What is bilirubin in the blood? Reasons for the increase

What is bilirubin? This is the question that patients are asked when they find a high indicator of this substance in a blood test. The answer to this question is simple. It is known that bilirubin is a bile pigment that appears during the breakdown of substances such as hemoglobin, myoglobin and cytochrome.

To find out the causes of hyperbilirubinemia, you need to see a doctor and perform diagnostics using modern methods of researching the body, and also follow the treatment prescribed by your doctor.

The process of bilirubin formation and its effect on the body

After taking a biochemical blood test, the doctor can tell the patient that he has increased bilirubin. What does it mean? This is a pigment of bile. If its rate is high, then the substance can have a toxic effect on every nerve cell. In addition, this is also the main factor in the development of encephalopathy, nuclear jaundice.

The process of conjugation, that is, the chemical binding of pigments (free type), occurs in the tissues of the liver. The breakdown of red blood cells, which manifests itself in the spleen, is able to ensure the release of a large amount of pigment through the veins with a blood stream passing into the liver itself. Biochemical “binding”, a change in bilirubin in the liver cells, explains the decrease in the harmful effects on each organ and tissues.

Different types of bilirubin

Continuing the topic of what bilirubin is, it should be noted that it is found in different types of bile fractions:

• direct bilirubin;
• indirect bile pigment.

In blood tests, it may be indicated that total bilirubin is elevated. What this means can be understood as follows: during a biochemical study of blood elements, the volume of bile pigment is calculated as a whole for two fractions (total). And with a large volume or presence of evidence, a study should be assigned to the indicators of all fractions (indirect and direct) separately from each other.

Indirect bilirubin is always produced: up to 300 milligrams of substance is released daily during decay. When passing through the bloodstream into the liver tissue of an indirect type, bilirubin begins to transform due to biochemical processes. They end with conjugation with acid and the appearance of bilirubin.

Indirect pigment is toxic to tissues and organs. With incomplete penetration into the cells, it begins to conjugate with fats - this leads to a possible disruption of the respiration of cells and metabolism. Protein begins to form, potassium ions are transported.

High concentration (indirect appearance) is considered especially dangerous for brain tissue. Because of this circumstance, bilirubin norms in different age categories of people should be considered.

Normal values ​​of bile pigment in infants

In newborns, bilirubin is important and needs to be controlled. It is clear that the highest levels of this pigment in the blood, which do not accompany any disease and dysfunction, can be seen in young children. This is due to the process of rapid decay of red blood cells in the blood of an infant.

So what is bilirubin? Continuing to answer this question, frequent signs in newborns should be noted. The yellowish tint of the skin and eyes in the first week after birth is a consequence of the temporarily elevated bilirubin content in the blood. It is known that its content varies depending on the age category.

The process of releasing a large amount of bile component begins to end when the child is exactly one month old. After this, the norm of bilirubin is reached, and it corresponds to the value of adults. Moreover, if this substance normalized, then this is not a reason to refuse further examination. It is worth identifying the cause.

Causes of Hyperbilirubinemia in Infants

The level of total bilirubin in newborns is very different from that in adults. This is due to excess fetal hemoglobin.

For full-term babies, normal bilirubin is a volume of 253 mmol / L, and for non-full-term babies, about 163-167 mmol / L.

Young children have disorders that occur in the production of such a substance. There is a high level of bile pigment in the presence of jaundice in newborns, various types of viral hepatitis.

Be sure to note the following reasons for the high content of bilirubin:

• liver pathology;
• metastasis of a tumor localized in another organ;
• the presence of a lack of vitamin B ₁₂ ;
• Dubin-Johnson syndrome - poor output of direct bilirubin into the bile duct;
• a syndrome arising from the absence or lack of development of a special substance - the process of combining acids: bilirubin and glucuronic acid is disrupted.

A high content of bile pigments is noted with Zhelber syndrome at different ages, but much more often in newborns.

Normal tests for different age categories

To find out in detail about the rate of bilirubin, you can consider the following table:

In some congenital diseases, the content of bile pigment in the blood may be higher compared to the norms of bilirubin indicated in the table.

The main causes of increased bile pigment in adults

A poor blood test, expressed by exceeding the norms of bilirubin of two fractions - not connected and direct, should alert the patient. The pathological threshold of hyperbilirubinemia is the volume of the blood component equal to 34 microns per liter of blood. With this concentration, jaundice begins to manifest itself.

High or low levels of bilirubin in the blood are associated with diseases. Often manifested as follows: a large accumulation of bile pigments in the eye proteins, mucous surface begins. This may result in a corresponding yellow tint.

Contrary to popular belief, hepatitis A caused by hyperbilirubinemia is not particularly related to hepatitis B, although it may occur as a symptom of this disease. The high content of the substance, especially with a large excess of norms, is considered a sign that poses a danger to the patient's life.

