What is bilirubin in the blood and its norm in a healthy person. direct bilirubin

In the course of any medical examination, a biochemical blood test is often prescribed. The study is able to display the exact amount of substances contained in the blood plasma. An excess or decrease in any indicator in the analysis indicates the presence of possible diseases or pathologies of the internal organs. High or low bilirubin for patient health.

pigments in the body

What does low bilirubin mean? Low bilirubin in the blood is a rather rare phenomenon that accompanies serious diseases and pathologies:

Renal failure. In this state, there is a depression of all functions. The disease may be hereditary or be the result of prolonged inflammation. Kidney damage can reduce plasma pigment levels.
. A rare blood disorder that requires immediate medical attention. There are various reasons for the onset of the disease (radioactive radiation, poisoning with drugs or poisons, infections, autoimmune diseases).
Leukemia in acute form. The disease occurs in the bone marrow, making it difficult for the formation of red blood cells. This helps to reduce bilirubin in the blood.
Alimentary exhaustion. For the development of the disease, one reason is enough - poor nutrition. The process of exhaustion intensifies with physical exertion.
Intoxication of the body on the background of tuberculosis. It is more common in children and adolescents than in adults. In this case, tuberculosis is diagnosed, but it is not possible to establish the localization of its pathogen. In this case, an increase in the number of bacteria against the background of a reduced amount of bilirubin in the blood is observed.

After receiving the results of a blood test, the patient wonders why bilirubin is lowered and what are the reasons for this condition. Despite the fact that the digital designation of the pigment content in the blood plasma is indicated on the laboratory form next to the permissible norm, a qualified doctor should deal with the decoding. Increased or decreased bilirubin may be due to external factors, which means that the result is invalid. In search of the cause of the violation of the permissible content of bilirubin in the blood, it should be remembered that in 5% of cases the test results can be distorted due to the fault of the laboratory. For an accurate diagnosis, the doctor prescribes a second examination.

How to prepare for a blood draw

Proper preparation for the analysis of the level of bilirubin will help to get the most accurate result. Particular attention should be paid to food and drinks. A couple of days before the visit to the laboratory, fatty, fried foods, pickles and smoked meats should not be included in the diet, alcohol is completely excluded. The result of the study may distort the recent use of antibiotics, hormonal drugs, diuretics and other medications.

Also, a few days before blood sampling, you should not visit the solarium.

Blood sampling is done early in the morning, before breakfast. Do not drink anything other than water before the test. Before the procedure, you can not do x-rays, put a dropper or smoke, this can reduce or distort the performance. 10-15 minutes before the test, it is necessary to normalize the pulse and breathing. The results of blood biochemistry in private laboratories can be ready in a day. District polyclinics provide the result of the analysis within a week.

Pregnancy and pigment levels

During pregnancy, the female body is rebuilt, the hormonal background and other indicators change, what does this mean? For a long time, bilirubin below the norm in the expectant mother was determined by doctors as a normal condition. Usually the level of pigment comes into line with the allowable natural way. But this is not always the case, and a low bilirubin level in the blood can be an alarming bell. Any deviations in the results of blood biochemistry require additional diagnostics.

Pregnancy is stressful for the body, which causes many indicators to go down. Stress and load on the body can provoke the development of many diseases, which means that a thorough diagnosis is necessary. A common occurrence in which a reduced level of pigment is observed during pregnancy is coronary heart disease. The cause of this pathology may also be a genetic predisposition or a large load on the body due to the need to nourish the growing fetus. In addition to the load on the heart, the kidneys are seriously tested. A drop in bilirubin in the blood, swelling and a violation of pressure indicate possible malfunctions in the kidneys.

How to normalize an indicator

If there is a decrease in bilirubin in the blood, you should find out the reasons. A low level of bilirubin reflects the presence or development of existing diseases. As long as the lower limit of 3 µmol/L is not violated, the doctor can give general advice on maintaining health. How to increase bilirubin and normalize the content of the substance in the blood plasma? First of all, it is necessary to adjust the diet, increase physical activity and ensure healthy sleep.

A balanced diet rich in vitamins and microelements prevents many painful conditions by raising the low level of bilirubin. An active lifestyle, walking and morning exercises will help to eliminate the stagnation of bile and lead to a general strengthening of the body. Healthy sleep is equally important. It provides a complete rest at night. If the permissible content of bilirubin is violated, alcohol is completely excluded.

