid. There is a transformation of the indirect form into a direct form, which is easily excreted along with urine and feces.

How is the amount of bilirubin determined?

There are several ways to determine the level of this chemical element in the blood:

Colorimetric method consists of identifying the amount of pigment, taking into account the color intensity of the resulting solution of pigment and diazotized sulfate acid.

This method is also called the Van Den Bergh method. The direct type reacts quite quickly, and the indirect type only after the introduction of an auxiliary substance - acetic acid, sodium benzoate, caffeine, methanol, urea or other reagents.

Medical diagnostic devices - bilirubinometers - are also used to calculate the concentration of bilirubin.

The work of some of them is based on the photometric research method.

The advantage of such devices is the speed of analysis and minimal error in the results, since in this case the human factor can be completely eliminated.

To carry out an analysis with a bilirubinometer, it is enough to donate a small amount of blood from a finger (capillary). To operate such a device, special small disposable vessels containing anticoagulants are required. The biological material for research contained in this vessel is placed in a centrifuge, where the red blood cells are deposited.

After which the device calculates the amount of bilirubin in the patient’s blood. Modern devices can provide results in 7–15 seconds.

The normal level of bilirubin in the blood of women

Bilirubin, normal for women by age, table:

The ratio of direct and indirect bilirubin in newborns is normally approximately 90% to 10%, and by the 1st month of a child’s life it is already 75% to 25%. In adult women, these values ​​change diametrically opposite - the amount of insoluble pigment is 75%, the direct type is 25%.

When the pigment concentration increases to 33–35 µmol/l, the whites of the eyes acquire a characteristic yellow tint. When the value exceeds 50 µmol/l, the mucous membranes and skin also begin to turn yellow. Increased bilirubin accumulates in organ tissues, poisoning them and affecting the central nervous system.

Bilirubin and pregnancy

The amount of pigment should be carefully monitored during pregnancy. When a woman is pregnant, the body may experience an exacerbation of chronic diseases acquired before pregnancy (cholecystitis, anemia). Normally, the concentration of bilirubin should not increase.

Some past infections can also increase bilirubin levels. Toxicosis in the 1st trimester signals that the norm of pigment in the body of a pregnant woman is exceeded. If the amount of pigment in the mother’s body reaches a critical value, early delivery is performed.

A growing embryo is able to put pressure on the liver and gallbladder, thereby disrupting the circulation of bile and causing a rise in pigment levels.

What additional tests are taken?

Additionally, the urine is examined for the presence of bilirubin. Such an analysis will not be able to display a complete picture of the course of the disease, but will help assess the course of the disease and make a prognosis for the patient’s recovery. Normally, there should be no pigment in the urine. It appears in the urine only when its amount in the blood increases to 30–32 µmol/l, which indicates a serious malfunction in the body.

Reasons for deviation from the norm

Basically, pathological conditions leading to the growth of pigment in the body are acquired (hepatitis, oncology, cirrhosis, cholecystitis), but there are also disorders transmitted genetically - Gilbert's syndrome and Crigler-Najjar syndrome.

In addition to diseases that lead to dysfunction of the gallbladder and liver, there are factors that do not in any way affect the functioning of these organs, however, they contribute to the growth of bilirubin in the body.

These include:

As can be seen from the table, the level of bilirubin in newborns can increase on days 3–4 and reach its maximum – 256 µmol/l. In children born prematurely, this value should not exceed 170 µmol/l.

Symptoms of abnormal bilirubin levels and when to see a doctor

Some factors may indicate an increase in the concentration of pigment in the blood even before the test results are obtained.

What to pay attention to:

• pain in the left hypochondrium after physical activity or sports training;
• feces become light-colored and urine darkens;
• the appearance of vomiting and nausea;
• yellowing of the whites of the eyes, skin and mucous membranes;
• dizziness and weakness;
• nausea, vomiting and lack of appetite;
• chronic fatigue and anxiety.

What drugs are prescribed

Bilirubin, the norm for women by age (the table above) should not exceed the limit value; in case of deviation from the norm, it gives a direct reason for prescribing therapy. If the cause of increased bilirubin is liver dysfunction, hepatoprotectors are used.

These remedies are not able to completely solve the problem in such serious diseases as hepatitis, cirrhosis, disorders caused by excessive use of alcohol or drugs, obesity, however, they can alleviate the patient’s condition.

Hepatoprotectors are pathogenetic agents for treating the liver. They restore cells, reduce inflammation, prevent fibrosis, and help cleanse the body of toxins.

Almost all drugs related to hepatoprotectors do not have proven medical effectiveness.

The exception is products containing ademetionine - Heptral, Heptor.

The detoxifying effect of ademetionine has been studied and proven scientifically. The herbal drug Karsil is also well known.

If the pigment concentration rises due to poisoning, therapy is prescribed with adsorbent agents that successfully absorb and remove toxins from the body. These include activated carbon, Smecta, Enterosgel.

If the cause of an increase in the amount of bilirubin is gallbladder dysfunction, choleretic drugs are prescribed. Diagnostics will allow you to determine the cause of the disease - a disorder in the liver, gallstones or pathological changes in the biliary tract.

The action of such drugs is aimed at enhancing the secretion of bile and facilitating its entry into the intestines, which helps speed up the digestion process and reduces the risk of gallstones.

Choleretic drugs differ in their effects - cholekinetics activate the work of the gallbladder, promoting its more frequent contraction, and cholespasmolytics, which affect the biliary tract, relaxing them; choleretics make bile less viscous. Choleretic drugs can also be of mixed type.

The composition of choleretic drugs can include not only synthetic, but also natural components. Chemicals have an analgesic effect, kill pathogenic bacteria and eliminate inflammatory processes, lower cholesterol levels. The effect of such drugs also affects the functioning of the intestines - digestion improves, and the decomposition process is suppressed.

The use of natural choleretic drugs, which may include not only medications, but also herbal decoctions and infusions, is based on the action of essential oils, resins, phytoncides, vitamins and some other substances included in their composition.

Herbal medicines have a beneficial effect on the functioning of the liver, dilute bile, stimulate the functioning of the stomach and pancreas, accelerate metabolism, and have an antibacterial and anti-inflammatory effect. The most famous natural choleretic drugs include Allohol, Holosas, Hofitol.

In case of serious disorders, choleretic drugs are prescribed in combination with antibiotics. In addition to medications, some types of mineral waters also have a choleretic effect.

To reduce the load on the liver and gallbladder, the doctor may prescribe medications containing enzymes that help improve the functioning of the pancreas and speed up metabolic processes. Examples of such drugs are Mezim, Pancreatin, Festal.

The consequence of some infectious diseases may be an increase in the concentration of bilirubin. To stop the inflammatory process, the doctor may prescribe treatment with antiviral drugs.

