Not every person thoroughly knows the anatomy of his body and substance, the elements that enter it. For this reason, after receiving test results, we sometimes experience increased anxiety. After all, we cannot explain or understand some meanings, which means that it is not in our competence to correctly assess our condition. One of these little-known values is elevated bilirubin in the blood. The causes and methods of treatment, as well as the symptoms of this condition, we will consider below.
Bilirubin - a substance in the human body
This is an organic substance formed during the natural breakdown of hemoglobin due to the destruction of red blood elements - red blood cells. This process occurs continuously as the life of red blood cells ends. Bilirubin can be seen in blood plasma or bile. Deviations from the norm of the presence of bilirubin in these fluids most often indicate the presence of pathological conditions of the blood (increased destruction of red blood cells), the liver, or biliary tract.
The difference between direct bilirubin from other species
In medical science, two types of bilirubin are distinguished - direct and indirect. The second of them, also called unbound, is formed in liver cells (about 80%), and the rest - in the spleen and bone marrow cells.
Direct bilirubin, called bound, is formed in the liver by the addition of glucuronic acid to indirect bilirubin. This is required in order for a toxic and insoluble substance to be converted into a soluble form and successfully excreted from the body with bile.
However, non-toxic and easily soluble direct bilirubin can also have a harmful effect on the body. With an increased concentration of this substance in bile, it is prone to precipitate and crystallize, this may ultimately lead to the formation of solid deposits in the structural elements of the gallbladder and its ducts.
In the results of laboratory examinations, common bilirubin is often mentioned, but this name is clinical, there is no such substance in the body. This concept refers to the total amount of direct and indirect bilirubin.
Why is a direct bilirubin blood test prescribed?
This study is very important because it allows you to answer the question of whether an increase in bilirubin is associated with impaired liver function or not. An increase in total bilirubin due to high indices only indirectly is possible with an increase in the breakdown of hemoglobin. And an increase in only readily soluble substances is most often encountered with difficulty in the outflow of already formed bile, for example, with mechanical blockage of the bile ducts.
The causes of increased bilirubin in the blood are different. Common is a serious diffuse liver pathology - hepatitis. The disease is characterized by the fact that the cells of this organ are not able to remove the pigment in the right amount to the gallbladder and its ducts. Timely conducting a blood test for direct bilirubin will identify this disease and prevent its further progression.
What is the norm of bilirubin blood?
In order to clearly determine the pathological condition, experts have established the concept of the norm of bilirubin in the blood. It can individually fluctuate over a wide range, but exceeding these values can indicate serious health problems.
| Norms for adults | Children under 1 month |
Total bilirubin | Range from 8.5 to 20.5 μmol / L | The first day after childbirth: 51-60 micromol / l
2-7 days after birth: up to 256 μmol / l |
Indirect bilirubin | up to 15.4 μmol / l
(accounts for 75% of the total amount of substance) | not less than 90% of total bilirubin |
Direct bilirubin | up to 5.1 μmol / l
(25% of the total) | no more than 10% of the total |
In the above table, we see that in different age categories the norm of bilirubin in the blood is different. Increased bilirubin, symptoms whose treatment is determined only by a specialist, can occur already in the first day after birth. Therefore, it is important to monitor its level in the blood, so as not to miss the serious pathology of the internal organs.
What pathologies increase direct bilirubin?
An increased concentration of pigment is possible when too much is formed, or there are obstacles to its removal from the body.
Most often, excessive formation of bilirubin is observed in various hereditary diseases, not only of the liver, but also of the blood. Various anemia can lead to this, and primarily associated with increased fragility of red blood cells, as well as the pathology of the spleen, which excessively destroys red blood cells, including healthy ones.
Difficulties in converting and eliminating bilirubin are more often associated with liver diseases that occur due to toxin damage or inflammation. Often this picture is given by cholelithiasis and oncological changes.
The reasons that led to an increase in bilirubin levels in the analyzes are divided into two large groups: hepatic and extrahepatic. The former are most often caused by diffuse processes in the liver tissues, and the latter are caused by cicatricial or other mechanical disturbances in the process of outflow of bile.
Hepatic causes:
- Acute viral hepatitis A, B, C.
- Chronic and bacterial hepatitis (with brucellosis, leptospirosis).
- Toxic hepatitis due to the action of drugs including.
- Intrahepatic cholestasis.
- Oncological diseases of the liver.
Extrahepatic causes:
- Compression of the ducts of bile.
- Diseases of these moves.
Thus, an elevated level of direct bilirubin may indicate various disorders in the body and cannot be the basis for an accurate diagnosis. But knowing this indicator, you can conduct further targeted examination of the patient.
Increased unbound bilirubin in the blood
If the test results indicate an increased level of indirect pigment, then you should pay attention to the general blood test, namely the number of red blood elements and hemoglobin. Since indirect bilirubin changes due to increased breakdown of hemoglobin, a person will have obvious signs of anemia. Due to the accumulation of excess unbound pigment in the blood, signs of hemolytic anemia appear and intensify (via jaundice).
Causes of Low Bilirubin
One of the leading causes of lower direct bilirubin is coronary heart disease. This phenomenon also occurs after taking alcohol, caffeine (including energy drinks) and a number of medications (penicillin, prednisolone, and others).
How does elevated bilirubin in the blood manifest itself?
