Jaundice is the yellow or icteric discoloration of visible mucous membranes and skin due to the accumulation of bilirubin in the blood. In newborns, staining occurs when the total bilirubin level reaches 70 µmol/l, and for premature infants - 50 µmol/l.

Physiological jaundice is more common in newborns, developing in the first 3 days after birth. Doctors classify this condition as borderline, which does not require treatment.

This condition is dangerous due to the toxic effect of free (unbound) bilirubin on the organs of the central nervous system.

Such children are prone to developing kernicterus, or bilirubin encephalopathy. It occurs only in newborns and leads to severe consequences: cerebral palsy and mental retardation.

Classification of the disease

During the neonatal period, there are several types of jaundice:

1. Indirect or unconjugated hyperbilirubinemia. More than 85% of total number bilirubin is indirect;

2. Conjugated or direct hyperbilirubinemia, when direct bilirubin accounts for 15% or more of the total bilirubin level; conjugation jaundice in newborns may indicate hereditary diseases;

3. Hemolytic jaundice;

4. Parenchymal jaundice;

5. Mechanical (obstructive) jaundice.

Physiological jaundice in the newborn period is called transient and develops in 60% of full-term healthy children on the 2-3rd day. At the same time, the level of bilirubin in premature infants reaches 85-103 µmol/l and in full-term infants – 51-60 µmol/l.

It is customary to divide the development of jaundice into phases:

1. In the first five days after birth, the fraction of direct bilirubin in the blood grows relatively quickly;

2. In the second phase, there is a moderate decrease in unbound bilirubin to 50 µmol/l during 11-14 days of a newborn’s life.

Rarely, the second phase can last up to a month. This is due to the functional maturity of the child and the type of feeding (jaundice lasts longer during breastfeeding).

The coloring of the baby's skin occurs naturally: the face, neck, body and limbs are painted in turn.

The disappearance of icteric staining is observed in reverse order: limbs, torso, neck and face. Some factors contribute to the prolongation of jaundice: a lack of breast milk in the mother or, conversely, jaundice is sometimes associated with the effect of mother's milk on the baby's body.

Causes of the disease

The causes of jaundice in newborns are different:

1. During childbirth there was a large release of red blood cells;

2. Initially high quantity fetal hemoglobin in the blood of a newborn;

3. Rapid breakdown of fetal hemoglobin after childbirth;

4. Lack of liver enzymes that are involved in conjugation indirect fraction bilirubin;

5. Incorrect infant feeding regimen.

Physiological jaundice in newborns has its own characteristics:

1. It appears externally 48 hours (2 days) after birth;

2. The level of bilirubin does not reach a critical value that can cause the development of bilirubin encephalopathy;

3. The general condition of the newborn remains satisfactory.

In children fed breast milk mothers, the most high level bilirubin levels are observed on days 4-5, since in the first days they receive less fluid due to unsteady lactation.

In premature babies, the severity of jaundice depends primarily on the maturity of the child and pathologies in the mother during pregnancy, and not on the weight of the newborn. The incidence of jaundice is higher among children who have suffered a birth injury, in children from multiple pregnancies and from mothers with diabetes.

Treatment of jaundice in newborns

The main method of treatment physiological jaundice What remains is frequent feeding, breastfeeding on demand, sometimes you have to wake up such children for feeding. It is recommended that a nursing mother establish drinking regime. No small importance is given to proper nutrition and rest for the mother.

If the child’s general condition becomes unsatisfactory and jaundice increases, it is recommended to determine the bilirubin level. If jaundice develops after 8 days of a newborn’s life or lasts more than 2 weeks, the true cause should be established this state.

Treatment of hyperbilirubinemia has its own principles:

1. The first step is to eliminate the causes of increased levels of toxic bilirubin in the blood;

2. Measures should be taken to prevent a further increase in the level of toxic bilirubin;

3. Use methods that promote the rapid removal of excess bilirubin from the blood.

Such methods include phototherapy and exchange blood transfusion, which is indicated for newborns who have an Rh conflict or blood type incompatibility with the mother.

The final decision on the use of this method is made after studying a detailed medical history, obtaining the results of a blood test for the presence and level of antibodies, if detected clinical signs an increase in bilirubin at a rate of 17 µmol/l/hour, and when bilirubin levels are below 110 µmol/l in the umbilical cord blood.

Phototherapy has been used for jaundice in newborns for 30 years. At correct implementation this method does not carry with it any negative consequences. Worldwide, phototherapy is the mainstay of treatment for this condition in newborns.

The method is based on the transition of the fat-soluble form of bilirubin, which is toxic to the brain, into a water-soluble non-toxic form that easily leaves the body. This process passes under the influence of ultraviolet rays.

A greater effect is achieved by increasing the illuminated area of ​​the child’s body. Therefore, such children are usually completely undressed, but are kept in incubators to maintain warmth.

When exposed to light, bilirubin breaks down into non-toxic fractions. The main one is lumirubin. Within 12 hours it completely leaves the child’s body with feces and urine.

Sometimes during phototherapy the newborn experiences frequent loose stool, peeling of the skin, excessive drowsiness. After stopping this procedure, the above phenomena disappear without a trace.

The action of the blue part of the light wave spectrum is toxic, so the child’s eyes are covered with special glasses and the genitals are covered with a dark cloth.

In order for the radiation to affect the largest area of ​​the child’s body, he should change position every 2 hours.

As long as there are indications for phototherapy, it should be carried out at regular intervals. The most acceptable regimen for most newborns is alternating phototherapy and feeding breaks.

The average duration of therapy is from 1 to 3 days.

The effect of treatment is assessed not only by external data on skin coloring, but also by laboratory indicators. A newborn needs to monitor bilirubin levels with a blood test up to 2-3 times a day. During the first 12-24 hours from the start of phototherapy sessions, the level of indirect bilirubin in the child’s body stabilizes.

Bilirubin is an orange-yellow bile pigment. Formed during the normal breakdown of red blood cells (erythrocytes), they are then released into bile and excreted from the body through stool.

Bilirubin can be classified as indirect (free, unconjugated or indirect bilirubin), a form in which the bile pigment does not dissolve in water, circulating in the blood it enters the bloodstream, where it takes on a soluble form (direct bilirubin).

All bilirubin circulating in the vessels along with the red liquid is called total bilirubin.

Detailed description of bilirubin and processes associated with it

Bilirubin appears in the body when hemoglobin (a complex iron-containing protein) in old red blood cells breaks down.

The breakdown of old cells is a normal, healthy process. After circulating in the blood, bilirubin is sent to the liver.

In the liver, bilirubin is conjugated, mixed with bile and released into the bile ducts and remains for some time in your gallbladder. Eventually, bile is released into small intestine to help digest fats, which are then excreted in your stool.

An increased level of this bile pigment is called hyperbilirubinemia (). Not everyone knows that this disease is transmitted from father and mother to child; unfortunately, with the disease, the level remains high throughout a person’s life.

Unconjugated bilirubin may harm the developing baby central department nervous system of a newborn (up to 2-4 weeks), it does not pose a threat to adolescence and adults.

In adolescents and adults, the “blood-brain barrier” is more developed and prevents bilirubin from reaching brain cells. However, high bilirubin levels indicate the presence of some process or disease in the body that needs to be diagnosed and treated.