Pigment growth may be associated with vitamin B12 deficiency. It will be enough to compensate for the lack of this vitamin to reduce bilirubin.

With anemia, there is a decrease in the concentration of bilirubin, since the body does not produce a sufficient number of red blood cells, and, accordingly, the level of hemoglobin also drops. The tissues of the internal organs do not receive the oxygen necessary for normal functioning.

This also entails a decrease in bilirubin levels. Then iron-containing drugs are prescribed, such as Maltofer, Ferlatum, Aktiferrin.

In some cases, a similar effect of lack of hemoglobin can be caused by a strict low-calorie diet.

They feed on useful substances that come with food, process them and remove toxic products of their vital activity into the human body, which tend to accumulate in the tissues of internal organs, thereby poisoning them and causing an increase in the concentration of pigment.

A stool analysis will help determine what type of worms the patient has, after which the doctor will prescribe treatment. The most well-known means for combating helminths are Pirantel, Vormil, Helmintox, Nemozol.

Diet

People suffering from diabetes mellitus are at risk of exceeding the norm of pigment in the body.. In this case, the doctor most often prescribes a special diet.

The essence of such a diet is to completely eliminate overeating. You need to eat in fractional portions, 4-5 times a day. At least 2–2.5 hours should pass between the last meal and sleep. The amount of water, juices, and liquid soups consumed should be at least 2 liters per day. Fried foods are completely excluded from the diet. Salt should be limited and not consumed more than 10 g per day.

Products that cause an increase in pigment concentration:

• sausages and smoked products;
• legumes;
• sorrel, radish, onion, garlic;
• hard cheeses;
• buns, chocolate, ice cream, cakes and pastries;
• lamb and pork, poultry – duck;
• types of fish with high fat content;
• berries or fruits that have a sour taste;
• alcoholic and carbonated drinks;
• hot seasonings and sauces;
• pickles;
• mushrooms;
• canned food

There is another group of products that help reduce bilirubin in the blood.

These include:

• low-fat fermented milk products;
• light dietary soups with vegetables;
• boiled eggs (the yolk must be omitted);
• sweet fruits and berries;
• cereal porridge;
• veal, rabbit, as well as turkey and chicken meat;
• teas, homemade compotes and jelly;
• some vegetable crops such as beet and carrots;
• a small amount of butter or vegetable oil;
• stale bread or homemade crackers.

These products will relieve the liver and gallbladder, relieve pain and increase the effectiveness of taking medications.

In medicine, this diet is called table No. 5.

For breakfast, you can prepare porridge with milk or water - semolina, buckwheat, rice or oatmeal. Products with cottage cheese are also added to the diet - cheesecakes, casseroles, dumplings. It is recommended to drink tea or weak coffee with milk.

The next meal should be in 2-3 hours. It is recommended to eat a baked apple, sweet fruit or a handful of berries.

For lunch you should eat a bowl of vegetable soup. Meat and fish, cutlets, vegetables should be either stewed or steamed. The second course can be puree or vegetable stew. They drink fruit juice, compote or jelly.

After 2-3 hours, you can eat a small amount of marshmallows or cookies, drink a glass of heated milk or freshly squeezed juice.

Dinner must be eaten no later than 7 pm. For dinner you can eat a casserole, pasta, mashed potatoes, stewed cabbage or porridge of your choice.

The diet can be supplemented with a small piece of chicken fillet or steamed fish and a salad of fresh vegetables. You can also prepare a vinaigrette by omitting the pickled cucumbers and beans. Half an hour before bedtime, you can drink a cup of low-fat yogurt or kefir. The principle of the diet for pregnant women remains the same.

Phototherapy

After birth, the child’s body no longer needs such a large number of blood cells, which leads to their increased destruction and an increase in bilirubin in the newborn’s blood. This manifests itself in the form of jaundice 3–5 days after birth.

Phototherapy is used to treat jaundice and hemolytic disease in newborns. It is carried out using special ultraviolet lamps, which contribute to the transformation of indirect toxic bilirubin into its direct form, which is not dangerous for the child’s body. Such light therapy is safe for the child, which cannot be said about drug treatment.

To carry out phototherapy, the child is placed in a box where lamps are installed. The genitals are covered with a bandage, and the eyes are protected with glasses. Usually the course of treatment is 4 days. You can take short breaks of 2–3 hours if the jaundice is not pronounced. Irradiation is carried out from all sides, periodically shifting the child, changing his position.

Breastfeeding should not be canceled, as it helps remove pigment from the child’s body. If it is not possible to attach to the breast, use a bottle. During phototherapy, a biochemical test of the child’s blood is performed every day to determine the effectiveness of the procedure.

Undesirable reactions include dryness and flaking of the skin, diathesis, diarrhea, and rashes. Phototherapy is mainly used in the treatment of newborns, but sometimes it is also used to treat adults.

Folk remedies

It is possible to normalize bilirubin levels, in accordance with the table, in a woman’s body at any age through the use of traditional medicine recipes.

An infusion prepared from corn silk stabilizes the functions of the liver, biliary tract and kidneys. Take 1 d.l. stigmas, pour 200 ml of boiling water, then keep in a steam bath for 15–17 minutes.

Then the infusion is allowed to cool for 45–50 minutes, after which it is filtered and water is added so that the volume is 200 ml. Before use, the infusion is heated and shaken. Drink it every 2–4 hours, 1–3 tbsp. for adults, and 1–2 d.l. for children for a month.

Tea made from chamomile flowers effectively reduces bilirubin. For this, 1 tbsp. the herbs are placed in a teapot and 200 ml of boiling water is poured in, left for half an hour and filtered. The liquid is then divided into three equal parts, which should be taken after each main meal.

Adding 1 tsp. mint leaves in tea help normalize digestion, improve the functioning of the liver and gall bladder. This tea can be drunk for 1.5–2 months.

A decoction of birch leaves effectively reduces the level of bilirubin in the blood. 3 tsp you need to pour 1 tbsp. boiling water and leave for 25–30 minutes. The resulting broth is divided into 8 equal parts. Drink 1 part 4 times a day. Store in the refrigerator.

For the infusion of St. John's wort, you need to take 2 tbsp. herbs and pour 200 ml of boiling water over them. Leave for 30 minutes and then filter. You need to drink the infusion in the morning and evening after meals, 100 ml. The course of treatment is usually 1 month.

Surgical intervention

Before any surgical interventions, the level of pigment in the blood is also examined. If it reaches 55 µmol/l, but other liver test parameters do not exceed normal values ​​and there are no signs of disturbances in the functioning of the liver and gallbladder, then the operation is not cancelled.