When the patient has low bilirubin and there are clear signs of the disease in the blood, a thorough medical examination should be carried out. The causes of a decrease in the level of pigment in the blood by modern medicine are not fully understood. Therefore, you should not neglect the recommendations of a doctor to maintain health. Bilirubin is an important indicator in blood biochemistry, thanks to which many diseases are diagnosed.

In contact with

Bilirubin: concept, norm, deviations and causes, jaundice in newborns and adults

In addition to the liver, the breakdown of red blood cells occurs in other "blood" organs - the bone marrow and spleen, although to a lesser extent. Thus, in one day the body loses about a hundredth of the red blood cells, from which up to 300 mg of hemoglobinogenic pigment comes out. Old cells are replaced by new, young and able-bodied ones.

With the normal functioning of all systems and organs, the formed bilirubin is excreted, and it is replaced by bilirubin released from the destroyed erythrocytes (also ≈ 0.3 g). And so every day, so that the level of this substance in the blood does not exceed the values 20.5 µmol/l, because in higher concentrations it begins to poison the body.

However, the norm up to 20.5 µmol / l implies total bilirubin, and, meanwhile, there are two more indicators of its content, expressing the state of human health:

Direct (bound, conjugated) bilirubin, which is ≈ a quarter of the total amount (25%), its norm is within 0.86 to 5.3 µmol/l and depends on the level of total bilirubin. If everything is normal in the body, conjugated bilirubin ceases to pose a particular health hazard, since it is bound, and, therefore, neutralized and is about to leave the bloodstream. The main thing is that there are no obstacles in its path, and the substance intended for removal does not come back;
Indirect (unbound, free, unconjugated) bilirubin occupies 2/3 of the total amount and is normal 1.7 to 17.0 µmol/l, it is he who freely moves and accumulates in the bloodstream, has properties that are far from useful for humans, and therefore poisons the body when it becomes too much in this state.

It should be noted that the indicators of the norm in different sources and laboratories sometimes differ somewhat. This is due to a change in the individual characteristics of the reagents and a modification of the methods of analysis. Of course, there is no need to expect any special differences, they will range from tenths of µmol/l to one.

The norm of bilirubin in the blood serum has no age and gender differences; it is the same for men and women. In children, the norms of this indicator do not depend on age and correspond to the figures of an adult, with the exception of only newborns.

Bilirubin in newborns: features and problems of the neonatal period

The norm of an adult can in no way be equated with the norm of a newborn in the first days of his life.

Immediately after birth, the level of bile pigment still somehow approaches the indicators that we are accustomed to perceive (≈ 22 µmol / l). Immediately, bilirubin begins to grow rapidly, on the 4th day of life it reaches about 120 µmol / l, which noticeably affects the skin of the baby.

Young mothers in such cases are sometimes frightened, experienced women affectionately call this condition “jaundice”, and the doctor on the round reassures with a smile, explaining that the newborn has physiological jaundice.

Hyperbilirubinemia in newborns is explained some destruction of red blood cells in order to make room for new, "adult" hemoglobin, and give the fetal (fetal) the opportunity to leave the baby's body. Just like that, a little man in the first hours of life begins to adapt to new conditions for him.

The child does not remain yellow for long, after a week the level of bilirubin decreases to 90 μmol / l, and then completely returns to normal as an adult. But this happens in strict terms, when everything is good and safe. In other situations, jaundice that does not appear on time or is too late causes concern for the neonatologist and requires certain therapeutic measures. This refers to an increase in bilirubin in children who are weak, premature, born with pathology.

If hyperbilirubinemia was the result or formed due to other circumstances that create conditions for a significant increase in the free fraction, which is not only present in the blood, but also penetrates into other organs, many problems arise. Overcoming the blood-brain barrier, the hemoglobinogenic pigment causes great damage to the nuclei of the brain, so this jaundice is called nuclear. It is a very dangerous condition in children in the first hours and days of life and requires immediate action by neonatologists, which happens in such cases: mothers report kernicterus in a child and begin intensive care.

Video: bilirubin and jaundice - Dr. Komarovsky

What happens to the bile pigment after its formation?

