As a result of the breakdown of red blood cells, a special substance appears in the blood - bilirubin. It is also called yellow-red pigment, it is one of the main components of bile. In serum, it occurs in two forms: direct (bound) or indirect (free).
Diagnosis of diseases
It is impossible to figure out what direct bilirubin means if you do not know why this study is necessary. It is needed to evaluate the liver and diagnose a number of diseases of the gastrointestinal tract. Any deviation of this indicator from the norm indicates that a failure has occurred in the body.
If
direct bilirubin is elevated, then doctors have reason to believe that the patient has acute or chronic liver disease or
gallstone disease. With any deviations of this indicator from the norm, it is necessary to conduct an additional examination of the patient in order to accurately diagnose and begin timely treatment. Usually, excessively elevated bilirubin levels can also be diagnosed without blood tests. After all, it accumulates in the eyeball, elastic membranes, skin and gives them a yellowish tint.
Causes of Bilirubin Increase
In most cases, it is important to reliably determine what exactly led to the deterioration of the liver. For this, it is important to understand that direct bilirubin can not be elevated just like that. Therefore, without determining the disease that led to this condition and prescribing adequate treatment, it will not decrease.
A change in the level of bilirubin can be caused by several reasons. It:
- An increase in the intensity of hemolysis of red blood cells.
- Disorders in the liver caused by damage to the parenchyma, while the function of the allocation of bilirubin deteriorates.
- Violation of the outflow of bile into the intestine.
- The loss of an important link responsible for the biosynthesis of bilirubin.
- Deterioration of the secretion process of the direct fraction in the bile.
Problems can also be caused by hemolytic anemia. Another reason may be malaria, vitamin B12 deficiency, and other equally serious problems.
The situation in which direct bilirubin is increased is also due to the fact that it is produced as a result of increased hemolysis. At the same time, disruptions in the functioning of the liver lead to the fact that it is unable to cope and form an increased number of glucuronides, which are so necessary for the body.
Dangerous diagnoses
Do not refuse, if the doctor recommends checking the liver and sends you to take tests. Direct bilirubin can help diagnose a number of fairly serious illnesses.
So, its level will be increased with:
- hepatitis (both viral and toxic etiology);
- cytomegalovirus, which led to infection of the liver;
- secondary or tertiary syphilis ;
- cholecystitis;
- hypothyroidism of newborns;
- pregnant jaundice.
If bilirubin is general and direct elevated, then the doctor may suspect both hepatitis and a number of other diseases. The patient may have liver cancer, primary cirrhosis, gallstone disease. Also, deviation of indicators from the norm can be in the case of toxic, drug or alcohol poisoning of the body.
Problems in pregnant
Some future mothers in the last trimester may find out that they have not very good test results. Indeed, some may have direct bilirubin elevated during pregnancy. This condition requires an additional examination. After all, an increase in this indicator indicates violations in the process of outflow of bile in the liver. This condition is called "intrahepatic cholestasis of pregnant women."
Also, a number of diseases, such as viral hepatitis, cholecystitis, hemolytic anemia, cannot be ruled out. It is important to diagnose them in time in order to prevent possible complications.
It is important to understand: if direct bilirubin is elevated, treatment should be prescribed. After all, this condition can threaten both the normal course of pregnancy itself and the life of an unborn baby. It can lead to an edematous form of hemolytic disease of the fetus, while there is a high probability of premature birth and death of the baby inside the womb or in the first hours after birth.
Symptoms of Hyperbilirubinemia
Often the question of the need for tests is raised after the person himself or the doctor at the examination suspects problems. So, the fact that bilirubin is general and direct is elevated, symptoms such as:
- yellowness of the sclera of the eyes, mucous membranes, skin;
- temperature rise;
- an increase in the spleen, which may indicate discomfort in the left hypochondrium;
- dark urine, it can become dark brown or even black;
- lethargy, increased fatigue, palpitations, headaches - these signs indicate that oxygen has become worse in tissues.
Such symptoms occur with hemolytic anemia. It is worth noting that a discoloration of urine is not always found. It can be with the destruction of red blood cells even inside the vessels, and this happens only in some diseases, for example, with Markiathava-Mikeli syndrome.
But hemolytic anemia is not the only factor that leads to the fact that direct bilirubin is elevated. The reasons also lie in violations of the liver. You can talk about such problems if the patient:
- nausea, discomfort after eating, bitter belching;
- a feeling of heaviness in the right hypochondrium, it occurs due to an increase in the liver;
- decreased performance, weakness.
Sometimes darkening of urine to the color of beer or strong tea can be observed. With viral hepatitis, an increase in temperature is also often observed.
Treatment
It is impossible to try to figure out what therapy should be carried out on your own, even if direct bilirubin is slightly elevated. After all, it is impossible to get rid of the problem until its cause is determined.
It is also important to conduct detoxification activities. They include a special diet aimed at reducing the load on hepatocytes and enzymes responsible for the elimination of toxins. In a hospital, infusion-transfusion therapy is often performed. It is designed to change the composition and volume of blood, intracellular and intercellular fluid. Only a doctor can choose a solution that will be administered intravenously. In some cases, a glucose solution, a mixture of amino acids, saline and other drugs can be prescribed.
Sometimes it is recommended to carry out phototherapy, which contributes to the destruction of toxic bilirubin. To reduce intoxication, doctors often prescribe activated charcoal and gels designed to remove toxins, for example, Enterosgel.