It should be noted that there are two fractions of bilirubin in the blood - free and bound. It is necessary to consider diseases accompanied by a high rate of direct bile pigment:

• acute viral hepatitis A, B,
• mononucleosis, as secondary hepatitis;
• protracted form of hepatitis C;
• hepatitis of a bacterial nature in conditions such as, for example, leptospirosis;
• complication after poisoning by food, medicine: non-steroidal drugs for inflammation, hormonal contraceptives and so on;
• gestational jaundice in women during pregnancy;
• tumor formations in the tissues of the liver.

Deviation from the norm of this component in the blood can be the cause of genetic abnormality and syndrome, which is a factor of jaundice.

Signs of Hyperbilirubinemia

If there are impaired liver function that interferes with conjugation, the production of bile pigments in the body and the outflow of bile, an increase in bilirubin content occurs. One of the signs of an increased value of this substance, which is detected during analysis, is considered a violation in the system.

A yellow tint from the bile pigment appears on the whites of the eyes, and after that on the oral mucosa. After that, it begins to appear on the front, on the surfaces of the palms and on the soles. At the same time, coverage of other parts of the body occurs. A very common symptom that accompanies jaundice during hyperbilirubinemia is itchy skin.

The presence of jaundice is not necessary with increased bilirubin. A similar feature of skin pigmentation can occur with a large accumulation of substances - carotenes, for example, with excessive consumption of carrots and tomatoes. The yellow color of the skin is a symptom of diabetes mellitus, hypothyroidism. A special sign of this condition is the normal color of the sclera of the eyes.

High unbound and direct bilirubin: the main reasons

The high content of such fractions is a consequence of factors (diseases), which are considered the root causes of hyperbilirubinemia. You should consider this point in more detail:

• exceeding the content of such blood components as eritrocit, accelerating the processes of their destruction;
• withdrawal of bile (non-free type);
• violations of the processing and removal of pigments.
• a large number of blood cells and their destruction.

The main thing to understand is that if direct bilirubin is increased, then you should immediately consult a doctor. The high rate of breakdown of blood cells (red blood cells) can cause the development of a type of jaundice, such as hemolytic. It is accompanied by the production of large amounts of indirect bilirubin. A similar condition manifests itself in many pathologies, including a hereditary defect in red blood cells and severe hemorrhage (hematoma, pulmonary infarction). A violation may occur if there are such problems:

• infectious pathologies;
• malignant tumors;
• poisoning.

If there are mismatches of such important components as the blood group of the donor and recipient, then jaundice is manifested. In this case, the following symptoms are noted:

1. Bright yellow shade of the proteins of the eyes, mucous membrane and skin.
2. Pale skin due to anemia.
3. A sufficiently large volume of some organs - the spleen. There are pain in the left hypochondrium.
4. The black color of such secretions as urine and feces is due to the high content of urobilin.

Deterioration of well-being is associated with poor oxygenation - headache, rapid heart rate, high fatigue, as well as an increase in body temperature to subfebrile values.

Damage to the nervous system and brain

Poor analysis may indicate possible damage to the nervous system and organs. This condition refers to nuclear jaundice. In an adult, a deviation from the norm in the analysis may indicate pathologies such as:

• cholecystitis;
• hereditary disorders of bilirubin metabolism;
• hepatitis;
• mononucleosis;
• cirrhosis of the liver;
• tumors in the liver;
• hemolysis of a toxic nature;
• hemolytic anemia;
• tumors in the pancreas;
• incompatibility of plasma groups during transfusion;
• poor reaction to the used bactericides, contraceptives and other medications.

Low levels of bile pigment in the blood are very rarely diagnosed. Usually it is associated with prolonged use of vitamin C, phenobarbital.

Gastrointestinal problems

Poor outflow of contents from the gallbladder can cause hyperbilirubinemia. In the presence of a similar problem, the component of bile does not leave the body and is sent to the general bloodstream. For this reason, jaundice develops. The very common causes that cause impaired outflow include the following:

• the appearance of any narrowing of the ducts that remove bile, as well as the presence of gallstones in them, formation, pathologies in the tissues, parasites;
• injury;
• tissue disease in the biliary tract of an inflammatory nature, which provokes sclerosis of the ducts.

It takes place in a poor blood test and pathology in the bile ducts that appears from birth.

Gilbert's syndrome

Is bilirubin elevated all the time? So this is a congenital liver disease? Such an option is also quite possible, and the main manifestation of this disease is benign hyperbilirubinemia. There are signs of yellowness, accumulations of lipofuscin in hepatocytes.

Gilbert's syndrome was described back in 1900 - it is called simple familial cholemia, that is, benign familial non-hemolytic hyperbilirubinemia.

The disease is rare. For this reason, benign hyperbilirubinemia should be included in screening diagnostics in patients with a high value of pigment in the blood.

Clinical picture: symptoms

With Gilbert's syndrome, bilirubin begins to increase as a result of such disorders as:

• capture;
• transportation;
• cell conjugation.