Bilirubin is not usually present in urine. However, the conjugated (direct form) is water soluble and can be excreted through urine if it cannot pass into bile.

Bile pigment found in urine usually indicates bad job liver or bile ducts, hepatitis or any other pathological process associated with this organ and can be found on early stages diseases.

Diagnostics

Doctors diagnose elevated bilirubin in combination with other laboratory research (alkaline phosphatase, alanine aminotransferase (ALT)) associated with liver problems.

Laboratory diagnosis of bilirubin is carried out when:

• Jaundice (Gospel's disease);
• When the patient suffers from alcoholism or often abuses alcohol;
• If you suspect that you are taking narcotic or toxic drugs;
• When a person has been exposed to viruses that cause hepatitis.

A biochemical test may also be performed if there is a suspicion of hemolytic anemia (a condition characterized by low level hemoglobin or red blood cells in the blood).

In this case, they are often prescribed additional research to assess hemolysis ( general analysis blood, analysis for reticulocytes, haptoglobin and lactate dehydrogenase (LDH)).

What will affect its incorrect indicators:

Reasons why you may not be able to take the test or why the results may be incorrect include:

• Drinking coffee or caffeine-containing products, which can reduce bile pigment levels.
• Abstaining from eating for long period(fasting), which usually increases indirect bilirubin levels.

What are normal bilirubin levels in adults?

A comprehensive bilirubin blood test will show the exact amount of all three levels of bilirubin in your blood: direct, indirect and total. Below are the norms for all three values ​​in an adult:

• Normal values ​​for direct bilirubin range from 1.8-5.2 mmol/L.
• Normal values ​​of indirect bilirubin vary between 3.5-12 mmol/l.
• Total bilirubin (direct and indirect) varies in the range of 5.2-17 mmol/l.

Why does total bilirubin increase in an adult?

If total bilirubin is elevated in an adult, this may indicate several types of problems, for example:

• Abnormal breakdown of red blood cells (eg, reaction to blood transfusion (intravascular whole blood or its components from healthy to sick));
• Scarring of the liver (occurs when the structure grows and changes connective tissue in a large digestive gland, with diseases such as);
• Inflammatory processes(call , B,C);
• Penetration of pathogenic (disease-causing) microorganisms into the body;
• Dysfunction of the common bile duct;
• Gallstones, or calculi;
• Malignant neoplasms (cancer, tumors) arising from the epithelium of glandular tissue or pancreatic ducts

Reasons for low value

A substance in the blood that does not reach the average level can be caused by:

• Reducing medications and supplements general level(vitamin C, phenobarbital and theophylline).

What are the symptoms of high bilirubin levels in adults?

In adults (a disease accompanied by yellowing of the skin or sclera of the eye) and itching are the main symptoms and signs of increased levels of bilirubin in the blood.

The following are some of the potential causes of elevated bilirubin and associated signs and symptoms (this is a short list, not a comprehensive list):

Symptoms and signs of anemia (as a cause low content red blood cells) include:

• Weakness;
• Pallor;
• Jaundice.

Symptoms and signs of viral hepatitis include:

• Fatigue;
• mild fever;
• Muscle pain;
• Nausea and vomiting;
• Jaundice.

Symptoms and signs of inflammation biliary tract include:

• Light chair;
• dark urine;
• Pain in the right side of the abdomen;
• Nausea, vomiting;
• Yellowness of the skin.

Signs of an infectious disease (such as malaria):

• Intermittent fever/chills;
• Weakness.

Genetic diseases (such as sickle cell disease and hereditary spherocytosis) have the following symptoms:

• Stomach ache;
• Dyspnea;
• Fatigue;
• Weakness;
• Red blood cells are irregularly shaped.

Signs and symptoms liver failure(causes may include cirrhosis, liver cancer, alcohol abuse, drugs, infectious diseases, Gilbert and Crigler-Najjar syndromes):

• Abnormal liver enzymes.

Also drugs such as sulfonamides and nitrofurantoin (a drug with a pronounced antimicrobial effect) can increase total bilirubin levels, increasing the breakdown of red blood cells in the blood. And a drug such as atazanavir increases unconjugated (indirect) bilirubin.

As a rule, the concentration of this bile pigment is higher in men than in women. African Americans tend to have lower concentrations of this substance. Also hard work or physical exercise may increase the level of total bilirubin in the blood.

Increased total bilirubin: treatment

1. Blood transfusion - research results and clinical trials conducted in China show that this method for reducing high bilirubin levels with fewer side effects is one of the effective methods.
2. Medicines - to remove bilirubin from the body and reduce bilirubin, you can use drugs such as salicylates, furosemide, ampicillin and ceftriaxone (some of the drugs are quite dangerous, you need to consult a doctor).
3. Phototherapy (phototherapy, light therapy) - Hyperbilirubinemia caused by jaundice can be easily treated without or with minimal consequences using phototherapy (treatment with sunlight or artificial light, rays). The effectiveness of phototherapy depends on many factors (the information below will be helpful when talking to your doctor):
   1. Body surface area exposed;
   2. Spectrum of the light source: usually for effective therapy special blue tubes marked F20T12/BB are used, and not F20T12/B, while the irradiation or energy output can be increased in the phototherapy unit, reducing the distance to the person within 15-20 cm.
   3. Continuous phototherapy will be better than intermittent phototherapy.

Conventional phototherapy:

Conventional or fiberoptic phototherapy units can be used, provided the jaundice is not hemolytic or progresses slowly.

Intensive phototherapy:

In conditions of hemolytic jaundice, a rapid increase in bilirubin, or failure of a conventional block, there will be correct use intensive phototherapy.

Diet for high bilirubin (treatment at home)

The following foods reduce the level of bile pigment in the body and help improve liver function:

• Tomato juice: One glass of tomato juice mixed with a pinch of salt and pepper should be taken on an empty stomach in the morning.
• Radish leaf juice: Take radish leaves and squeeze the juice out of them using a grater, meat grinder or blender. Drink about half a liter of this concentrated juice daily, after about ten days you can go for a retake test and observe a decrease in the substance in the body.
• Papaya leaf tea and honey: Add one tablespoon of honey to a cup of papaya leaf tea (available at the pharmacy). Drink this tea regularly for one to two weeks. Helps effectively, especially if the elevated level is caused by jaundice.
• Basil leaves : Take about 10-15 basil leaves and make a paste. Add half a glass to the pasta fresh juice radish. Drink this daily for two to three weeks.
• Lemon: The anti-inflammatory property in lemon helps with. Squeeze the juice from 2 whole lemons and add to a glass of water. Prepare and drink this infusion three times a day, as it protects liver cells from damage.
• Turmeric: Into a glass warm water add a pinch of turmeric. Mix well and drink 3-4 times a day.
• Beetroot and lemon: Take one cup of beetroot juice and mix in equal quantities lemon juice. The drink should be drunk regularly for several 2-3 days.
• Chamomile: In folk medicine it is very effective; a glass of brewed chamomile tea should be drunk at least once a day for several weeks.

Products that are best avoided

• Anything spicy and fried.
• Stop drinking alcohol, caffeine and large quantities red (black) tea.
• Avoid unpasteurized milk.

• Increase your intake of foods rich in calcium and minerals (iron and magnesium).
• Vegetables and fruits should be taken raw or steamed.
• Drink more vegetable juices(carrot, tomato).