In some cases, if the cause of increased bilirubin is gallbladder dysfunction, surgery may be performed. Gallstones or the gallbladder itself are removed. Stones are formed due to the fact that the consistency of bile becomes more viscous, which complicates its outflow from the body.

Prerequisites for the development of gallstone disease are:

• lack of physical activity and obesity;
• pregnancy;
• inflammatory processes in the biliary tract;
• female;
• elderly age;
• excessive consumption of alcoholic beverages;
• operations performed on the stomach and intestines.

Surgical intervention is performed in several ways. The laparoscopic method is based on the use of special medical equipment - a laparoscope.

This method is the least traumatic and the safest for the patient, since the incisions on the abdomen are very small and other internal organs are not affected during the operation. The duration of such an operation is on average 40–50 minutes.

Under certain conditions, only the stones are removed, and the gallbladder itself is preserved. This operation is performed if there are no disturbances or inflammatory processes in the functioning of this organ, and the diameter of the largest stones does not exceed 3 cm.

An experienced doctor will be able to quickly establish the reason for the excess bilirubin value in a woman’s body at any age, based on the data in the table and finding out which type of pigment indicators exceeded the norm. It is important to recognize the symptoms of the disease in time and conduct the necessary research, which will determine an effective course of treatment.

Article format: Mila Friedan

Video about bilirubin

Mechanism of action of bilirubin:

In general human health, the main part of the bilirubin formed during the breakdown of proteins in the tissues of the spleen, bone marrow and lymph nodes is extracted from the body with bile; only a small part penetrates into the blood.

Increased breakdown of heme proteins, liver dysfunction and impaired bile outflow lead to an increase in the amount of bilirubin - hyperbilirubinemia, upon reaching certain concentration thresholds, accompanied by jaundice. What are the reasons for the increase in bilirubin concentration, why is this condition dangerous, and how is hyperbilirubinemia treated and prevented?

What is bilirubin?

Bilirubin is a type of chemical pigment compound. It is this element that gives bile and feces their characteristic color, since in its pure form bilirubin is a brownish crystal.

Bilirubin has a toxic effect on nerve cells, becoming a factor in the development of characteristic encephalopathy, kernicterus. Conjugation or the process of chemical binding of free bilirubin occurs in the liver tissues. The breakdown of red blood cells, which occurs predominantly in the tissues of the spleen, ensures the release of a large amount of free bilirubin, which enters the liver through the portal veins with the bloodstream. The biochemical processes of “binding” and transformation of bilirubin in liver cells cause a decrease in its toxic effect on tissues and organs.

Different types of bilirubin

In the human body, bilirubin is present in two varieties, bile fractions: conjugated, bound or direct bilirubin, and indirect or free bilirubin. In a biochemical study of blood components, the amount of bilirubin can be calculated in a general form for both fractions (total bilirubin); if the norm is exceeded or there are indications, a study of the indicators of each fraction separately is prescribed.

Indirect bilirubin is produced constantly: every day, the breakdown of red blood cells releases almost 300 milligrams of bilirubin. Entering the liver tissue through the bloodstream, indirect bilirubin is transformed through biochemical processes that culminate in conjugation with glucuronic acid and the formation of conjugated bilirubin.
Indirect bilirubin is toxic to tissues and organs. Easily penetrating cells, it conjugates with fats and contributes to disruption of cellular respiration and metabolism, protein formation, and transport of potassium ions. An increased concentration of indirect bilirubin is especially dangerous for the brain tissues that are most sensitive to it.

Total bilirubin is increased

What is considered an increased amount of bilirubin? The norms vary depending on the person’s age: the highest levels of bilirubin, which do not accompany diseases and dysfunctions, are observed in infants, which is due to the process of accelerated breakdown of fetal red blood cells, which are found in large quantities in the blood of the fetus and newborn. The yellowish color of the skin and sclera of children in the first weeks after birth is a consequence of a temporary high concentration of bilirubin.

The process of increased production of bilirubin normally ends by the age of one month, after which the normative indicators almost correspond to the norms for the adult body.
What is the norm of bilirubin determined for different age periods?

The main diagnostic value for dysfunctions and diseases is excess of bilirubin standards in both fractions. The pathological threshold for hyperbilirubinemia is 34 microns per 1 liter of blood; at this concentration, jaundice develops as a syndrome. The accumulation of bile pigment in the subcutaneous tissues, sclera, and mucous surfaces leads to the appearance of an icteric tint. Contrary to popular belief, jaundice is not synonymous with hepatitis B, although it can occur as part of the symptom complex of this disease. In various diseases and pathologies, the manifestations of jaundice have features characteristic of each individual case.
Elevated bilirubin, especially when significantly higher than normal, is a sign of a health- and, in some cases, life-threatening condition.
The reasons for the increase in free and bound fractions are divided.

If direct bilirubin is elevated, this can cause diseases such as:

• acute viral hepatitis A, B, secondary hepatitis due to infectious diseases such as mononucleosis;
• chronic form of hepatitis C, hepatitis of autoimmune etiology;
• hepatitis of bacterial etiology due to brucellosis, leptospirosis;
• consequences of food poisoning, medications (non-steroidal anti-inflammatory drugs, hormonal contraceptives, etc.);
• gestational jaundice in women during pregnancy;
• tumor formations in liver tissue;
• some genetic abnormalities and syndromes that are factors in the development of hereditary jaundice.

In most cases, direct bilirubin exceeds standards in diseases and conditions associated with damage to liver tissue.
Diseases accompanied by an increase in the concentration of indirect bilirubin:

• some types of congenital hemolytic anemias;
• mismatch of blood type, Rh factor when donating blood and its components;
• autoimmune, resulting from the development of an autoimmune disease (systemic lupus erythematosus, rheumatoid arthritis) hemolytic anemia;
• diseases of infectious etiology (general sepsis, malarial fever, typhoid fever);
• hemolytic anemia, provoked by uncontrolled use of medications (acetylsalicylic acid, insulin, a group of cephalosporins, penicillins, non-steroidal anti-inflammatory drugs);
• hemolytic anemia of toxic etiology (poisoning from snake bites, consumption of mushrooms, contact with arsenic, copper sulfate, poisons, etc.);
• hereditary diseases

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Causes of increased bilirubin in the blood

If liver function is impaired, preventing conjugation, excessive production of bile pigment in the body, or difficulty in the outflow of bile, the content of bilirubin in the serum begins to increase. The reasons for high bilirubin detected during the analysis of blood components are different, but always have a direct correlation with its excess production or dysfunction in the hepato-biliary system.

The accumulation of bilirubin as its concentration increases manifests itself in several stages. First of all, a yellowish tint appears on the sclera of the eyes, then yellowness of the oral mucosa occurs, at the next stage the yellowness spreads to the face, the surface of the palms, soles and covers the rest of the body. A common symptom accompanying jaundice with hyperbilirubinemia is itching.