Thus, red blood cells, being destroyed, "release" their contents - hemoglobin, the molecule of which also decomposes with the formation of a toxic substance, hemoglobinogenic pigment - bilirubin. Released bilirubin in this state cannot accumulate, be stored in organs, or circulate in the blood, so it must be sent to a place where it will turn into a water-soluble form that can leave the human body. Here everything is provided by nature:

Based on these transformations, we can conclude that the entire bile pigment (total bilirubin) consists of:

Indirect (unbound, free, unconjugated), which appears during the destruction of red blood cells and the breakdown of heme components;
Direct (bound, conjugated), formed in the liver as a result of reaction with glucuronic acid.

The condition when bilirubin is elevated is called hyperbilirubinemia. Total bilirubin can increase due to any of its fractions (bound, free), therefore, methods for determining them are provided for a blood test.

Video: bilirubin metabolism

Hyperbilirubinemia and its main manifestations

A high level of bilirubin, several (perhaps tens) times higher than normal, can be not only dangerous for the patient's health, but also endanger his life, therefore, such a situation requires an immediate reduction in the indicator. And, of course, one can hardly hear from a doctor the conclusion that total bilirubin is lowered, and its fractions are normal. Such options are somehow not considered (as meaningless). Just a low level of total and free bilirubin indicates that everything is in order in a person in many organs and systems: red blood cells do not decay ahead of time, there is enough albumin for transportation, the synthesis of glucuronic acid is normal, the liver is healthy, the bile ducts are free, and so on.

It is not very good when the bound bilirubin is low or approaches zero, and all available in the body is in free swimming, but in such cases, total bilirubin, if not very elevated, may still be somewhere near the upper limit of the norm or slightly exceed it. Similar phenomena can sometimes be observed in benign hyperbilirubinemia (Gilbert's disease): bilirubin seems to be not very high (22 - 30 µmol / l), but all free, while conjugated - 0.

In the exchange of bilirubin in the body, the main role is played by the liver. If something is wrong, she reacts with a vivid syndrome that is hard to miss. This is jaundice, it appears:

When the functional abilities of the liver fall, and the state of its parenchyma no longer allows you to bind excess amounts of bilirubin;
If bile cannot move freely through the ducts and remove already bound bile pigment.

It would be erroneous to think that a person will “turn yellow” as soon as the level of bilirubin leaves the normal range - jaundice appears when the content of this substance exceeds 34-35 µmol / l.

Who is "turning yellow"

The degree of increase in bilirubin mainly affects the nature of yellowness, that is, the higher the indicator, the more staining of tissues is manifested. Usually, jaundice of the sclera, oral mucosa is the first to be reported, then the skin of the face, palms and feet joins, the rest of the skin turns yellow last, when hyperbilirubinemia is already in full swing. It should be noted that obese and edematous people "turn yellow" less than thin and lean people. However, when you see a person with an unusual skin color, one should not rush to conclusions - such a coloration may be the result of endocrine disorders (hypothyroidism, diabetes mellitus) or simply food addictions. Lovers of carrots and red tomatoes often acquire the appropriate shade. And, by the way, the sclera in these cases will have an absolutely normal color (intact, as doctors say).

Thus, elevated bilirubin in the blood can be evidence of various disorders, sometimes benign, but often not very. Such situations require the separation of this substance into fractions (bound and free) and further examination of the patient in order to determine the cause of the increase in bilirubin.

As for urine, the pigment there (normally!) Is in such meager amounts that it is not possible to determine it by the traditional method (ordinary general analysis), therefore, in the form of the results of the study in healthy people, they usually write: “bile pigments - neg.” , which corresponds to normal values. In liver pathology, elevated bilirubin, in addition to blood, is also seen in the urine, but since this is not available indirectly, it does not dissolve in water and does not pass through the kidney filter, all changes in laboratory tests can be attributed to conjugated bilirubin.

Why does bilirubin rise?

The reasons for the increase in bilirubin in the blood are very diverse and usually come down either to excessive production of this substance in cells scattered throughout the body (reticuloendothelial system or macrophage system), or due to a shift in various links (one or more) of the hepato-biliary metabolic process.