At elevated level bilirubin, you should immediately talk to your doctor and ask for additional tests to rule out any serious diseases.

Until they are carried out additional diagnostics, you cannot rely on treatment at home; you must first rule out a number of serious diseases.

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Bilirubin (B) - toxic chemical compound, formed during the disposal of red blood cells. The liver is responsible for neutralizing it. The process protects the entire body and especially the brain from poisoning. An increase in B level is an indicator of a disorder of pigment metabolism and the functioning of liver enzymes.

What is bilirubin

The source of bile pigment is heme, the iron-containing part of the transport protein in the blood. Aging red blood cells are the main suppliers of B. Every day, 1% of their total number disintegrates to form 300 mg of a yellow-brown substance. Through the portal veins it enters the liver, where it changes properties: it becomes water-soluble and loses toxicity. It ends up in the intestines with bile, coloring the stool. Some passes through the kidneys and is excreted in the urine. IN healthy body contains a minimum of B, so there is no toxic effect on its part.

Normal bilirubin level in blood

Biochemical analysis is performed on an empty stomach. Biomaterial is taken from a vein. The day before the procedure, you must refrain from fatty foods and alcohol. The results are influenced by:

• Caffeine.
• Herbs with choleretic action.
• Strict diet or overeating.
• Medicines that affect blood clotting.
• Pregnancy.

Analysis on B is indicated for the following conditions:

• Hemolytic and cholelithiasis.
• Intoxication.
• Inflammation of the pancreas.
• Determination of liver performance.
• Jaundice.
• Monitoring of treatment.

Table. Norm B in adults is the same for men and women.

The diagnostic value of the analysis for determining bilirubin is higher, the earlier it is performed and correctly assessed, from the point of view of identifying deviations from the norm.

Direct and indirect bilirubin

The following pigment fractions are distinguished:

• Indirect (unrelated)- a water-insoluble toxic compound that easily penetrates plasma membranes. The reticuloendothelial system (RES) is responsible for the synthesis, where heme transformation occurs. The bile pyment then combines with albumin and is transported to the liver.
• Direct, which has undergone neutralization in hepatocytes. It is excreted in the feces in the form of stercobilin.

Total bilirubin is, respectively, the sum of the previous two. If it is within acceptable values, then further research to determine the level of individual fractions is impractical.

Hyperbilirubinemia is a concentration of B that exceeds the norm. At levels above 36 µmol/l, yellowness of the sclera and skin appears. An increase tenfold threatens human health and even life.

What increases the level of bilirubin in the blood

Massive destruction of red blood cells increases the proportion of unconjugated pigment. The liver is not able to neutralize such an amount, so the concentration of B in the plasma increases. These changes occur with hemolytic anemia (anemia) - pathologies in which the processes of formation and maturation of red blood cells are disrupted. Provocateurs can be environmental factors, including:

• medicines;
• irradiation;
• diseases such as malaria.

Anemia can be congenital, then the activity of the enzyme system in red blood cells decreases or the cell membranes become defective.

Increased bilirubin in the blood is sometimes associated with insufficient intake of vitamin B12.

Metabolism B is disrupted in chronic liver diseases, alcohol damage to hepatocytes, resulting in the release of pigment into the blood. In Gilbert's syndrome, there is a deficiency of glucuronyl transferase, an enzyme involved in pigment metabolism.

Symptoms of elevated bilirubin

When associated with hemolytic anemia, the condition is accompanied by the following symptoms:

• Tachycardia.
• Lag in physical development in children.
• Headaches.
• Fatigue.
• Fever.
• Enlarged spleen.
• Heaviness in the left hypochondrium after physical activity.

Yellowness of the skin and mucous membranes develops gradually: from the sclera and oral cavity to the face, palms, feet and throughout the body. Its degree depends on individual characteristics In a person, for example, in overweight people the coloring is less intense compared to thin ones. The following symptoms indicate liver pathologies:

• Colorless or too light-colored stools.
• Dark urine.
• Jaundice.
• Bitterness in the mouth.
• Vomit.

Impaired outflow of bile is a consequence of cholelithiasis, tumor and inflammatory processes.

Why is the condition dangerous?

Bile pigment is toxic. The brain is especially sensitive to it. Other organs are able to function normally even in conditions of high levels. How long such activity will last depends on the degree of hyperbilirubinemia:

1. Insignificant with indicators of 50-70 µmol/l. Not accompanied by toxic damage to organs. Requires clarification of the reason for the increase.
2. Pronounced (150-170). The danger is present, but it is not critical. If it persists for a long time, it causes poisoning of the body, which is unacceptable and must be quickly eliminated.
3. Heavy (300). In an adult, this means that there is severe intoxication, threatening patient's life.
4. Extremely heavy. Without medical care, a person dies.

The consequences of hyperbilirubinemia are:

• Gallstone disease.
• Cholecystitis.
• Liver failure.
• Hypovitaminosis, as a result of disorders in the digestive canal.

Which doctor and when should you contact?

The first signs of increased bilirubin- a reason to visit a gastroenterologist. In case of blood diseases, the patient will receive a referral to a hematologist. The help of a surgeon may also be needed if obstructive jaundice is the result of cholelithiasis. But we must not forget that mild jaundice may be a sign of hypothyroidism or diabetes mellitus. Sometimes it is the result of consuming foods with high content carotene. If necessary, an infectious disease specialist will treat viral hepatitis, an oncologist malignant neoplasms, and a hepatologist with liver diseases.

How to reduce bilirubin in the blood

Hyperbilirubinemia is not an independent pathology requiring specific therapy. But icteric discoloration of the mucous membranes and skin is a reason to consult a doctor. Attempting to cope with the problem on your own until the cause of high bilirubin is clarified is unacceptable.

Only a doctor, after a timely examination, will find out the etiology of the condition, make a diagnosis, and prescribe adequate treatment, sometimes a complex operation. In case of toxic liver damage or infectious hepatitis, hospitalization and the introduction of detoxifying compounds will be required.

Drug therapy

If total bilirubin is increased, and the cause is associated with a violation of the outflow of bile, then appropriate medications are prescribed:

• Holenzim.
• Silimar.
• Odeston.
• Karsil.
• Allohol.

All of them, along with hepatoprotectors, contribute to the cleansing and healing of the liver, as well as its normal functioning. To reduce the load on the gland, enzyme preparations are prescribed:

• Festal.
• Pancreatin.
• Mezim.

To get rid of toxins, absorbent agents are indicated:

• Enterosgel.
• Activated carbon.

For serious infectious diseases you will need antiviral compounds, as well as immunomodulators. Antioxidants will eliminate the damaging effects of toxins. Drugs based on barbiturates will reduce the level of B.

Taking lipoic acid, ascorbic acid, folic acid, B vitamins in long courses will help restore the functioning of the digestive canal.

The introduction of solutions of protein, Hemodez, glucose with the simultaneous intake of diuretic compounds allows you to accelerate the release of tissues from bilirubin and reduce its toxic effect. Any prescriptions can only be made by a doctor.

Phototherapy

A highly effective method that allows you to convert toxic bilirubin into direct bilirubin under the influence of various artificial light sources. Perform procedures in strict accordance with the instructions for portable dichroic, fluorescent and other lamps (protect your eyes). In the absence of equipment, it is useful to take sunbathing, preferably in the morning and evening for at least 15 minutes. During the cold season, take walks in diffused sunlight.

