Total bilirubin: normal
One of the components of the biochemical blood test is bilirubin – product of pigment metabolism. Quantitative indicators of bilirubin are markers of certain diseases of the blood, help to identify malfunctions of the liver, spleen and biliary tract. At a high level of bilirubin observed yellowness of the skin and the eye sclera.
What is the bilirubin?
Bilirubin – a yellow pigment-red colour, a substance, formed from the haemoglobin of outdated blood cells – erythrocytes. The destruction of red blood cells occurs in the cells of the spleen, liver and bone marrow. While the released hemoglobin is a chain of chemical reaction, forming new substance – bilirubin. So the formation of indirect bilirubin, which is toxic to the body. In this form it enters the bloodstream and in the liver is associated with other substances, obezvrezivate in the process. Neutralized, «associated» is the direct bilirubin, which is secreted by the liver as a component of bile, participating in digestion and imparts a dark color feces. Together with fecal matter (mostly) and urine (a small amount) be processed bilirubin is excreted from the body.
Bilirubin in serum
In the liquid part of the blood bilirubin is the following (fractions):
- indirect bilirubin is insoluble in water; the organism is able to penetrate through the wall of the cell membrane, therefore, is non-toxic;
- direct (free) bilirubin is soluble in water; the body is formed in the liver, becoming toxic, the bile enters the duodenum and participates in the digestive process and is partially absorbed into the bloodstream.
Total bilirubin is the entire amount of bilirubin in the plasma portion of blood (the sum of direct and indirect).
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Rules of bilirubin in the blood
Quantification of fractions is very important in the diagnosis of diseases of the liver, blood, blood-forming organs, the bile ducts. In the adult human norm of total bilirubin is in the range from 5.1 micromole/liter (µmol/l) to 17.1 µmol/l. While the factions rules are:
- straight – a minimum of 1.7 µmol/l, with a maximum of 5.1 mmol/l;
- at the indirect minimum of 3.4 mmol/l, a maximum of 12 µmol/L.
The amount of direct bilirubin should be between 70 to 75% of total.
During pregnancy in the absence of concomitant somatic diseases in women should be bilirubin normal, typical adult. Valid slight excess of its concentration, caused by impaired blood flow in the portal vein. This can occur due to the compression of the veins by the growing uterus or due to an increase in intra-abdominal pressure. In some cases in the third trimester of pregnancy may increase bilirubin levels due to violations of the outflow of bile (cholestasis of pregnancy). However, any increase in normal values is the reason for detailed examination. Perhaps the woman has one of the pathologies:
- blood disease (hemolytic anemia);
- liver damage (viral hepatitis);
- inflammation of the bile ducts and gall bladder (cholangitis, cholecystitis).
In children, the normal levels of total bilirubin depends on the age. For the neonatal period is characterized by a very high level. This is due to the massive destruction of fetal hemoglobin to replace it with a normal. A large amount of bilirubin, along with the substance of hemoglobin – heme. Gradually, the level of indicators is reduced and compared to older standards. Norms in children:
- the first hours after birth – up to 60 µmol/l;
- newborns to 3 – 4 days – up to 256 µmol/l for full-term, to 171 mmol/l premature;
- until the second week of life – a maximum of 25 µmol/l:
- from the third to the fourth week, to a maximum of 20;
- 1 and 2 months – maximum of 18.5;
- up to 5 months a maximum of 18.4;
- from six months to a year – high of 18.1;
- up to two children – a maximum of 18;
- three to five years, to a maximum of 17,9;
- 6 to 8 years – a maximum of 17.8;
- 9 to 10 years, to a maximum of 17,6;
- from 11 to 14 years – a maximum of 17.5;
- from 15 to 18 years – maximum of 17.2.
To determine the level of bilirubin in the blood of newborn children is used bilitest – portable non-invasive photometric device. The measurement is made by applying bilitest head against the baby’s skin in the forehead above the nose or on the skin of the sternum in its upper part.
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The indicator «reads» the device by determining the severity of the yellowness of the subcutaneous tissue caused by the presence of large amounts of hemoglobin. Monitoring of bilirubin in newborns should be because of the risk of development of pathologic jaundice, which requires urgent measures.
What pathology leads to a decrease of bilirubin level?
The reduced concentration of rare, however, such indicators often show that there are significant changes in the body. Causes of low bilirubin might be:
- chronic renal failure (CRF);
- acute leukemia;
- aplastic anemia;
- coronary heart disease (CHD) in patients older than 60 years;
- taking some medicines (ascorbic acid, Phenobarbital, Theophylline).
When the concentration of bilirubin is increased?
Cause is one of the States:
- hemolysis caused by massive destruction of red blood cells;
- failures of process of formation of direct bilirubin by the liver cells;
- violation of the outflow of bile.
These reasons may be caused by the following situations and pathological conditions:
- condition after transfusion of incompatible blood and blood components;
- hemolytic anemia;
- the presence of viral and toxic hepatitis;
- cirrhosis of the liver;
- neoplastic diseases of the liver;
- the presence of parasites, stones or tumors of the bile ducts and gallbladder;
- a lack of vitamin B12;
- hereditary deficiency of the hepatic enzyme glucuronyltransferase;
- neoplastic processes in the pancreas.
Based on the reasons that caused the increase of bilirubin, your doctor will determine which treatment method is most appropriate and effective.