Yellow skin may not necessarily be a sign of increased bilirubin. This pigmentation feature can occur with excessive accumulation of carotene, for example, with excessive consumption of carrots and tomatoes. Yellowness of the skin is included in the symptom complexes of diabetes mellitus and hypothyroidism. A distinctive feature is the invariability of the color of the sclera.

Types of jaundice depending on the cause of high bilirubin

Increased free and direct bilirubin are detected as a consequence of one or more factors that provoke hyperbilirubinemia:

• increasing the number of red blood cells, accelerating the process of destruction of red blood cells;
• non-free excretion of bile;
• pathology of the process of processing and/or excretion of bile pigment.

Increasing the number or accelerating the process of destruction of red blood cells

Increased breakdown of blood cells - red blood cells - causes the development of hemolytic jaundice, accompanied by an excess of standards for indirect bilirubin. This condition occurs with hereditary defects of red blood cells, as well as with significant hemorrhages (extensive hematomas, infarctions of lung tissue), some infectious diseases, malignant tumors, poisoning, as well as with a mismatch of blood type and Rh factor in the donor and recipient or in the mother and fruit.
Hemolytic jaundice is manifested by the following symptoms:

• lemon-yellow tint of the sclera, mucous membranes, and skin;
• pale skin as a result of anemia;
• increased volume of the spleen, accompanied by pain in the left hypochondrium;
• dark color of urine and feces due to high concentration of urobilin;
• general deterioration of health due to insufficient oxygenation (headache, increased heart rate, increased fatigue), a possible increase in temperature to low-grade levels.

Bile flow disorders

With various disturbances in the removal of this biological fluid from the liver, conjugated bilirubin, instead of being excreted from the body, enters the bloodstream, which contributes to the development of so-called subhepatic jaundice. The most common causes of disruption of bile outflow include:

Subhepatic jaundice is manifested by the following symptom complex:

• pronounced yellowness of the sclera, skin, mucous membranes;
• sensation of skin itching of varying severity, from mild to unbearable;
• signs of disruption of the gastrointestinal tract - increased gas formation, nausea, dyspepsia, lack of appetite, reflux of food mass from the stomach into the esophagus, etc.;
• The color of stool with this type of jaundice is light, almost white, which is associated with a reduced amount of stercobilin, urine is dark;
• pain in the area of ​​the right hypochondrium.

With this type of jaundice, blood tests reveal an excess of conjugated bilirubin.

For any reason, it is worth remembering that the severity of external manifestations of hyperbilirubinemia depends not only on the stage of the disease or pathology, but also on the characteristics of the skin, physique, and accompanying symptoms. Thus, with increased deposition of fatty tissue or swelling, jaundice of the skin is much less noticeable than with a thin build.

Pathologies of the processing and excretion process as causes of high bilirubin

Disturbances in the process of metabolism and excretion of bilirubin from the body are one of the factors contributing to the constant increase in its concentration. Among the diseases and pathologies, there is a group of hereditary jaundice, caused by genetic abnormalities, and acquired, arising as complications of diseases.

Increased bilirubin in hereditary jaundice

The hepatic processing step consists of conjugation of free bilirubin, transport and removal. Disturbances in this process may be associated with genetic pathologies in the following diseases:

• Gilbert's syndrome is the most common pathology caused by an enzyme deficiency that prevents the conjugation of bilirubin in the liver cell. This form of hyperbilirubinemia is considered the most easily occurring and can be asymptomatic with episodes of exacerbation due to stressful situations, illnesses, injuries, excess load on the liver (alcohol abuse, fatty, spicy foods, etc.). The frequency of occurrence in the population depends on the region: for example, in the European population, Gilbert's syndrome is registered in 3-5 people out of 100; in the countries of the African continent this figure reaches almost 40%. The prognosis of the disease is favorable; if the rules for preventing exacerbations are observed, therapy is not required;
• Crigler-Najjar syndrome;
• Dubin-Johnson syndrome.

Acquired jaundice

Acquired jaundice is one of the most common types of icteric symptom complex. There are prehepatic jaundice, in which excess bilirubin cannot be processed by the liver, and hepatic or parenchymal jaundice.

With parenchymal jaundice, damage to the parenchyma and bile ducts leads to disturbances in the uptake, binding and excretion of bilirubin, and its return to the blood serum during bile stagnation. This pathology is accompanied by increased direct bilirubin in the blood. Why does hepatic jaundice occur?

The most common causes of hepatic jaundice are liver diseases. Among them are cirrhosis of the liver and hepatitis of various etiologies.

Liver cirrhosis can be a consequence of various diseases, as well as alcohol addiction and other toxic effects on the body. This is a condition of the liver in which a change in its tissue occurs, a violation of the histoarchitecture of the parenchyma. Normal liver tissue is replaced by connective tissue, blood supply and transportation of bile through capillaries are disrupted. These processes develop due to damage or death of liver cells.

When the liver tissue is replaced by connective tissue, the organ is not able to fully function, including the function of conjugation and excretion of bilirubin. Most often, cirrhosis develops in the last stages of hepatitis, as well as with severe alcoholism.

The clinical picture of cirrhosis includes parenchymal jaundice with characteristic additional manifestations: increased volumes of the liver, spleen, severe skin itching, abdominal ascites, varicose veins of the esophagus and intestines.

Liver failure with progressive cirrhosis is accompanied by damage to brain tissue, decreased blood coagulation, internal hemorrhages and extensive bleeding.

Hepatitis as a disease accompanied by hepatic jaundice can have a diverse etiology. The inflammatory process in the liver during hepatitis can be a consequence of a viral infection, an autoimmune disease, toxic damage or alcohol poisoning.

There are acute and chronic stages of hepatitis. Among acute hepatitis, the most common is infectious hepatitis, caused by various hepatitis viruses. Common symptoms of infectious hepatitis include:

• a picture of general intoxication of the body: nausea, headaches, fever, etc.;
• pain in muscles, joints;
• pain in the right hypochondrium during palpation or occurring spontaneously;
• yellowness of the sclera and skin of varying degrees of severity;
• changes in the color of stool and urine;
• a characteristic change in the blood picture detected during laboratory diagnostics.

The progression of the disease may be accompanied by a transition to the chronic stage, degeneration of liver tissue, damage to brain tissue (hepatic encephalopathy), a combination of liver and kidney failure, which can lead to death.

Bilirubin as a cause of newborn jaundice

Jaundice of a newborn baby, which is a cause of concern for many young parents, refers to the physiological phenomena of the child’s body adapting to life outside the mother. Physiological jaundice of newborns is also a manifestation of hyperbilirubinemia. After birth, the hemoglobin present in the fetal blood breaks down, being replaced by a new form of hemoglobin. This process is accompanied by a partial breakdown of red blood cells and, as a result, an increase in the amount of bilirubin. So the most common cause of jaundice in children during infancy is bilirubin, which the liver will successfully convert into a bound form within a few days without consequences for the child’s health.