Folk remedies

At mild degree For hyperbilirubinemia that does not require urgent hospitalization, you can use alternative medicine recipes. They are unable to cope with the problem on their own, but supplement outpatient drug therapy.

To improve bile formation, use yarrow, rose hips, chicory, and for outflow - oregano, dandelion, chamomile, mint. Some herbs, such as milk thistle and tansy, have all of these properties. It is useful to drink freshly prepared beet juice (a third of a glass before meals), as well as calendula decoction.

The liver will respond favorably to a recipe for a tincture of 1 tbsp. l. dry birch leaves and 250 ml of boiling water. Leave for half an hour and drink at night. The composition will soothe and remove toxins from the liver, including free bilirubin. The same recipe is used to prepare a product based on corn silk. Take 2 times a day, 125 ml. Tea with mint will quickly cleanse the liver not only for adults, but also for children. You can drink for 2 months without a break.

Diet correction

Your liver condition will improve if:

• Eat fractionally, in small portions.
• Avoid heavy foods.
• Include foods high in pectin and fiber in your menu.
• Drink more still water.
• Minimize the amount of salt.
• Eat porridge more often.
• Steam or boil.
• Do not indulge in spicy, fatty foods.

Products from the following list reduce bilirubin:

• Herbal teas.
• Vegetable and milk soups.
• Lean meat.
• Kefir, cottage cheese.
• Egg white.

As for fruits, they must be ripe.

Prevention

Bilirubin levels will remain within normal limits if:

• Timely detect and treat anemia, alcohol poisoning, infectious diseases, pathologies of the liver, as well as the gallbladder.
• Limit psycho-emotional and physical stress.
• Eat rationally. Quit alcohol and smoking.
• Take medications as prescribed by specialists, follow instructions and dosages.

Doctor's report

High bilirubin is a sign of primary pathology. Seeking medical help will ensure accurate diagnosis and effective comprehensive treatment.

Source: projivot.ru

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Blood is the study of pigment metabolism in the body. It can be assessed by indicators of total bilirubin and individual fractions. In daily practice, doctors often have to deal with conditions when, according to research results, increased bilirubin in the blood is recorded. How to correctly assess such a condition, why it arose and what needs to be done about it is described in general terms in this article.

Everyone should know this...

For the common man to understand, bilirubin is pigmented chemical substance, which is constantly formed in the body and must circulate through only one metabolic pathway. Its direction consists of several consecutive links in the chain of the bilirubin cycle. These include:

1. Bilirubin formation. Occurs in the spleen, where those that have completed their life cycle red blood cells. When hemoglobin breaks down, total bilirubin is formed. Through the splenic vein it rushes into the systemic bloodstream. brings it to the liver, where neutralization occurs;
2. Conjugation. This process is based on its combination with glucuronic acid, which occurs in the liver. This is necessary in order to neutralize bilirubin in the blood, because it is very toxic to tissues;
3. Excretion. Conjugated (bound) bilirubin in the liver is less toxic to the body and therefore as soon as possible must be removed from the body. This happens by its release from the liver with bile into duodenum. The main part is excreted in the feces in the form of stercobilin. The part that is absorbed into small intestine, is excreted by the kidneys in urine in the form of urobilin.

Important to remember! Bilirubin is a breakdown product of blood elements that has toxic properties to the tissues of the human body. The liver acts as the main responsible organ for its neutralization and removal from the body!

Normal bilirubin levels in biochemical analysis

A biochemical blood test allows you to assess the state of bilirubin metabolism in the body. The main indicators include:

• Indirect bilirubin. This indicator reflects the part of bilirubin that has not been neutralized in the liver;
• Direct bilirubin is a fraction that has been inactivated in liver cells by binding to glucuronic acid;
• Total bilirubin is the combination of direct and indirect bilirubin. This indicator is the most important guideline in assessing bilirubin metabolism and determines the feasibility of determining individual bilirubin fractions. If it is normal, then this is not necessary. If the norm is exceeded, there is a need for a detailed study of the fractions of this substance, which will help determine the cause of the increase in bilirubin in the blood.

Generally accepted standards for bilirubin metabolism are shown in the table.

What is the danger if the indicators exceed the norm?

Bilirubin, as an extremely toxic compound, causes intoxication of the body and disruption of the functioning of important organs. The tissues of the brain are considered the most sensitive in this regard. All other systems (heart, liver, kidneys) are more resistant to its action and long time able to function in conditions increased concentration bilirubin. It all depends on the severity of this increase, which is called hyperbilirubinemia.

With regard to specific figures for the increase in blood bilirubin, the following degrees and patterns can be noted:

1. Slight excess of the standard indicator. This type of hyperbilirubinemia can include an increase in the level of total bilirubin to 50-70 µmol/l. It does not pose an immediate threat to life, since it does not cause severe intoxication and toxic damage internal organs. A person can live with such bilirubin for a long time, but it is necessary to determine the causes of this condition;
2. Marked increase in bilirubin in the blood. These figures include its concentration up to 150-170 µmol/l. Such conditions are dangerous, but not critical. The prolonged existence of such hyperbilirubinemia causes severe intoxication, which must be eliminated in the near future;
3. Severe hyperbilirubinemia. It is said to occur when the bilirubin level rises to 300 µmol/l. With such figures for this indicator, there is an immediate threat to the patient’s life due to severe intoxication and disruption of the functioning of internal organs;
4. Extremely severe hyperbilirubinemia. Bilirubin numbers that exceed 300 µmol/l are not compatible with life. If the cause of such an increase is not eliminated within a few days, this will lead to the death of the patient.

Important to remember! The main indicator of bilirubin metabolism in the body is total bilirubin. The degree of its increase determines the danger to human life and health. Indicators of direct and indirect bilirubin allow us to roughly determine the cause of deviations from the norm!

Yellowness of the sclera and skin is the main symptom of increased bilirubin

Not only analysis helps to identify the problem

Any pathological changes in the body are reflected in the form of certain symptoms. This rule is also relevant for hyperbilirubinemia, which manifests itself:

• Yellowness of the skin and sclera of the eyes. It occurs when the bilirubin level is more than 50 µmol/l. Its nature and intensity depend on the cause of the pathology and the degree of increase in the content of the substance;
• Itchy skin;
• Bitterness in the mouth;
• Darkening of urine;
• White color of stool;
• General weakness;
• Impaired memory and intellectual abilities;
• Enlarged liver and heaviness in the right hypochondrium.

Why does this happen

Define probable cause, which increases bilirubin, is not always easy. But only by finding out why this happened can you decide how you can help the person. The main diseases that may be hidden behind hyperbilirubinemia are shown in the table.

Increased bilirubin in newborns is a physiological transient condition

How can you help?

You need to understand that an increase in bilirubin in the blood is not a separate pathological condition which requires specific treatment. Such a phenomenon should be considered only as a symptom of a number of diseases. The most important thing is to correctly identify exactly the one that caused the changes in the analysis results. Only treatment of the causative disease normalizes bilirubin. Therefore, in the presence of hyperbilirubinemia, it is unacceptable to try to help in other ways.