If
direct bilirubin is elevated, what does it mean? With a high concentration of direct bilirubin in the blood, yellowing of the sclera is observed in patients, and with more severe conditions and skin integuments. Urine acquires a rich yellow color, and feces, on the contrary, become discolored due to impaired pigment excretion through the intestines. Upon examination, the doctor may detect a seal or an increase in the size of the liver, painful sensations in the area of the projection of the gallbladder are possible.
If direct bilirubin is elevated, what does this mean for a patient who has had acute viral hepatitis? In this case, a person may complain of loss of appetite, nausea, heaviness and pain in the right hypochondrium.
With difficult outflow of bile, a discoloration of the skin occurs. This is due to the fact that bilirubin is not evacuated through the intestines, but returns to the bloodstream and is filtered out in the kidneys. In addition to the symptoms of "obstructive jaundice", signs of a disease that caused a violation of the outflow of bile can clearly appear. These are symptoms of acute, chronic pancreatitis, cholelithiasis , etc. The most effective methods for diagnosing diseases in such cases are ultrasound or tomography. They help to identify inflammatory edema of the walls of the bile ducts, as well as their overlap with various neoplasms.
Bilirubin in children of the first days of life
The metabolism in newborns is slightly different from that in adults. At birth, a high content of fetal hemoglobin is observed in the blood, which is subject to rapid decay and excretion from the body. Therefore, on the first day of life, physiological, natural jaundice is very often observed. But as the enzyme system of the liver, which converts indirect bilirubin into a direct one, develops, these signs quickly go away.
However, there is a likelihood of the occurrence of pathological jaundice of the newborn. It can be caused by processes such as:
- incompatibility by blood type or Rh factor of the mother and child;
- hereditary fragility of red blood cells, which leads to increased formation of indirect bilirubin;
- infectious hepatitis;
- violations of the outflow of bile from the liver of a mechanical nature and others.
Treatment for elevated bilirubin in the blood
What to do if bilirubin is elevated is definitely impossible to say. Actions depend on several factors. First you need to identify the nature of the disease, why it arose. The reasons for the increase in bilirubin in the blood are varied, when making a diagnosis and prescribing treatment, the doctor cannot rely on data from only one or two studies. Additional tests may be prescribed: ultrasound diagnostics, computed tomography, which reveal the presence of solid deposits or other obstructions to the outflow of bile, due to which there is an increased bilirubin in the blood. The reasons and treatment of this pathological process can be determined in some cases by a hematologist (specialist in blood diseases), in others - by an infectious disease specialist. If there is difficulty in the outflow of bile, a therapy is prescribed to relieve spasms of the bile duct and gall bladder.
However, like many substances in the body, bilirubin should not be taken as completely useless slag. Recent studies have shown that bilirubin is a very good antioxidant, superior in its effectiveness to vitamin E. It is able to inactivate peroxide compounds, preventing the development of many pathological conditions and diseases. So, in people with high blood bilirubin, the risk of atherosclerotic vascular lesions and related heart diseases is significantly reduced. Bilirubin is able to combat aggressive free radicals, significantly reducing the risk of cancer.
Features of bilirubin in pregnant women
Sometimes it happens that in pregnant women, direct bilirubin is elevated. What does this mean for them? The state of pregnancy can not provoke a decrease or increase in this substance. Most often, future mothers note that in the results of the analysis, the reference indicator of the substance corresponds to the column "Bilirubin direct norm". Increased, lowered it may not be due to pregnancy, but with an exacerbation of chronic diseases or the emergence of new pathologies. Increased blood pigment can be triggered by diseases such as cholestasis, hemolytic anemia, viral hepatitis, cholecystitis. Such conditions require an immediate and complete examination of the woman, after which the doctor prescribes an adequate and effective treatment.
Ways to Lower Bilirubin
If you find yourself having symptoms of increased direct bilirubin, then you need to get rid of them, since such a condition can affect the condition of internal organs. To lower the level of this pigment, you first need to study your diet. A good result can be achieved with a change in nutrition. To do this, you must:
- stop eating fried and spicy foods;
- completely exclude alcoholic beverages from the diet;
- Do not use drinks with gases;
- newborns need to drink more fluids to quickly remove toxins from the body.
It is necessary to pay maximum attention to the state of the liver. Applying these simple rules of nutrition, you enable this body to cleanse and recover. A healthy liver actively gets rid of large amounts of bilirubin in bile and blood. In addition, it is necessary to monitor the healthy functioning of the intestine. Boiled and baked foods contribute to good bowel function. You can not exhaust yourself with endless diets or hunger, this leads to a malfunction in the digestive organs.
Thus, the only symptom is a condition in which direct bilirubin is elevated. What does it mean? This suggests that it is important not only to lower the amount of pigment in the blood, but also to treat the cause.
Pathological processes in the liver will manifest themselves through nausea, pain in the area of this organ, a feeling of heaviness, fever, and a bitter taste in the mouth. If increased bilirubin is caused by anemia, this will manifest itself through a yellow tinge of the mucous membranes, chronic fatigue, frequent heart contractions, pain in the left side of the chest. Increased bilirubin due to diseases of the biliary tract, manifests itself through dark urine, impaired appetite, severe itching and nausea.
In such conditions, it is necessary to take a blood test for direct bilirubin. What do the results and recommendations for its reduction mean? The doctor will say.