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As a rule, the highest concentration of bilirubin in infants is observed on days 3-5, after which the levels begin to decrease on their own.
However, physiological jaundice in children does not always go away on its own and without consequences. If the indicators are exceeded, it is necessary to identify the cause and timely elimination of the hyperbilirubinemia factor and symptomatic therapy. With an increased content of unconjugated bilirubin, this fraction is able to penetrate the blood-brain barrier and cause the development of a condition such as kernicterus, damage to the nuclei of the brain, a condition that threatens severe health problems and death.
What factor can cause the development of a pathological form of hyperbilirubinemia in a newborn? Factors that provoke the development of this condition include prematurity of the fetus, Rh conflict in mother and baby, congenital pathologies of the biliary tract, liver, etc. With insufficient nutrition in the first days of life, intestinal pathologies or spasms that make defecation difficult, anomalies of the urinary tract bilirubin can also reach critical values ​​against the background of physiological jaundice in newborns.

Decrease in bilirubin levels

As an indicator, bilirubin in the blood is a marker not only of liver function, but also of the processes of hemolysis, bile extraction, and the condition of many organs and tissues. Despite popular belief, jaundice is not only a symptom of hepatitis, and also does not require treatment and medical intervention in all cases. There are transient physiological conditions accompanied by yellowing of the skin, sclera and increased concentration of bilirubin (physiological jaundice of a newborn, jaundice of pregnant women), occurring under medical supervision and in most cases passing on their own. With Gilbert's syndrome, most patients also only need preventive measures and supportive enzyme therapy.

But in many other cases, jaundice, like other manifestations of increased bilirubin concentrations, indicates a developing disease or pathological process. Identification of the factor due to which bilirubin is excessively produced and determination of the nature of the pathological process determines the choice of treatment methods.

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In addition to the liver, the breakdown of red blood cells occurs in other “blood” organs - the bone marrow and spleen, although to a lesser extent. Thus, in one day the body loses approximately a hundredth of its red blood cells, from which up to 300 mg of hemoglobinogenic pigment is released. Old cells are replaced by new, young and able-bodied cells.

With the normal functioning of all systems and organs, the formed bilirubin is excreted, and it is replaced by bilirubin released from destroyed red blood cells (also ≈ 0.3 g). And so on every day, so that the level of this substance in the blood does not exceed the values 20.5 µmol/l, because in higher concentrations it begins to poison the body.

However, a norm of up to 20.5 µmol/l implies total bilirubin, and, meanwhile, there are two more indicators of its content that express the state of human health:

• Direct (bound, conjugated) bilirubin, which is ≈ a quarter of the total amount (25%), its norm is within from 0.86 to 5.3 µmol/l and depends on the level of total bilirubin. If everything is normal in the body, conjugated bilirubin ceases to pose a particular danger to health, since it is bound, and therefore neutralized, and is about to leave the bloodstream. The main thing is that no obstacles arise in its path, and the substance intended for removal does not come back;
• Indirect (unbound, free, unconjugated) bilirubin occupies 2/3 of the total amount and is normal from 1.7 to 17.0 µmol/l, it is this substance, which moves freely and accumulates in the bloodstream, that has properties that are far from beneficial for humans, and therefore poisons the body when there is too much of it in this state.

It should be noted that normal values ​​in different sources and laboratories sometimes differ slightly. This is explained by changes in individual characteristics of the reagents and modification of analysis methods. Of course, there is no need to expect any special differences; they will range from tenths of a micromol/l to one.

The level of bilirubin in blood serum does not differ by age or gender; it is the same in men and women. In children, the norms of this indicator do not depend on age and correspond to the figures of an adult, with the exception of newborns.

Bilirubin in newborns: features and problems of the neonatal period

The norm for an adult cannot in any way be equated with the norm for a newborn in the first days of his life.

Immediately after birth, the level of bile pigment still somehow approaches the indicators that we are accustomed to perceive (≈ 22 µmol/l). Immediately, bilirubin begins to grow rapidly, on the 4th day of life it reaches about 120 µmol/l, which noticeably affects the baby’s skin.

Young mothers sometimes get scared in such cases, experienced women affectionately call this condition “jaundice,” and the doctor on rounds calms them down with a smile, explaining that the newborn has physiological jaundice.

Hyperbilirubinemia in newborns is explained some destruction of red blood cells in order to make room for new, “adult” hemoglobin, and give the fetal one the opportunity to leave the baby’s body. It’s just that in the first hours of life a little person begins to adapt to new conditions for him.

The child does not remain yellow for long; after a week, the bilirubin level drops to 90 µmol/l, and then completely returns to normal as an adult. But this happens within strict deadlines, when everything is good and prosperous. In other situations, jaundice that appears at the wrong time or is delayed too long causes concern for the neonatologist and requires certain therapeutic measures. This refers to an increase in bilirubin in weak, premature children born with pathology.

If hyperbilirubinemia is the result or formed due to other circumstances that create conditions for a significant increase in the free fraction, which is not only present in the blood, but also penetrates into other organs, many problems arise. Crossing the blood-brain barrier, hemoglobinogenic pigment causes enormous damage to the nuclei of the brain, which is why this type of jaundice is called nuclear. It is a very dangerous condition in children in the first hours and days of life and requires immediate measures from neonatologists, which is what happens in such cases: mothers report kernicterus in the child and begin intensive therapy.

Video: bilirubin and jaundice - Dr. Komarovsky

What happens to bile pigment after it is formed?

Thus, red blood cells, when destroyed, “release” their contents - hemoglobin, the molecule of which also disintegrates with the formation of a toxic substance, the hemoglobinogenic pigment - bilirubin. The liberated bilirubin in this state cannot accumulate, be stored in organs or circulate in the blood, so it must be sent to a place where it will be converted into a water-soluble form that can leave the human body. Everything here is provided by nature:

Based on these transformations, we can conclude that all bile pigment (total bilirubin) consists of:

• Indirect (unbound, free, unconjugated), which appears during the destruction of red blood cells and the breakdown of heme components;
• Direct (bound, conjugated), formed in the liver as a result of a reaction with glucuronic acid.

The condition when bilirubin is elevated is called hyperbilirubinemia. Total bilirubin can increase due to any of its fractions (bound, free), so blood tests provide methods for their determination.