Many sources of information indicate that it can help reduce bilirubin special diet, herbs and other methods. But this is nothing more than absurd. There is only one condition in which minor hyperbilirubinemia should be corrected in this way: genetic defects in bilirubin metabolism enzymes in the liver. In all other cases, the person should be examined as early as possible. After all, help may require not only drug treatment, but also complex operation.

Correct assessment and early identification of the cause of increased bilirubin maximizes diagnostic value this indicator. This should only be done by a qualified specialist!

In daily practice, doctors often have to deal with conditions when, according to research results, increased bilirubin in the blood is recorded. How to correctly assess such a condition, why it arose and what needs to be done about it is described in general terms in this article.

Everyone should know this...

For the common man to understand, bilirubin is a pigmented chemical that is constantly produced in the body and must circulate through only one metabolic pathway. Its direction consists of several consecutive links in the chain of the bilirubin cycle. These include:

1. Bilirubin formation. Occurs in the spleen, where red blood cells that have completed their life cycle are destroyed. When hemoglobin breaks down, total bilirubin is formed. Through the splenic vein it rushes into the systemic bloodstream. The portal vein brings it to the liver, where neutralization occurs;
2. Conjugation. This process is based on its combination with glucuronic acid, which occurs in the liver. This is necessary in order to neutralize bilirubin in the blood, because it is very toxic to tissues;
3. Excretion. Conjugated (bound) bilirubin in the liver is less toxic to the body and therefore should be eliminated from the body as soon as possible. This happens by its release from the liver with bile into the duodenum. The main part is excreted in the feces in the form of stercobilin. The part that is absorbed in the small intestine is excreted by the kidneys in urine in the form of urobilin.

Normal bilirubin levels in biochemical analysis

A biochemical blood test allows you to assess the state of bilirubin metabolism in the body. The main indicators include:

• Indirect bilirubin. This indicator reflects the part of bilirubin that has not been neutralized in the liver;
• Direct bilirubin is a fraction that has been inactivated in liver cells by binding to glucuronic acid;
• Total bilirubin is the combination of direct and indirect bilirubin. This indicator is the most important guideline in assessing bilirubin metabolism and determines the feasibility of determining individual bilirubin fractions. If it is normal, then this is not necessary. If the norm is exceeded, there is a need for a detailed study of the fractions of this substance, which will help determine the cause of the increase in bilirubin in the blood.

Generally accepted standards for bilirubin metabolism are shown in the table.

What is the danger if the indicators exceed the norm?

Bilirubin, as an extremely toxic compound, causes intoxication of the body and disruption of the functioning of important organs. The tissues of the brain are considered the most sensitive in this regard. All other systems (heart, liver, kidneys) are more resistant to its action and are able to function for a long time under conditions of increased bilirubin concentration. It all depends on the severity of this increase, which is called hyperbilirubinemia.

With regard to specific figures for the increase in blood bilirubin, the following degrees and patterns can be noted:

1. Slight excess of the standard indicator. This type of hyperbilirubinemia can include an increase in the level of total bilirubin dommol/l. It does not pose an immediate threat to life, since it does not cause severe intoxication and toxic damage to internal organs. A person can live with such bilirubin for a long time, but it is necessary to determine the causes of this condition;
2. Marked increase in bilirubin in the blood. These figures include its concentration dommol/l. Such conditions are dangerous, but not critical. The prolonged existence of such hyperbilirubinemia causes severe intoxication, which must be eliminated in the near future;
3. Severe hyperbilirubinemia. It is said to occur when the bilirubin level rises to 300 µmol/l. With such figures for this indicator, there is an immediate threat to the patient’s life due to severe intoxication and disruption of the functioning of internal organs;
4. Extremely severe hyperbilirubinemia. Bilirubin numbers that exceed 300 µmol/l are not compatible with life. If the cause of such an increase is not eliminated within a few days, this will lead to the death of the patient.

Yellowness of the sclera and skin is the main symptom of increased bilirubin

Not only analysis helps to identify the problem

Any pathological changes in the body are reflected in the form of certain symptoms. This rule is also relevant for hyperbilirubinemia, which manifests itself:

• Yellowness of the skin and sclera of the eyes. It occurs when the bilirubin level is more than 50 µmol/l. Its nature and intensity depend on the cause of the pathology and the degree of increase in the content of the substance;
• Itchy skin;
• Bitterness in the mouth;
• Darkening of urine;
• White color of stool;
• General weakness;
• Impaired memory and intellectual abilities;
• Enlarged liver and heaviness in the right hypochondrium.

Why does this happen

Determining the likely cause of increased bilirubin is not always easy. But only by finding out why this happened can you decide how you can help the person. The main diseases that may be hidden behind hyperbilirubinemia are shown in the table.

• Infectious diseases (malaria);
• Hemolytic anemia;
• Splenomegaly and hypersplenism;
• Intoxication of external and internal origin;
• Hemolysis in newborns with Rh conflict;
• Incompatibility of transfused blood.

• The presence of stones inside the bile ducts and choledocholithiasis;
• Atresia of the biliary system;
• Myrisia syndrome;
• Gallbladder and duct cancer;
• Cholangitis;
• Caroli's disease;
• Chronic pancreatitis (indurative);
• Pancreatic cancer with tumor localization in the head.

• Viral and toxic hepatitis;
• Liver damage caused by infectious diseases of any localization and sepsis;
• Cirrhosis;
• Liver cancer and metastases of malignant tumors;
• Fatty hepatosis of alcoholic or other origin;
• Genetic damage to enzymes that metabolize bilirubin (Gilbert, Dabin-Jones, Rotor syndromes);
• Pylephlebitis;
• Budd-Chiari syndrome.

Increased bilirubin in newborns is a physiological transient condition

How can you help?

You need to understand that increased bilirubin in the blood is not a separate pathological condition that requires specific treatment. Such a phenomenon should be considered only as a symptom of a number of diseases. The most important thing is to correctly identify exactly the one that caused the changes in the analysis results. Only treatment of the causative disease normalizes bilirubin. Therefore, in the presence of hyperbilirubinemia, it is unacceptable to try to help in other ways.

Many sources of information indicate that a special diet, herbs and other methods can help reduce bilirubin. But this is nothing more than absurd. There is only one condition in which minor hyperbilirubinemia should be corrected in this way: genetic defects in bilirubin metabolism enzymes in the liver. In all other cases, the person should be examined as early as possible. After all, help may require not only drug treatment, but also complex surgery.

Correct assessment and early determination of the cause of increased bilirubin maximizes the diagnostic significance of this indicator. This should only be done by a qualified specialist!

The newborn has had elevated bilirubin for 7 days, he is in Krasnodar maternity hospital No. 5, it reaches 300, he cries at night, his mother is worried. Tell me how to help the baby, what are your recommendations.

Sorry for the late reply. Judging by the indicators, my recommendations, unfortunately, are no longer relevant.

I began to feel bad: in the evening I think stupidly, there is fog in my head, there is also fog in my eyes, there is no attentiveness, when talking to an interlocutor, I can’t concentrate, something has become wrong with my memory - I forget, in the evening some kind of sticky mucus appears in my mouth . Red droplets appeared on the body, and the legs were cold in the evening. I donated blood for a fee for bilirubin and cholesterol, but I don’t have an appointment with my doctor. Total bilirubin is 27.6, and direct bilirubin is 11.8. Total cholesterol - 2.83.