So, if as a result of intensive destruction of blood cells it turned out that direct bilirubin is elevated, the causes of such hemolysis must be established without fail. First of all, it is necessary to understand what exactly led to this. After all, it will be necessary to treat not the consequences, but the cause of hemolysis. To do this, use glucocorticoid hormones, for example, the drug "Prednisolone". After eliminating the cause, the bilirubin level will decrease by itself.
If problems were caused by a violation of the outflow of bile, then medication can not be dispensed with. Doctors in such cases prescribe a treatment regimen that may include such drugs as Ursosan, Febichol, Tseruglan, Hermitage, Papazol, Gepabene, Analgin. Therapy is aimed at stimulating the outflow of bile, anesthesia. But you should not use drugs without the consent of a doctor. Indeed, in some cases, antibacterial or antiparasitic therapy is necessary.
Often the cause of jaundice is hepatitis. In such a situation, it is necessary to treat the liver. For this, the following drugs can be prescribed: Essential, Methionine, Heptral.
Established standards
Regardless of the age of the patient (with the exception of newborns), the indicators should be within the established limits. So, for total bilirubin, the norms are from 3.4 to 17.1 μmol / L, while the direct bilirubin in the blood should be no more than 4.3 μmol / L. These standards do not change, they are valid for adults at any age, and for children. Moreover, the level of the indirect fraction is not determined separately, it is calculated as the difference in the analysis results between the amount of total and direct bilirubin. It should not exceed 13.7 μmol / L. Indirect bilirubin with jaundice of newborns, hemolytic and pernicious anemia, syndromes of Rotor, Gilbert, Krigler-Nayyar increases.
The situation is slightly different with babies under the age of 1 month. On the first day of life, crumbs may have bilirubin ranging from 24 to 149 μmol / L. On the second day of life, the norm is in the range of 58-197. On day 3-5, bilirubin can be from 26 to 205 μmol / L. In full-term children, this indicator usually normalizes to two weeks (sometimes to a month) age.
Causes of Hyperbilirubinemia in Babies
In all newborns, the amount of yellow-red pigment in the blood is overestimated. This is due to the fact that the liver of babies who have just been born does not work like in adults. She is unable to cope with bilirubin, and it accumulates in the body. That is why in many babies its level is increased.
Do not panic, this is a completely normal situation, unless, of course, the indicators do not exceed the norm set for babies of this age. Usually, the liver is rebuilt and begins to function normally by the second week of life, and the level of bilirubin is normalized independently.
When the doctor suspects that problems are possible, he can conduct a special study. If direct bilirubin is elevated in newborns in excess of the established norm, then it is often recommended to conduct treatment in a hospital. It is undesirable to refuse the recommended therapy, because the jaundice of newborns is not as safe as many parents think.
Possible problems in babies
Due to the fact that the liver of newborns does not function as it does in adults, direct and indirect bilirubin may be increased in them. This may be due to the following reasons. In the process of blood cell breakdown, toxic hemoglobin is formed - heme, which begins to be fermented by the body and turns into bilirubin. Moreover, its indirect fraction does not dissolve in the liquid, and therefore cannot be excreted in the urine. After combining it with various substances, it is transported to the liver, where it is converted into direct bilirubin and moves into the gall bladder. In babies, this process is established only a few weeks after birth. Therefore, physiological jaundice is quite normal.
But there are situations when the level of bilirubin goes off scale. This is a rather dangerous situation, because its chronic increase can become a hindrance to the normal development of the brain, lead to various mental disorders, cause hearing loss, vision or even mental retardation. This is due to the fact that excessively high bilirubin does not allow albumin to block its toxic effect. And this leads to the fact that the nervous system suffers.
Treating children
Excessively increased direct bilirubin in the blood often causes the baby to be treated even in the hospital or transferred to a children's hospital. The main method is phototherapy. This is the illumination of the baby with a special light that can convert toxic bilirubin into safe forms. They are excreted within 12 hours with feces and urine. This method has its own side effects, but they disappear as soon as the course of treatment is completed. So, in a baby, slight peeling of the skin, loose stools and increased drowsiness may begin.
But in some cases, the body needs additional help to accelerate the withdrawal of bilirubin. In this case, in a hospital, droppers with glucose are prescribed, choleretic drugs, ascorbic acid are used.
The main method of preventing jaundice in newborns is called breastfeeding. It is colostrum that has a mild laxative effect on the newborn and contributes to the fact that the increased direct bilirubin in the blood gradually normalizes. But there are situations when the problems lie precisely in breast milk. In this case, it is recommended to replace breastfeeding with the mixture for several days. If the level of bilirubin begins to decline, it means that the jaundice was caused precisely by breast milk. But this is not a reason for abandoning natural feeding. Usually, 3 days of feeding the mixture are enough to normalize the condition of the crumbs, after which you can again apply the baby to the chest.
Problems in children
But an increase in the amount of yellow-red pigment in the blood happens not only in newborns. True, if direct bilirubin is increased in a child, then it must be carefully examined without fail. If the baby has already come out of the age of newborn, then the causes of jaundice are no different from those that cause problems in adults.
Even before determining the causes that led to an increase in bilirubin, it is important that the child follows a proper diet. It can help the liver process toxic bilirubin and turn it into a free, water-soluble fraction. So, the diet involves the exclusion of all fatty and fried foods, peppers, sodas. Parents should also know that in a situation where direct bilirubin is increased in a child, his health noticeably worsens. Therefore, detoxification measures aimed at cleansing the baby's body from toxic fractions should be started as soon as possible.