Video: bilirubin metabolism

Hyperbilirubinemia and its main manifestations

A high level of bilirubin, several (possibly tens) times higher than normal, can not only be dangerous to the patient’s health, but also threaten his life, therefore, such a situation requires an immediate reduction in the indicator. And, of course, you can hardly hear from a doctor a conclusion that total bilirubin is low and its fractions are normal. Such options are somehow not considered (as meaningless). Just a low level of total and free bilirubin indicates that a person has everything in order in many organs and systems: red blood cells do not break down prematurely, there is enough albumin for transportation, the synthesis of glucuronic acid is normal, the liver is healthy, the bile ducts are free, and so on.

It is not entirely good when bound bilirubin is low or approaches zero, and all that is available in the body is in free floating, but in such cases, total bilirubin, if not very elevated, can still be somewhere near the highest limit of normal or slightly exceed it. Similar phenomena can sometimes be observed with benign hyperbilirubinemia (Gilbert's disease): bilirubin does not seem to be very high (22 - 30 µmol/l), but all is free, while conjugated bilirubin is 0.

The liver plays a major role in the metabolism of bilirubin in the body. If something is wrong, she reacts with a striking syndrome that is difficult not to notice. This is jaundice, it appears:

1. When the functional capacity of the liver declines and the condition of its parenchyma no longer allows it to bind excess amounts of bilirubin;
2. If bile cannot move freely through the ducts and remove already bound bile pigment.

It would be a mistake to think that a person will “turn yellow” as soon as the bilirubin level leaves the normal range - jaundice appears when the content of this substance exceeds 34-35 µmol/l.

Who is turning yellow?

The degree of increase in bilirubin mainly affects the nature of yellowness, that is, the higher the indicator, the more staining of the fabrics appears. Usually the sclera and oral mucosa are the first to report jaundice, then the skin of the face, palms and feet joins, the remaining skin turns yellow last, when hyperbilirubinemia is already at its height. It should be noted that obese and edematous people “turn yellow” less than thin and lean people. However, when you see a person with an unusual skin color, there is no need to rush to conclusions - such coloring may be a consequence of endocrine disorders (hypothyroidism, diabetes) or simply food addictions. Lovers of carrots and red tomatoes often acquire the corresponding shade. And, by the way, the sclera in these cases will have an absolutely normal color (intact, as doctors say).

Thus, increased bilirubin in the blood can be evidence of various disorders, sometimes benign, but often not very good. Such situations require the division of this substance into fractions (bound and free) and further examination of the patient in order to determine the cause of the increase in bilirubin.

As for urine, the pigment (normally!) is found in such minute quantities that it is not possible to determine it using the traditional method (usual general analysis), therefore, in the form of study results for healthy people they usually write: “bile pigments - negative.” , which corresponds to normal values. In case of liver pathology, increased bilirubin, in addition to the blood, is also seen in the urine, but since this is not available indirectly, it does not dissolve in water and does not pass through the kidney filter, then all changes in laboratory tests can be attributed to conjugated bilirubin.

Why does bilirubin increase?

The reasons for the increase in bilirubin in the blood are very diverse and usually come down to either excessive production of this substance in cells scattered throughout the body (reticuloendothelial system or macrophage system), or are explained by a shift in various links (one or more) of the hepatobiliary metabolic process.

A failure in the processes of exchange and excretion of hemoglobinogenic pigment from the body, as a rule, is followed by an excessive increase in the concentration of bilirubin, which ultimately leads to the appearance of yellow staining of the tissues. This violation may appear as a result of hereditary pathology (hereditary forms) or during life under the influence of various unfavorable factors (acquired hyperbilirubinemia). Depending on the amount of total bilirubin present in the blood and the predominance of a certain fraction, hyperbilirubinemia is distinguished:

• Conjugative, which is characterized by an increase in the total value due to bound bilirubin (its level can reach 50.0 or more µmol/l;
• Non-conjugative, characterized by normal values ​​of bound bilirubin, but an increase in the concentration of the free fraction (it approaches the generally accepted norm of total bilirubin or exceeds it - more than 17.10 µmol/l).

The greatest attention of clinicians is attracted by various types of acquired hyperbilirubinemia:

1. Prehepatic jaundice. They are also called hemolytic. They owe their appearance to the excessive accumulation of hemoglobin pigment, the high concentration of which is very difficult to cope with; suprahepatic jaundice is extremely difficult to correct. The use of the latest treatment methods, which force the liver to intensively bind a harmful substance, does not ensure its complete removal from the body.
2. Parenchymal or hepatic hyperbilirubinemia are formed as a result of various pathologies leading to damage to liver cells (and therefore its parenchyma) and bile capillaries. This, in turn, results in a disorder in the uptake, binding and excretion of bilirubin, as well as its return back into the bloodstream from the bile ducts, which is observed in the case of cholestasis (stagnation of bile in the liver). This is the most common form among other types of jaundice, which is characterized by an increase in conjugated (direct) bilirubin.
3. Subhepatic hyperbilirubinemia- this is the result of the return of bilirubin that is already bound, but unable to be removed with bile. This occurs in cases where the bile itself cannot squeeze through and overcome the obstacle that has closed the bile ducts.

various forms of jaundice: mechanical (subhepatic), parenchymal (hepatic), hemolytic (suprahepatic)

However, it turns out that the listed jaundices can be perceived as a consequence and business card of increased bilirubin in the blood. Obviously, they are strongly interconnected: the concentration of bilirubin increases - the skin turns yellow, or vice versa: the skin turns yellow - you need to look for the reason for the increase in bilirubin. What then causes these jaundices, under the influence of what factors are they formed and where lies the reason for the increase in this indicator? To answer this question, it is advisable to consider each type of hyperbilirubinemia separately.

Prehepatic jaundice

An increase in the level of total bilirubin due to its unconjugated fraction is observed with intensive breakdown of red blood cells circulating in the bloodstream (hemolytic anemia), which is typical for conditions combined into the group of suprahepatic jaundice:

• Hereditary anomalies of the red blood cells themselves (, sickle cell) and acquired variants ();
• Severe infectious processes (malaria, typhoid fever);
• Ingestion of toxic substances into the body that cause (salts of heavy metals, snake venom, toxins contained in toadstool and other poisonous plants);
• Extensive hematomas as a result of massive hemorrhages;
• Incompatible blood transfusion (system and Rh - first of all) and Rh conflict during pregnancy (GBN -);
• Malignant blood diseases and other neoplasias.

Hemolytic anemia is a rather serious condition: a painful appearance, pale lemon-yellow color of the skin, and an enlarged spleen immediately indicate a sick person. In addition to blood, other laboratory tests are also restless: there is a significant excess of uro- and stercobilin in urine and feces.

Table: common types of jaundice and their characteristics

Hepatic (parenchymal) hyperbilirubinemia

Hepatic jaundice, as a rule, is caused by the destructive effect on liver cells of a viral infection, certain medications and products taken orally to increase vitality (alcohol, for example). First place among the diverse and numerous factors that “kill” the liver and increase bilirubin rightfully belongs to hepatitis and cirrhosis.