This condition occurs due to an enzyme defect. Due to the poor activity of this enzyme, the liver may completely lose such a function as neutralization. Given the pathogenesis of the disease, it should be noted that it is associated with impaired transport functions of proteins that deliver bilirubin (total) to microsomes.

Most often, the disease begins to appear in children at the age of 14 years by accident and accompanies a person all his life. About 30% of people do not complain about health. It takes a very long time in a state of remission, and at the same time there are no changes in the shade of the skin and eyes that relatives notice. Most often, such a syndrome is an accident that becomes noticeable during the examination of the patient.

Usually a disease has a whole bunch of symptoms:

1. The intermittent type of jaundice is associated with an excess of bilirubin of the unconjugated type.
2. Asthenoneurotic symptoms.
3. The presence of pain and disturbances in the work of the stomach. Slight hysteria of the sclera is noted.

With the development of Gilbert's syndrome, bilirubin in adults exceeds 21 mmol / l.

Hyperbilirubinemia in Pregnant Women

An increase in this indicator for this category of people has various reasons, but there are the most frequent ones. For example, during pregnancy, a slight increase in the content of a substance that is associated with large sizes of the fetus is possible. Because the changes are small and physiological, they are not visible in the blood screening.

With significant excesses of the norm of bilirubin in the blood of women, the possibility of a dangerous disease or poor functioning of the bile duct organs is of particular importance in this condition.

There are several diseases and conditions that cause changes in the performance of this pigment. They are dangerous, so it is so important to consult a doctor in a timely manner.

An increase in the volume of bilirubin in the blood occurs not only with the disease, but also for a physiological reason related to pregnancy:

• stagnation of bile - their cause is the growth of the fetus and organ, which puts pressure on the inside of a woman;
• the presence of a condition such as early toxicosis is noted in many women in the first trimester of pregnancy;
• pregnant cholestasis (intrahepatic) - manifests itself later, and during childbirth begins to pass without the need for medical intervention.

Liver dystrophy of pregnant women is also a rather rare pathology that develops in the initial stages of pregnant women who first bear a child.

Hemolytic anemia - the cause of early childbirth or the death of the baby in the womb. The second cause of the disease is hepatitis. Poor development of the placenta is also possible, which leads to a delay in the development of the fetus. There is also the likelihood of an infection in the fetus from a condition such as hepatitis E in the womb.

A disease such as cholecystitis can cause the development of gestosis in the later stages. It is dangerous for the mother and the newborn with the following symptoms: edema, high blood pressure, leading to intrauterine growth retardation.

High bilirubin leads to dangerous births and consequences, but before panic, it is necessary to repeat the biochemical screening, as another reason may be the incorrect preparation of the woman for analysis. It is worthwhile to carefully approach issues related to passing tests.

There are cases when during the screening, it was found that the total bilirubin in the blood is quite low. Sometimes this is due not only to prolonged renal failure, but also to other causes.

What causes a decreased bile pigment?

Provoking factors can be diseases such as:

• acute leukemia;
• tuberculosis;
• aplastic anemia;
• wrong preparation.

Leukemia is the cause of low bilirubin in the blood. It is still possible that intoxication from tuberculosis leads to poor analysis. These diseases are considered dangerous, and timely studies and treatment can avoid dangerous complications.

Aplastic anemia

A bad indicator appears due to this form of anemia, which is a rare and complex disease that requires timely medical attention and treatment.

So what is bilirubin? Returning to this problem, in the context of aplastic anemia, it should be noted that with such a disease there is a decrease in the content of red blood cells in the blood and, accordingly, there is a tendency to their destruction and to a decrease in the content of bilirubin.

Coronary artery disease

It also becomes the reason for the disruption of the gastrointestinal tract and, as a result, poor analysis.

Speaking about patients who have reached the age of more than 60 years, it should be noted that a decrease in the number of bile pigments is characteristic of IHD (coronary heart disease) of different types of intensity. Clinically, this disease proceeds with symptoms of reduced bilirubin.

It is worth noting that improper preparation for donating blood for research can also be the cause.

Tips for Successful Analysis

It is recommended that you familiarize yourself with certain expert advice that should be performed immediately before blood sampling for biochemical analysis:

1. Do not eat 12 hours before screening.
2. High physical activity is prohibited. This may affect the result of the analysis.
3. Do not drink drinks containing caffeine or alcohol.
4. It is proposed to abandon drugs that affect bilirubin.

Before performing the test, it is recommended to avoid heavy physical exertion, since with them the results may be incorrect.

High Bilirubin Guidelines

You should adhere to all the advice from a doctor with a poor analysis, because if you do not take the prescribed drugs and do not contact specialists with this problem, you can provoke the development of serious complications.

The main goal of treating diseases and other causes of hyperbilirubinemia is to achieve a normal or acceptable indicator of the content of this substance. It is determined by the doctor and it does not have to be within 21 mmol / l - higher values ​​are possible in the presence of certain diseases. In any case, a dangerous condition is when bilirubin is increased in the blood. The causes of this violation need to be identified and treated in a timely manner.