A failure in the processes of metabolism and excretion of hemoglobinogenic pigment from the body, as a rule, is followed by an excessive increase in the concentration of bilirubin, which ultimately leads to the appearance of yellow staining of tissues. This violation may appear as a result of hereditary pathology (hereditary forms) or in the process of life under the influence of various adverse factors (acquired hyperbilirubinemia). Depending on the amount of total bilirubin present in the blood and the predominance of a certain fraction, hyperbilirubinemia is distinguished:

conjugation, which is characterized by an increase in the total value due to bound bilirubin (its level can reach 50.0 or more µmol / l;
non-conjugated, characterized by normal values of bound bilirubin, but an increase in the concentration of the free fraction (it approaches the generally accepted norm of total bilirubin or exceeds it - more than 17.10 μmol / l).

The greatest attention of clinicians is attracted by various types of acquired hyperbilirubinemia:

Prehepatic jaundice. They are also called hemolytic. They owe their appearance to the excessive accumulation of hemoglobin pigment, with a high concentration of which it is very difficult to cope, suprahepatic jaundice is extremely difficult to correct. The use of the latest methods of treatment, forcing the liver to intensively bind a harmful substance, does not ensure its full removal from the body.
Parenchymal or hepatic hyperbilirubinemia are formed as a result of various pathologies leading to damage to liver cells (hence, its parenchyma) and bile capillaries. This, in turn, turns into a disorder of the capture, binding and excretion of bilirubin, as well as its return back to the bloodstream from the bile ducts, which is observed in the case of cholestasis (stagnation of bile in the liver). This is the most common form among other types of jaundice, which is characterized by an increase in conjugated (direct) bilirubin.
Subhepatic hyperbilirubinemia- this is the result of the return of bilirubin, already bound, but not able to be removed with bile. This occurs in cases where the bile itself cannot squeeze through and overcome the obstacle that has closed the bile ducts.

various forms of jaundice: mechanical (subhepatic), parenchymal (hepatic), hemolytic (suprahepatic)

However, it turns out that the listed jaundice can be perceived as a consequence and a calling card of elevated bilirubin in the blood. Obviously, they are strongly interconnected: the concentration of bilirubin increases - the skin turns yellow, or vice versa: the skin turns yellow - you need to look for the cause of the increase in bilirubin. What then causes these jaundices, under the influence of what factors they are formed and where is the reason for the increase in this indicator? To answer this question, it is advisable to consider each type of hyperbilirubinemia separately.

Prehepatic jaundice

An increase in the level of total bilirubin due to its unconjugated fraction is noted with an intensive breakdown of red blood cells circulating in the bloodstream (hemolytic anemia), which is typical for conditions grouped into a group of suprahepatic jaundices:

Hereditary anomalies of the erythrocytes themselves (, sickle cell) and acquired variants ();
Severe infectious processes (malaria, typhoid fever);
Ingestion of poisonous substances that cause (heavy metal salts, snake venom, toxins contained in pale grebe and other poisonous plants);
Extensive hematomas as a result of massive hemorrhages;
Incompatible blood transfusion (system and Rh - in the first place) and Rh conflict during pregnancy (GBN -);
Malignant blood diseases and other neoplasias.

Hemolytic anemia is a rather serious condition: a painful appearance, pale lemon-yellow color of the skin, an enlarged spleen immediately give out a sick person. In addition to blood, other laboratory tests are also restless: in urine and feces, a significant excess of uro- and stercobilin.

Table: common types of jaundice and their characteristics

Hepatic (parenchymal) hyperbilirubinemia

Hepatic jaundice, as a rule, is caused by the destructive effect on the liver cells of a viral infection, certain drugs and products taken orally to increase vitality (alcohol, for example). The first place in a number of diverse and numerous factors that “kill” the liver and increase bilirubin rightfully belongs to hepatitis and cirrhosis.

Inflammation of the liver, acute and chronic

Infectious agents, penetrating into the tender hepatic parenchyma, cause its inflammation, which we call hepatitis. But what happens during the acute stage with liver cells - hepatocytes, and why is direct (conjugated) bilirubin increased in the first place?

hepatitis progression and liver condition

The inflammatory process localized in the liver leads to the suffering of its cells, which, due to the aggressive behavior of foreign microorganisms or chemicals, begin to “shrink, wrinkle”, forming gaps between themselves, allowing bile containing already bound bilirubin to flow freely from the bile ducts and stagnate. in the liver.