Inflammation of the liver, acute and chronic

Infectious agents, penetrating the delicate liver parenchyma, cause inflammation, which we call hepatitis. But what happens during the acute stage with liver cells - hepatocytes, and why does direct (conjugated) bilirubin increase in the first place?

Progression of hepatitis and liver condition

The inflammatory process localized in the liver leads to the suffering of its cells, which, due to the aggressive behavior of foreign microorganisms or chemicals, begin to “shrink, wrinkle,” forming gaps between themselves, allowing bile containing already bound bilirubin to flow freely from the bile ducts and stagnate. in the liver.

The acute course of the disease, the cause of which was any currently known virus that affects the liver (A, B, C, D, G, etc.), manifests itself similarly to many infectious processes: headache and fever, signs of general intoxication, "ache" in the bones and pain in the muscles. Other, more specific symptoms help diagnose liver disease:

1. Discomfort and heaviness in the liver area (under the costal arch on the right);
2. Decreased appetite, mild nausea;
3. Changes in the color of the skin and mucous membranes (the sclera turns yellow earlier than other areas);
4. Noticeably lighter stool;
5. Urine that resembles dark beer;
6. Exceeding the level of bilirubin (due to the direct fraction), .

Signs that the process has captured large areas of parenchymal liver tissue and bile stagnates in it are considered to be the appearance of annoying skin itching, increased bleeding at the slightest scratch, and decreased brain activity (hepatic). These symptoms allow you to judge the level of bilirubin even without any tests. And he is usually tall.

In chronic hepatitis caused by the influence of viruses, drugs, alcohol and other factors, parenchymal jaundice with skin rash, joint pain, and fever is observed. These symptoms indicate a significant increase in bilirubin and liver enzyme activity, and also warn the patient about the possible development of liver failure, which is often fatal.

Cirrhosis

In cirrhosis, the cause of increased bilirubin is significant damage to liver cells. This disease is often (but not always) the result of hepatitis, or rather, the long-term suffering of an organ that fought as long as it could, but, ultimately, its parenchyma could not stand it and began to collapse, irrevocably giving way to its rightful place to connective tissue. Of course, under such circumstances, the entire structure of the liver suffers: following its tissue (disappearance of lobules), the blood vessels and bile capillaries are modified beyond recognition, which naturally leads to a disruption in the functional abilities of the organ. The liver “forgets” its main tasks, and the connective tissue that replaced it simply does not know them. All this leads to the fact that bilirubin is not bound and excreted, toxins are not neutralized, and “disorder” occurs in the hemostasis system due to impaired protein synthesis. Such metamorphoses cannot go unnoticed; the patient has a lot of complaints indicating a clear problem in the organ responsible for binding and excreting bile pigment:

The development of liver failure in cirrhosis is obvious. Bleeding (gastric, uterine, etc.) is threatening and the patient may die.

Stumbling block in the path of bilirubin (subhepatic jaundice)

Bound bilirubin in bile is sent closer to the exit from the body, that is, to the intestines. However, on his way he may encounter an insurmountable obstacle that will return him to his previous place. An increase in the content of bile pigment in the blood will lead to the development obstructive jaundice, the symptoms of which are more pronounced than those of other forms of hyperbilirubinemia: brighter yellowness, itching to the point of bleeding, headache is stronger, feces generally take on the color of clay (stercobilin - 0). The reasons for the increase in bilirubin (direct) lie in the occurrence of some kind of mechanical barrier that inhibits the flow of bile:

Defective genes that increase bilirubin

When considering the causes of increased bilirubin, one cannot ignore inherited hyperbilirubinemia (Dabin-Johnson syndrome, Crigler-Nayyar syndrome), and especially focus on benign hyperbilirubinemia - Gilbert's syndrome, which is called "disease of excellent students."

The reason for the increase in bilirubin in this case is a lack of glucuronidase(an enzyme that catalyzes the formation of glucuronic acid), which is clearly visible in a biochemical blood test: the conjugated fraction in such individuals is equal to zero or approaches it, while the entire existing fraction is in a free state.

Interestingly, many people do not even suspect that they have a defective gene hidden in the second pair of chromosomes. Typically, the development of the disease requires conditions: stress, great mental or physical stress. The debut of the syndrome is accompanied by tears and a search for the causes of increased bilirubin (what if it is some kind of hepatitis?), the course in most cases goes without treatment, however, to keep the head clear and not hurt, students before the session still try to reduce bilirubin with phenobarbital, which increases enzyme activity and thus helps bind bile pigment.

In most cases, Gilbert's syndrome does not remind of its presence at all, it does not destroy the liver, and the prognosis is favorable. Unless such patients should not forget simple rules: hard physical work, enormous psycho-emotional stress and large doses of alcohol - all this is not for them.

How to reduce bilirubin?

It’s good if yellowed skin color and other signs of trouble in the body, which can be caused by increased bilirubin, prompt a person to consult a doctor, and he will find out the origin of the incomprehensible symptoms. As a rule, an increase in bile pigment in tests indicates serious health problems; it does not cross the designated boundaries just like that, so they need to be taken seriously. You should not try to reduce bilirubin on your own, because even if this succeeds, it will not last long. It is not folk remedies that will help reduce bilirubin, but the professional approach of official medicine:

• Severe hemolysis requires treatment, aimed at eradicating the cause in a hospital setting (droppers with glucose, administration of albumin, therapeutic plasmapheresis);
• Small children who are just born are subjected to ultraviolet irradiation, which helps bind the released harmful product and remove it from the body. But this concerns physiological “jaundice”. Treatment of kernicterus, unfortunately, is not always doomed to success, therefore, it should be dealt with even more by specialists;
• Some independence is provided for persons with Gilbert's syndrome, but only to go to the clinic, write out a prescription for phenobarbital and take it in small doses (approximately ¼ tablet) once a day at night, since even in tiny quantities the drug causes drowsiness in healthy young people. True, some, without consulting a doctor, go to the pharmacy and buy Corvalol. And by the way, it helps because it contains phenobarbital. Meanwhile, it should be borne in mind that in this case a person takes not only the drug he needs, but also other substances that make up Corvalol, including alcohol, which is not very useful for Gilbert’s disease (so why get used to it?) .

I would like to believe that we managed to convince the reader not to self-medicate if suddenly the sclera and skin acquired an unnatural color for them, and doubts about their health crept into their souls. It is very easy to go and take a biochemical blood test, where the red line will indicate bilirubin, and then go to the doctor, who, perhaps, immediately (or after an examination) will establish the cause and prevent serious complications and consequences.

