Elevated direct and indirect bilirubin: what does it mean?

Bilirubin and its fractions (varieties) included in the biochemical analysis of blood. The increased rate may reflect the presence of hemolysis (massive destruction of red blood cells), pathology of the liver and biliary tract, as well as indirectly indicate poor condition of the duodenum or pancreas.

The metabolism of bile pigments

Where in the body there is a connection? When the lifespan of the erythrocyte, it must be destroyed, and the hemoglobin from it is disposed of. Hemoglobin is a complex protein consisting of iron atom (heme) and a protein part (globin). Under the action of several enzymes, it undergoes a complex transformation in the cells of the spleen – cleaved first, the iron atom so that it can be re-used for the needs of the body, and then the globin is changed to biliverdin and bilirubin. This bilirubin is called free, unbound or indirect (as it gives indirect reaction with the Ehrlich reagent).

Indirect bilirubin does not dissolve in water, so cannot be filtered by the kidneys and removed from the body with urine. It penetrates well through blood-brain barrier (a special membrane that separates the blood vessels from the nervous tissue) and toxic for the brain. When you increase its level up to 300 mmol/l and above there is a failure of special structures – nuclear jaundice. Blood indirect bilirubin binds to special proteins-albumin, which reduces its toxicity.

Circulating in the blood the complex with albumin is captured by liver cells – hepatocytes. With their help, the bilirubin molecule is separated and bound with glucuronic acid into bilirubinuria. This bilirubin is called associated, or direct. This form is transported to the bile and in its composition enters into the duodenum. The connection part is displayed in the oxidized form of a stool, and the part absorbed through the intestinal wall and re-appears in the blood. Direct bilirubin is not toxic, is highly soluble in water, therefore, in somewhat modified form (urobilin, urobilinogen) is excreted in the urine.

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Causes of problems

In the blood serum of healthy person has both direct and indirect bilirubin. Their sum should be 8 – of 20.5 µmol/l and direct bilirubin is 25%, and indirect – 75%. As a result of certain diseases in the body can disrupt the formation, transformation and excretion of this bile pigment. Exceeding its permissible level in blood and thus in tissues, it causes staining in jaundiced color. There are three kinds of jaundice:

  • Hemolytic (suprarenal) caused by massive red blood cell destruction and release large amounts of hemoglobin. In the blood is excess indirect bilirubin because the liver does not have time to use it. While not elevated direct bilirubin.
  • Liver due to inflammatory damage of hepatocytes – hepatitis. Повышен прямой и непрямой билирубин: что это значит?Most often this condition is caused by a virus, but it is also possible bacterial lesions (Treponema pallidum), parasitic disease (Echinococcus, Giardia), toxic hepatitis (heavy metals, drugs). Cells due to inflammation is not able to dispose of indirect bilirubin with the necessary speed, so its level in blood increases. Hepatocytes increase in size and can’t give a direct bilirubin in the bile passages, in this case, it undergoes reverse absorption into the bloodstream, which causes an increase in direct bilirubin.
  • Mechanical (obstructive) jaundice caused by bile duct overlapping an obstacle (stone, tumor, etc.). The pressure of bile in the confined space of the bile ducts increases, and the engine runs reverse suction direct bilirubin of bile into the blood stream. Indirect bilirubin is also above the standard figures, because the hepatocytes cannot in these circumstances continue to effectively bind free bilirubin.
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    Increasing the level of direct and indirect bilirubin – what does this mean?

    It is obvious that only one biochemical blood analysis it is impossible to establish an accurate diagnosis. If the tests detected the increasing need expert advice:

    • therapist;
    • infectious diseases;
    • the gastroenterologist.

    In large cities presents more narrow specialists – Hepatology. The doctor will examine and prescribe the necessary examinations to clarify the diagnosis. Among them may be:

    • General analysis of blood;
    • urinalysis;
    • a detailed biochemical analysis of blood;
    • General analysis of feces;
    • a blood test for viral hepatitis;
    • analysis of antibodies to Echinococcus and lambley;
    • Ultrasound examination of abdominal cavity;
    • Fegds (fibroesophagogastroduodenoscopy).

    The same specialists you should contact, if there is yellowness of the skin, eyes or mucous membranes (e.g., gums and inside of cheeks). Be sure to inform the doctor if you noted the color change of physiological functions: in many diseases of the liver and biliary tract observed a darkening of the urine («dark beer») and discoloration of the feces.

    Remember what medications you took, how long and in what dosage. Note the presence of bruises and bruises on the skin, recurrent abdominal pain, sleeping problems. All this will help the doctor make the most accurate diagnosis and choose proper treatment. The increase in direct and indirect bilirubin – not the final diagnosis. This condition, which requires detailed examination. The cause may be liver disease, cholelithiasis, cancer problems in the abdomen or other factors.