Uv. Galina, urgently take all tests for tumor markers, your venous system no longer holds blood, passing fractions through capillaries! Mucus is already a defect of the liver, if it doesn’t make you feel bitter and nauseous, then you may not have time. Don’t delay with tumor markers, they can still save you or at least extend your life for several years.

I was in the hospital and was discharged today. I went to see the doctor to get a discharge from the hospital. Sitting in line, I looked at the statement and noticed that my bilirubin was elevated - total - 28.8. I noticed before that I periodically have pain in my right side, a little closer to the ribs. Sometimes nausea occurs. In 2008, my total bilirubin was 48.8, but I didn’t feel such discomfort, but now I feel like something is bothering me.

Unfortunately, this is not the liver. This is already a heart and then either a transplant or how long you can last on the machine. I advise you to look for a clinic, the sooner, the better your chances.

Hello! Passed a biochemical blood test. Total bilirubin - 22.6; straight - 10.2; total protein- 75; creatinine - 70; ALT -36; AST - 41. I am 81 years old. Is treatment required? Thank you!

What kind of doctor are you? Not a comment, but complete nonsense.

Were you looking for a commentator or a doctor?

Yes, I agree, the comments are stupid.

Hello! I have yellow sclera and the body has been a long time since school, more than 10 years to be exact, I did a series of examinations - everything is clear, but bilirubin remains at 200 without changes. What forecasts can I expect, and is there any point in doing anything?

Hello, Natalya! How can you treat your health like that! Your bilirubin level is ten times higher, and you say, “Is it worth it..” This is your life, and its quality depends on you. Or you don’t care about yourself - forgive me for such a syllable. “Dig” the Internet and look for a way to somehow reduce the indicators. Cleanse your colon first. Drink immortelle, corn silk, rosehip decoction, review your diet, take care of your liver, finally. Caress her like a child, nurse her, and she will reciprocate your feelings. This is not nonsense, but the very truth. Until you love yourself, just as you love the world and your loved ones, nothing will change in improving your health. Best regards, Nadezhda.

Health to everyone, people! a week ago I passed the UBC and biochemistry tests. Liver tests are almost all elevated, especially total and direct bilirubin - two times the norm. in 1988, after an accident with an anti-tetanus injection, hepatitis B was introduced into the blood, she was sick for a long time and everything was very difficult. Then diets, etc. I haven’t taken any tests at all for a long time. But on the eve of this diagnosis, I was fasting for the second day. I read somewhere that an increase in bilirubin may be associated with this. Please answer. I don’t eat fatty, fried, salted or smoked foods; meat is only poultry without skin, including turkey (not geese or ducks). I feel good, there is no heaviness. Sometimes there are unpleasant sensations in the liver area, I associate them with stagnation of bile in the gallbladder, nothing more.

I forgot to thank you for a very detailed and competent article.

Hello! Tell me which doctor we should contact. My son is 17 years old; his blood test for total bilirubin is -113. Ultrasound of all organs abdominal cavity normal. The liver corresponds to age without any pathologies. Hemoglobin 150. What could it be?

I am 62 years old. I took a blood test. It showed total bilirubin 28*8, indirect 15.7, direct 13*1. What is this. It’s very bad and what should I do?

I took the test - total bilirubin 16, direct 6.0, indirect 10.0, alat 97, asat 86, what should I do?

I can’t sleep. I was discharged from the neurological department. They took me away with grade 2 DEP. After 5 days I was as healthy as a horse. And now it’s the same. In the extract I read that bilirubin was 42.7. I'm shocked. It doesn't hurt, doesn't hurt, doesn't bother me. I don't drink at all and I don't smoke. So what, my liver isn’t working?

My total bilirubin is 36, cholesterol is 5.19, dull ache in the right hypochondrium, in the morning nausea, dry mouth.

A boy was born, increased bilirubin, tell me what is needed or what should be done?

What if bilirubin is slightly elevated? What to do?

You most likely have hemorrhoids, urgently run to the pharmacy for candles, you may still have time. Slightly elevated bilirubin is serious.

My friend is a hockey player. Today we discovered a high level. bilirubin. This has something to do with sports (he was told that if he continues to play, he might not live even four years.)

Hello, please tell me, I donated blood and according to the results, total bilirubin is 20.7. Other liver tests are normal. Blood parameters are normal, is any additional examination required? I have problems with the flow of bile from my gallbladder.

Total bilirubin was increased (24.5), other indicators were normal.

Hello! My son is 15 years old. The yellowed sclera alerted me. According to the tests, total bilirubin was 66 µmol/l, also according to ultrasound right side liver is enlarged 2 times. What could it be? We live on the periphery in the Krasnoyarsk Territory. What are your recommendations to our further actions in establishing a diagnosis. Where is the best place to go? Best regards, Ekaterina

The doctor here apparently visits the site very often, and as I see it, he gives advisory opinions during the time.

My personal advice! - Google less about diseases, better go to specialists immediately! And don't waste your condition! Our life is in our hands!

Blood test for bilirubin. Why is high bilirubin level dangerous?

Blood test for bilirubin

Bilirubin is a substance that is formed in the human body during the disposal of destroyed or damaged red blood cells. It is initially formed from parts of hemoglobin in the cells of the spleen, after which it penetrates the liver and is converted into a water-soluble form. Bilirubin is excreted mainly in bile and in small amounts in urine. A blood test shows the total concentration of this substance, as well as its fractions. This study is very important, since with a critical increase in the level of this toxic component, severe lesions central nervous system.

Types of bilirubin

Bilirubin in the body is presented in the form of several fractions:

1. Indirect fraction, which is bile pigment. It is insoluble in water and can penetrate through cell membrane. The main thing connected with this toxic effect. This fraction of bilirubin is synthesized in the cells of the reticuloendothelial system through the enzymatic transformation of heme, which is formed during the breakdown of hemoglobin. Next, it binds to carrier proteins, most often albumin, and penetrates the liver.
2. The direct fraction (free) is formed in liver cells by combining with glucuronic acid. Thanks to this reaction, the pigment acquires water-soluble properties and, together with bile, enters the duodenum. IN gastrointestinal tract bilirubin undergoes further changes. A small part of it is reabsorbed into the blood, and then filtered in the kidneys and excreted in the urine. Basically, it ultimately turns into stercobilin, which is found in feces and provides its characteristic color.

Some patients do not quite understand what total bilirubin is in a blood test. This value is obtained by adding the concentration of the direct and indirect fractions.

Bilirubin norms

A standard biochemical blood test is performed on an empty stomach, a fluid sample is taken from a vein (usually in the crook of the elbow). To get reliable results, before donating blood you should, at least for knocking, refuse to take fatty foods and alcohol. The analysis result may also be influenced by:

• some drugs acting on the blood coagulation system (heparin, warfarin, aspirin);
• pregnancy;
• overeating or following a strict diet, in particular fasting;
• caffeinated drinks;
• choleretic herbs.

As a rule, a blood test for bilirubin is performed in the following situations:

• during medical examination;
• when symptoms of jaundice appear, including in newborns;
• for diagnosing liver function in hepatitis, cirrhosis, tumors;
• if available cholelithiasis or pancreatitis;
• with hemolytic disease;
• at various types toxic effects and poisoning;
• as a control of the effectiveness of therapy.