Video: liver tests, bilirubin - “Live Healthy!” program

The human body is created intelligently and in a healthy state should work like a clock: smoothly and accurately. Blood circulates throughout the body, which acts as the connective tissue of the internal environment. It flows through a closed system of blood vessels due to the rhythmic work of the heart. Blood does not communicate directly with the rest of the body's tissues, but without it they would not be able to function. After all, it is this life-giving liquid that supplies them with nutrients and oxygen, transports unnecessary metabolic products to the kidneys and lungs for elimination from the body.

Therefore, it contains simple and complex components formed as a result of the vital activity of individual organs. Many of them can be determined using a general blood test. Even more information can be obtained from its biochemical study, including data on bilirubin. This is a bile pigment that is formed during the breakdown of hemoglobin and the destruction of red blood cells. The final decay substances enter the bile and are removed from the body through the intestines. The level of bilirubin in the blood can be used to judge how productive the liver is.

Every day the human body creates approximately 300 mg of pigment, in particular 80% from old red blood cells.

Bilirubin is found in the blood in two groups:

• Direct (bound, conjugated).
• Indirect (free).

Direct is synthesized in the liver and is a low-toxic fraction of total bilirubin. It is soluble in water and is mostly excreted in bile into the small intestine.

Indirect bilirubin is insoluble and toxic because it can easily penetrate cell membranes and disrupt their normal functioning. By binding to other blood components, it moves to the liver.

Normal levels of bilirubin in the blood of children

Bilirubin levels in children's blood are in the same range as in adults. They are measured in micromoles per liter (μmol/L).

But for newborns the situation is somewhat different. Immediately after birth, they exhibit physiological jaundice, which is associated with the adaptation of the child’s body to the environment. The baby's liver is not yet fully functioning, and due to the bilirubin formed, the skin and mucous membranes become yellowish. This shade is most pronounced on the third day after birth. After a week, the pigment completely returns to normal, as the enzyme systems gradually begin to work at full capacity.

When a baby is only two or three days old, the level of bilirubin in his blood is up to 61 µmol/liter.

Then the rate increases to 250 µmol/liter. It remains relevant throughout the first week of the baby’s life. If the child was born premature, then the value of the indicator is 170 µmol/liter.

Starting from the tenth day, the norm gradually decreases to 21 µmol/liter.

The normal ratio between indirect and direct bilirubin is 90:10 (as a percentage).

An increase in bilirubin should alert pediatricians. Indeed, in addition to the usual ailments, infants can develop hemolytic disease of the newborn. It is based on the incompatibility of the baby’s and mother’s blood in terms of the Rh factor or group antigens. This antagonism causes accelerated destruction of red blood cells and an increase in bilirubin levels.

• Gilbert's syndrome;
• folic acid deficiency;
• low-quality neoplasms in the liver;
• hepatitis;
• congestive processes in the liver.

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Bilirubin norms in women

The levels of bilirubin in women's blood are slightly lower compared to the levels established for men. This is explained by less production of red blood cells, and therefore less hemoglobin - it is during its breakdown that bilirubin is formed.

The standard indicators are as follows (in µmol/liter):

• total bilirubin – 8.2–17.1;
• connected – 0.9–4.2;
• free – up to 17.2.

The norm of bilirubin remains unchanged for pregnant women. If the expectant mother is healthy and pregnancy proceeds naturally, then the content of bile pigment in the blood should not deviate from the established norm. However, in the third trimester its level may increase. The cause is intrahepatic cholestasis of pregnancy - a violation of the outflow of bile from the liver. After childbirth it quickly disappears.

Norms of bilirubin in the blood of men

The standard level of the substance in the blood of men and women is almost the same. For the stronger sex, its values ​​are as follows (in µmol/liter):

• total bilirubin – 8.4–19.8;
• connected – 1.0–8.1;
• free – up to 20.0.

The share of direct pigment is 20–22%; indirect pigment is 78–80%.

Men are more likely than women to develop Gilbert's syndrome. This is a very common form of pigmentary hepatosis, transmitted hereditarily. The syndrome occurs in 2–5% of the population and is ten times more common in males. The disease is benign and chronic. The syndrome is characterized by a moderate increase in unconjugated bilirubin in the blood. Clinical signs do not appear until the age of twenty. Very often a man has no idea that he has jaundice. It is detected during examination or laboratory tests.

Signs of increased bilirubin in the blood

When bilirubin metabolism is within normal limits, a small amount of bound bilirubin enters the blood. But in the presence of pathologies, it can quickly accumulate in both the blood and urine. Bilirubin penetrates into nearby tissues and causes a slight yellowing of the skin, mucous membranes and eye sclera.

Other symptoms of the disease are also observed:

• nausea and vomiting attacks;
• feeling of heaviness in the liver area;
• bitterness in the mouth;
• discoloration of feces;
• darkening of urine.

Analysis transcript

A biochemical blood test allows you to determine the level of total bilirubin and both of its fractions in micromoles per liter.

Comparison of the results obtained with standard indicators allows us to assess the level of performance of the body as a whole and its individual organs, understand the causes of identified deviations and determine the nature of pathological processes.

The blood test contains information that the bilirubin level is more often above the norm than below its level.
If total bilirubin rises above 26 µmol/liter, then jaundice begins.

Its mild form is observed when the bilirubin concentration is not higher than 87 µmol/liter. The range from 87 to 160 µmol/liter indicates a moderate stage of the disease, and a reading above 160 indicates the onset of a severe form of jaundice.

Various ailments provoke an increase in certain fractions of bilirubin in the blood.

• Congenital anemia. This disease accelerates the destruction of red blood cells, thereby increasing the level of bile pigment in the blood.
• Acquired anemia - develops against the background of rheumatoid arthritis, lymphogranulomatosis, systemic lupus erythematosus.
• Infectious diseases: sepsis, typhoid fever, malaria.
• Vitamin deficiency, in particular B12.
• Syphilis (second and third stages).
• Taking certain medications can also cause an increase in bilirubin above normal. Such drugs include insulin, chloramphenicol, aspirin. Medicines can cause a variety of side effects, which should always be taken into account.
• Gilbert, Lucy-Driscoll, Crigler-Nayyar syndromes.

The decrease in bilirubin levels was not taken into account for a long time. But recent research suggests that a low rate may be a sign of developing coronary artery disease (CHD).

When conducting a biochemical study, blood is drawn from a vein. The procedure should be carried out in the morning on an empty stomach. Before the analysis, you need to abstain from dinner so that the break in food intake is at least eight hours. In order for the analysis results to be as objective as possible, it is advisable not to consume fatty foods and strong drinks at least three days before the test.

Bilirubin level is an important diagnostic indicator that contains a lot of information about the condition of the body. But in order to finally determine the diagnosis, it is necessary to conduct other studies. Only then can treatment be prescribed correctly.