Modern analyzes make it possible to determine whether certain organs and systems are working correctly, as well as to identify pathologies at an early stage of development. When diagnosing, the level of bilirubin in the blood can be studied. Deviation of this indicator from the norm indicates the development of various pathologies. When it can be considered that bilirubin is elevated, as well as what are the causes of this phenomenon and what are its consequences - all this will be considered below.
What is bilirubin?
Sometimes at a reception at the therapist you can hear the phrase: "Total bilirubin is increased." What does it mean? Bilirubin is called a pigment of red-orange color with a yellowish tinge. It is formed during the breakdown of red blood cells. This is a normal process that is constantly observed during metabolic processes of the body. Bilirubin is excreted in the bile, and then excreted in the urine or feces from the body.
Initially, bilirubin has the form of an indirect (indirect) type. It circulates in the body. In this case, the bile pigment does not dissolve in water. It is a toxic substance that can harm the body.
To remove a dangerous substance from the body, blood albumin reacts with it. It delivers indirect bilirubin to the liver. In this organ, bile pigment takes on a soluble form. It is called direct bilirubin. In the form associated with albumin, the indirect form of the substance does not penetrate the cells and does not pass through the filtration section located in the kidneys.
All bilirubin (direct and indirect) is called common. If the level of one of the types of pigment rises, this indicates a failure at one of the stages of metabolism. Direct bilirubin is not toxic.
Elevated bilirubin in the blood is a deviation from the norm. He can talk about the development of serious diseases.
Diagnostic Features
During a laboratory examination, it may be established that bilirubin is increased in the blood. What does it mean? Laboratory diagnosis is an effective method for detecting abnormalities in the work of the liver, gall bladder and other organs. Similar analyzes are carried out in a complex.
In addition to blood tests for bilirubin, a different diagnosis is made. Your doctor may order blood tests for AST and ALT, as well as alkaline phosphatase. This allows you to identify problems in the liver.
A similar diagnosis is indicated for a number of diseases. First of all, jaundice belongs to them. Also, if the patient is abusing alcohol or has a serious dependence on him, the doctor prescribes such an examination. If you suspect taking psychotropic drugs, the amount of bilirubin in the blood is also examined. If you suspect that a person has been infected with viruses that cause hepatitis, this analysis also needs to be done.
If insufficient red blood cells are found in the blood, anemia will be diagnosed. In this case, bilirubin levels are also examined. This allows us to draw conclusions about the presence of hemolytic anemia. In this case, additional analyzes are also carried out. These include a general blood count, haptoglobin analysis, reticulocytes, LDH.
There are a number of third-party factors that explain why bilirubin is elevated. What the results of the examination mean, the doctor will be able to establish. An incorrect result can be obtained when a patient consumes coffee or other drinks that contain caffeine. They can affect the amount of bilirubin in the blood. Also, prolonged fasting, abstinence from food can lead to an increase in indirect bilirubin. In this case, you will need to re-diagnose.
The norm in adults and children
There are certain standards. If you go beyond this, it can be argued that bilirubin is elevated. What does it mean? During the analysis, the amount of both direct and indirect bilirubin is studied. The indicator is correlated with the age of the patient.
So, for children under three days of life, this figure is 24-190 μmol / L. In this case, direct bilirubin should be from 0.5 to 10.2 μmol / L, and indirect - 23.5-17.8 μmol / L. Three days after birth, babies normally have a common indicator of this pigment from 28 to 210 μmol / L.
After the first month, bilirubin in the baby's blood decreases. Now it should be 3.5-20.4 micromol / l. At the same time, they also make a decryption. Direct bilirubin in the blood should be 0.5-1 μmol / L, and indirect - up to 16.5 μmol / L.
In an adult, total bilirubin should be 8-20.5 μmol / L. It is this pigment that paints urine and feces. If their color changes, becomes saturated yellow, you need to undergo an examination.
It does not matter what gender the patient is. The values shown are the same for women and men.
Causes
If bilirubin is elevated, what do such analysis results mean? Such an indicator can talk about many pathologies. If such a situation is observed in an adult, this is a sign of abnormal breakdown of red blood cells. This, for example, may be a reaction to the intravenous administration of whole blood of a healthy person during a period of illness or other critical condition of the patient.
Bilirubin also increases with liver scarring. Its structure is expanding and rebuilding. Its cells are replaced by connective tissue. This situation is observed with fibrosis, cirrhosis of the liver.
Inflammatory processes also affect the amount of hemoglobin in the blood. This happens in the presence of hepatitis type A, B, C. Also, a similar situation is possible if pathogenic viruses or bacteria enter the body.
Another reason why adult total bilirubin is elevated is bile duct dysfunction. When gallstones appear, the ducts become clogged. As a result, bilirubin begins to be excreted from the body in a slightly different way, it accumulates. This situation also occurs with the appearance of malignant tumors in the tissues of the pancreas.
Hemolytic jaundice
If bilirubin is elevated in an adult, some diseases explain this condition. One of the common pathologies is hemolytic jaundice. It is worth considering that red blood cells live about 4 months. Then they are destroyed and excreted from the body. If, for some reason, red blood cells begin to rapidly and massively collapse, the liver does not have time to transform and remove them from the body. In this case, suprahepatic jaundice occurs.
In this case, when conducting analyzes, it will be established that the total bilirubin will be slightly increased or even normal. In this case, indirect bilirubin will be increased, and direct - normal.
This condition occurs for certain reasons. Hepatic jaundice is caused by hemolytic anemia, sepsis, malaria, Addison-Birmer disease, rheumatic conditions. Severe poisoning, including helminth waste products, can also lead to a similar phenomenon. In newborns, a hemolytic disease provokes a similar situation.