Three indicators are determined in blood plasma:

1. Total bilirubin, which is the total concentration of water-soluble and fat-soluble fractions. Its norm in an adult is 5.1-17 µmol/l.
2. The indirect fraction can range from 3.4-12 µmol/l. Its share is usually 70-75%.
3. The normal direct fraction is 1.7-5.1 µmol/l.

During pregnancy, a slight increase in the concentration of this substance can be considered normal. This is due to impaired blood flow through the portal vein as a result of increased intra-abdominal pressure and the effects of an enlarged uterus.

Bilirubin levels in newborns

The concentration of bilirubin in the plasma of newborns varies. This is due to the fact that after the start of breathing through the lungs, the composition of the child’s blood changes. In particular, fetal hemoglobin is replaced with normal hemoglobin. Therefore, massive destruction of this substance occurs and the formation large quantities heme, and, consequently, bilirubin. Normal indicators believe:

• in children in the first hours after birth – less than 60 µmol/l;
• on the third or fourth day - no more than 250 µmol/l (in premature babies this figure is 170 µmol/l);
• after a week – less than 170 µmol/l.

Subsequently, the concentration of this substance in the child’s blood gradually decreases to the level of an adult.

Under what conditions does bilirubin decrease?

Low bilirubin is detected quite rarely. This is most often observed in the presence of ischemic heart damage. However, this sign is not specific and is not used in diagnosing the disease. The same situation may occur while taking certain medications (phenobarbital, ascorbic acid, theophylline).

Another reason for such a change may be an erroneous determination of concentration. That is why in such cases it is advisable to perform a repeat study.

Why does the concentration of bilirubin increase?

The level of bilirubin in the blood can increase for three reasons:

• massive destruction of red blood cells (hemolysis);
• formation of an obstruction in the biliary tract;
• disruption of the formation of the water-soluble fraction in liver cells.

Active destruction of red blood cells can be observed when exposed to toxic agents, improper blood transfusion, and also as a result of hemolytic diseases. Since active excretion occurs toxic substances out of the body, the urine usually becomes dark in color.

Impaired hepatic metabolism of bilirubin is caused by damage to hepatocytes. This occurs with the following diseases:

• with hepatitis of viral or toxic etiology;
• with cirrhosis of the liver;
• as a result of certain types of congenital hereditary deficiency of a number of liver enzymes, for example, with Gilbert's syndrome;
• with tumor processes in this area;
• with a lack of vitamin B12.

An increase in direct bilirubin in the blood plasma is characteristic of gallbladder diseases. These include:

When the outflow of bile through the ducts is impaired, bilirubin in the feces decreases. The feces become a characteristic whitish color.

Why is high bilirubin dangerous?

An increase in the concentration of this pigment in the blood can lead to the development of toxic effects. Their appearance is associated with several mechanisms:

1. Penetrating into cells, it affects the respiratory cycle and leads to their death.
2. If the level of this hemoglobin breakdown product reaches a critical level, it can penetrate the blood-brain barrier into the nervous system. By affecting neurons, it leads to the development of toxic encephalopathy, and in severe cases, to coma.

Hyperbilirubinemia is usually accompanied by the following symptoms:

• staining of the skin and mucous membranes yellow various shades;
• unbearable skin itching;
• neurological disorders in the form of weakness, headache, irritability;
• dyspeptic symptoms;
• change in color of stool and urine.

In order to bring bilirubin levels back to normal, you should focus on treating the underlying disease.

In addition, the elimination of this toxic metabolite can be accelerated using forced diuresis or plasmapheresis.

Only by understanding what bilirubin is and which fractions of it change in specific diseases can this analysis be used to diagnose pathological conditions.

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Chubeiko Vera Olegovna - general practitioner, cardiologist, candidate of medical sciences. Ask a question

Blood pressure 140 over 100, pulse 90 or 100. What is this?

Intestines hurt. Not much. Around the navel. It's a dull pain for 3 days. When I fall asleep, it hurts.

Why is bilirubin in the blood increased, and what does it mean?

Bilirubin is a yellow-green pigment that is formed when hemoglobin breaks down. In the human body it is found in the blood and bile. The liver is directly responsible for the exchange and excess of bilirubin.

Typically, high bilirubin manifests itself in the form of diseases such as jaundice, hepatitis or blood anemia.

Based on this, we can say that there are many reasons for increased bilirubin in the blood in adults, so you need to initially determine why this happened and what was the impetus for the increase in bilirubin.

What is bilirubin and where does it come from?

Why is an adult diagnosed with elevated bilirubin, and what does this mean? Hemoglobin is found in erythrocytes - human red blood cells; it carries oxygen to the body tissues from the lungs. Damaged and old red blood cells are destroyed in the spleen, liver and bone marrow. This releases hemoglobin and turns it into bilirubin.

Newly formed bilirubin is indirect and toxic to the human body, especially to the central nervous system. Therefore, in the liver it is neutralized by other substances. Bound - direct bilirubin is secreted along with bile by the liver and leaves the body naturally. Dark color stool often indicates changes in bilirubin levels.

Classification

The metabolism of bilirubin is complex chemical process, which constantly occurs in our body, when it is disrupted at any stage, a change in the level of this substance in the blood serum appears. Therefore, bilirubin is an important indicator of the functioning of several body systems at once.

Depending on the type, direct and indirect bilirubin are distinguished.

• Indirect - the one that is formed as a result of the breakdown of hemoglobin. It is only soluble in fats and is therefore considered highly toxic. It is able to easily penetrate cells, thereby disrupting their functions.
• Direct - the one that is formed in the liver. It is water soluble and therefore considered less toxic. Direct bilirubin is excreted from the body along with bile.

Direct bilirubin is safe for the body, since it has been previously neutralized by liver enzymes. This substance leaves the body easily and does not cause much harm. Bilirubin indirect type is highly toxic, it was newly formed from hemoglobin and is not bound by liver enzymes.

Normal bilirubin level in blood

For an adult up to 60 years of age normal result bilirubin test will be:

• 5.1-17 mmol/l – total bilirubin;
• 3.4-12 mmol/l – indirect;
• 1.7-5.1 mmol/l – straight.

Tables of normal levels of bilirubin in the blood for both sexes are almost the same. However, scientists have proven that Gilbert's syndrome is 10 times more common in men than in women.

Increased bilirubin in a newborn

Total bilirubin is increased - what does this mean in an adult?

For what reasons does the amount of total bilirubin in the blood increase in adults, and what does this mean? What factors contribute to this?

Depending on which process is disrupted, an increase in one of the bilirubin fractions may be observed in the blood. If an increase in total bilirubin with a uniform distribution of fractions is detected, then this is most characteristic of liver diseases.

Causes of elevated direct bilirubin

The level of direct bilirubin in the blood increases due to a violation of the outflow of bile. As a result, bile is directed into the blood rather than into the stomach. The reasons for this most often are the following pathologies:

• hepatitis of viral etiology in acute form(hepatitis A, B, infectious mononucleosis);
• hepatitis of bacterial etiology (leptospirosis, brucellosis);
• chronic hepatitis;
• autoimmune hepatitis;
• drug-induced hepatitis(as a result of therapy hormonal drugs, nonsteroidal anti-inflammatory drugs, antitumor and antituberculosis drugs);
• toxic hepatitis (poisoning with mushroom poisons, industrial toxic substances);
• cancer of the gallbladder, liver or pancreas;
• cholelithiasis;
• biliary cirrhosis;
• Rotor and Dubin-Johnson syndromes.