There are several more factors why bilirubin is elevated in the blood. The reasons for the appearance of this condition can be explained by the use of certain drugs. This situation is caused by many antibiotics, aspirin, insulin and other drugs.
Symptoms of this ailment can be chills and fever, the rapid development of the disease. In this case, the skin turns yellow. Signs of anemia appear. These include pallor, a decrease in hemoglobin, weakness. Upon examination, the doctor may pay attention that the spleen is enlarged. In this case, the liver either remains the same size, or slightly enlarged.
Hepatic cell (parenchymal) jaundice
There is another disease that can affect the amount of bilirubin in the blood. This is hepatocellular jaundice. The metabolism of bilirubin in this case is disrupted at the stage of conversion from an unbound to a bound state. In this case, we can say that the liver cells are damaged.
In this case, indirect bilirubin will remain normal. However, his diseased liver cannot be converted to a bound form. In this case, direct bilirubin levels may also increase. This is due to disturbances in the formation and outflow of bile through the internal channels of the liver. Analysis will also show that total bilirubin is elevated.
The cause of the development of such a disease is all types of hepatitis, cancer, as well as cirrhosis. Ictohemorrhagic leptospirosis leads to this condition. Also, the cause may be poisoning with special types of poisons, sepsis, Dabin-Johnson, Rotor, Gilbert, Lucy-Driscoll, and Krigler-Nayyar syndromes.
Also, certain drugs cause a similar situation. It can be birth control pills with estradiol, Morphine, Paracetamol, Rifadin. Often entails the appearance of hepatocellular jaundice excessive drinking.
Symptom of this condition is the gradual development of the disease. The patient begins to feel periodic nausea, loss of appetite. The color of his skin turns yellow. Over time, the shade may even become greenish. Feces become either completely or partially discolored.
Mild skin itching may also appear. The urine is getting dark. Fever, pain in the right side, and vomiting may occur. In this case, the liver is always enlarged. The spleen may have a normal size.
Obstructive jaundice
The cause of increased bilirubin in the blood can be mechanical (subhepatic) jaundice. In children, this ailment is extremely rare. It usually develops in adulthood or old age. In this case, unbound bilirubin is detected in normal amounts. It is transformed in the liver into a bound substance. However, it is not excreted in the right amount due to problems with the biliary tract.
A blood test in this case shows that the total bilirubin will be increased. At the same time, its indirect type will be normal. The amount of direct bilirubin increases. There are several reasons for the appearance of such a disease. It can cause stones or narrowing of the bile ducts. Also, swelling or cyst of the pancreas can lead to similar consequences.
Acute or chronic pancreatitis, portal biliopathy, Mirizi syndrome, as well as cancer of the stomach, bile ducts, pancreas, and liver also provoke obstructive jaundice.
In infants, this condition can be explained by a rare congenital disease. In this case, the bile ducts are either poorly developed or absent altogether. This situation requires surgical intervention.
If the cause of the disease is a tumor, the deterioration occurs rather slowly. In other cases, the disease develops rapidly. The skin takes on a yellow-green hue. The feces become discolored, and the urine darkens. The skin is very itchy, nausea and vomiting appear. In the right side, severe pain occurs. The gallbladder may be enlarged. In this case, the liver and spleen are usually not enlarged.
Jaundice in newborns
Elevated bilirubin may also be observed in the blood of a newborn. In this case, physiological jaundice is diagnosed. This is one of the most common causes of increased bilirubin in newborns.
A young child who is not yet a week old has a significantly higher hemoglobin level than an adult. With the breakdown of red blood cells, liver enzymes are not yet able to cope qualitatively with a high amount of bilirubin. In this case, the baby's skin may turn yellow. It is normal if this situation continues for 2-3 weeks after the birth of the baby. This process is called physiological jaundice of the newborn.
According to various sources, a similar situation is observed in 25-50% of newborns.
Moreover, the skin turns yellow, starting with the head. The lower this shade descends, the more bilirubin is determined in the baby's blood.
It is also worth noting that physiological jaundice appears more often in children who are breast-fed. Mother's milk somewhat dulls the production of enzymes in the baby’s liver. Because of this, characteristic signs of an increase in bilirubin appear.
This situation requires examination. If various diseases that can cause such a phenomenon are excluded, the yellowness of the skin of the baby should not cause concern in the first months after childbirth. Moreover, in dynamics, the level of bilirubin should decrease.
Nuclear jaundice
Often in newborns, bilirubin is elevated. This is quite normal, but requires medical supervision. In some cases, bilirubin levels become critically high. In this case, nuclear jaundice is diagnosed . This is a severe form of the disease, which is not the norm and is dangerous to the baby's health.
In this case, the amount of unbound bilirubin increases in the blood of the newborn. It extremely negatively affects the central nervous system of the baby. Brain cells begin to break down. If the baby was born full-term, the critical threshold for bilirubin in the blood is 324 μmol / L. If the baby is premature, this indicator drops to 150-200 μmol / L.
Factors for the development of nuclear jaundice
If bilirubin is elevated in a newborn strongly, there are a number of pathologies that provoke this condition. The development of nuclear jaundice contributes to the hemolytic disease of the newborn, as well as their prematurity. Pathological hemolysis, hemolytic anemia, Hirschsprung's disease, pyloric stenosis can lead to a similar pathology. There is also a serious risk of hemorrhage, endocrine disorders, fermentopathy, intrauterine infections or sepsis.
If it is established that bilirubin is elevated, you should consult an experienced doctor. He will conduct a comprehensive diagnosis, establish the cause of this condition. After that, it will be possible to begin the correct treatment.