Predominant increase in direct bilirubin levels. The basis is a violation of the outflow of bile.

Causes of increased indirect bilirubin

Diseases in which indirect bilirubin increases:

1. Gilbert, Crigler-Najjar, Lucy-Driscoll syndromes.
2. Infectious diseases - typhoid fever, sepsis, malaria.
3. Congenital hemolytic anemia- spherocytic, non-spherocytic, sickle cell, thallasemia, Marchiafava-Michele disease.
4. Toxic hemolytic anemia - poisoning with poisons, insect bites, snake bites, mushroom poisoning, lead, arsenic, copper salts (copper sulfate). Drug-induced hemolytic anemia - provoked by taking cephalosporins, insulin, aspirin, NSAIDs, chloramphenicol, penicillin, levofloxacin, etc.
5. Acquired autoimmune hemolytic anemias - develop against the background of systemic lupus erythematosus (symptoms, treatment), rheumatoid arthritis, lymphocytic leukemia, lymphagranulomatosis (symptoms, treatment), etc.

Predominant increase in indirect bilirubin levels. It is based on excessive destruction of red blood cells.

Liver problems

The liver has the most important in the processes of bilirubin production. With pathologies of this organ, the normal process of neutralizing free bilirubin and its transition to a direct state becomes impossible. Among the liver diseases in which bilirurin metabolism is disrupted are cirrhosis, hepatitis A, B, C, B and E, alcoholic and drug-induced hepatitis, and liver cancer.

The level of both types of bilirubin increases, which is manifested by the following symptoms:

• discomfort and heaviness in the right side due to liver enlargement;
• faded color of feces and dark color of urine;
• lightheadedness, belching after eating, especially severe discomfort from fatty and heavy foods;
• loss of strength, dizziness, apathy;
• increase in body temperature (with viral hepatitis).

May identify other causes of increased bilirubin levels. These include a hereditary deficiency of liver enzymes, this pathology is called Gilbert's syndrome. In patients, the level of bilirubin in the blood is significantly increased, so the skin and eye sclera often have a yellow tint.

Impaired flow of bile

With diseases of the biliary system, for example, cholelithiasis, the patient usually exhibits the following symptoms:

• yellowness of the skin and sclera;
• pain in the right hypochondrium (with hepatic colic very intense);
• bloating, bowel dysfunction (diarrhea or constipation);
• discoloration of feces and darkening of urine;
• skin itching.

Unlike diseases of the blood and liver, in this situation the amount of direct (bound) bilirubin, which has already been neutralized by the liver, increases.

Prehepatic causes

The development of suprahepatic jaundice is caused by increased destruction of red blood cells. In this case, mainly the free fraction increases. Among the diseases are:

• hemolytic and B12-deficiency anemia;
• extensive hematomas;
• effects of toxic substances on blood cells;
• reaction to foreign blood transfusion or organ transplantation;
• thalassemia.

Symptoms

If the metabolism of bilirubin is disturbed, its quantitative indicators in the bloodstream can become large. This is expressed by jaundice, or discoloration of the mucous membranes and skin in a yellow color.

1. If the concentration of bile pigment in the blood serum reaches 85 µmol/l, then they speak of a mild form of increase.
2. Jaundice with values ​​of µmol/l is considered moderately severe, and jaundice with values ​​above 170 µmol/l is considered severe.

Depending on the type of jaundice, its manifestations vary. The skin may take on a bright yellow, green or saffron yellow hue. In addition, with increased bilirubin, darkening of the urine (it becomes the color of dark beer) and severe itching of the skin are noted.

Other signs may include:

• bitterness in the mouth;
• darkening of urine;
• white color of stool;
• general weakness;
• memory and intellectual impairment;
• liver enlargement and heaviness in the right hypochondrium.

Gilbert's syndrome

How to treat increased bilirubin in the blood

Bilirubin can be reduced only after the cause of its increase has been established. This means that you will have to get tested for viral hepatitis, liver tests (determining the activity of ast alt, alkaline phosphatase, etc.), undergo an ultrasound of the liver and more specific studies.

At the same time, treatment in adults is mainly etiotropic, that is, it affects leading disease. For example, if the patency of the biliary tract is obstructed, it is necessary to remove stones or tumors; in some cases, duct stenting is effective.

If bilirubin is very elevated due to severe hemolysis of red blood cells, it is indicated infusion therapy with the introduction of glucose, albumin, as well as plasmapheresis. Phototherapy is very effective for neonatal jaundice. ultraviolet irradiation skin promotes the conversion of free toxic bilirubin into bound bilirubin, which is easily removed from the body.

Why is bilirubin increased in urine, what does this mean?

4 comments

I was transferred from the maternity hospital to the Children's Clinical Hospital. There they measured Belerubin -267. We spent a month in the hospital. It went down, then up. They lay under a blue light lamp, gave ursofalk, did not let me go home, checked belerubin once a week.

Lots of tests. I suffered terribly. I don’t know how the milk didn’t disappear due to stress. While the child is under the lamp, I make sure that he doesn’t open his eyes or take off the blindfold, because you can’t look at the bright light of the lamp. Then I pumped, because... The baby lost 10% of her birth weight. And I supplemented with bottle feeding. She at least sucked the bottle better; during the first month she got tired of sucking the breast and fell asleep on the breast immediately. But she hasn’t weaned off the breast, the right person still doesn’t breastfeed properly, and swallows air. Be healthy and patient to the whole family!

pregnant women 26 weeks urgently gave birth with the help of medicine he has 300 µmol/l bilirubin still does not decrease then 250 toto 311 plays analysis already 21 days wife has been in intensive care the child is also in children's intensive care in a vacuum 29 weeks weight 740 g height 32 cm how long should they lie and treatment?

I gave birth at 30 weeks. I also had high bilirubin. The boy was 1 kg 900 g. Height 47 cm. He lay under the dome for 1 month. The child had pneumonia due to early birth. They treated me with three antibiotics and burned off the hemoglabin. I was discharged 10 days after giving birth, I came and brought diapers and waited. I pumped milk at home. Then a month later, when he got stronger and was able to breathe on his own and maintain his body temperature, I was admitted to him. We gained weight for 2 weeks, I breastfed him and supplemented him with formula. Now the boy is 4 years old. Everything is normal, only there is a slight lag in the maturity of the cerebral cortex, this is manifested in the fact that later than his peers he began to dress himself and eat. In your case, it is necessary pay attention to vision, hearing and nervous system due to low weight Potologies are possible. Be sure to save the milk. What you did not add in the womb you will add with milk. Good luck to you.

Gilbert's syndrome in the military educational institutions It’s forbidden to study, but you can serve in the army WHAT IS THIS RIDICULOUS AND BULLSHIT IF YOU CAN’T STUDY, IT MEANS YOU’RE NOT ELIGIBLE FOR SERVICE THERE ARE NO EMERGENCIES IN THE SERVICE ANYWHERE I SERVED FOR 27 YEARS AND I’M CONVINCED OF THIS FOR THE DIAGNOSIS SOMEONE SIGNS THESELF A VERDICT N

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