The acute course of the disease, caused by any currently known virus that affects the liver (A, B, C, D, G, etc.), manifests itself similarly to many infectious processes: headache and fever, signs of general intoxication, "ache" in the bones and pain in the muscles. Other, more specific symptoms help diagnose liver disease:

Discomfort and heaviness in the liver (under the costal arch on the right);
Decreased appetite, mild nausea;
Change in the color of the skin and mucous membranes (the sclera turn yellow earlier than other areas);
Noticeably brightened feces;
Urine like dark beer;
Exceeding the level of bilirubin (due to the direct fraction),.

Signs that the process has captured large areas of the parenchymal tissue of the liver and bile stagnates in it are the appearance of annoying skin itching, increased bleeding at the slightest scratch, and a decrease in brain activity (hepatic). These symptoms make it possible to judge the level of bilirubin even without any tests. And he's usually tall.

In chronic hepatitis caused by the influence of viruses, drugs, alcohol and other factors, parenchymal jaundice is observed with skin rash, joint pain, and fever. These symptoms indicate a significant increase in bilirubin and liver enzyme activity, and also warn the patient about the possible development liver failure which is often fatal.

Cirrhosis

With cirrhosis, the cause of an increase in bilirubin is significant damage to liver cells. This disease is often (but not always) the result of hepatitis, or rather, prolonged suffering of an organ that fought as hard as it could, but, in the end, its parenchyma could not stand it and began to collapse, irrevocably giving way to its rightful place of connective tissue. Of course, under such circumstances, the entire structure of the liver suffers: after its tissue (disappearance of the lobules), the blood vessels and bile capillaries change beyond recognition, which naturally leads to a violation of the functional abilities of the organ. The liver “forgets” its main tasks, and the connective tissue that replaced it simply does not know them. All this leads to the fact that bilirubin does not bind and is not excreted, toxins are not neutralized, in the hemostasis system, due to a violation of protein synthesis, “irritation” occurs. Such metamorphoses cannot go unnoticed, the patient has a lot of complaints, indicating a clear trouble in the organ responsible for binding and excreting the bile pigment:

The development of liver failure in cirrhosis is obvious. Bleeding (gastric, uterine, etc.) are threatening, the patient may die.

Stumbling block in the way of bilirubin (subhepatic jaundice)

The bound bilirubin in the composition of bile is sent closer to the exit from the body, that is, to the intestines. However, on his way he may encounter an insurmountable obstacle that will return him to his former place. An increase in the content of bile pigment in the blood will lead to the development obstructive jaundice, the symptoms of which are more pronounced than in other forms of hyperbilirubinemia: yellowness is brighter, itching to bleeding scratches, headache is stronger, feces generally acquire the color of clay (stercobilin - 0). The reasons for the increase in bilirubin (direct) lie in the occurrence of some kind of mechanical barrier that inhibits the flow of bile:

Faulty genes that increase bilirubin

When considering the reasons for the increase in bilirubin, one cannot ignore the hyperbilirubinemia inherited (Dubin-Johnson syndrome, Crigler-Najjar syndrome), and especially dwell on benign hyperbilirubinemia - Gilbert's syndrome, which is called the "disease of excellent students".

The reason for the increase in bilirubin in this case is a lack of glucuronidase(an enzyme that catalyzes the formation of glucuronic acid), which is clearly visible in a biochemical blood test: the conjugated fraction in such individuals is equal to zero or approaches it, while all that is present is in a free state.

Interestingly, many people are not even aware that they have a defective gene hidden in the second pair of chromosomes. Usually, conditions are required for the development of the disease: stress, great mental or physical stress. The debut of the syndrome is accompanied by tears and a search for the causes of increased bilirubin (what if it's some kind of hepatitis?), In most cases, the course goes without treatment, however, so that the head is light and does not hurt, before the session, students still try to reduce bilirubin with phenobarbital, which increases enzyme activity and thus helps to bind the bile pigment.

In most cases, Gilbert's syndrome does not remind of its presence at all, the liver does not destroy, the prognosis is favorable. Unless such patients should not forget the simple rules: hard physical work, a huge psycho-emotional load and large doses of alcohol - all this is not for them.

How to lower bilirubin?

It is good if the yellowed skin color and other signs of trouble in the body, which may be caused by elevated bilirubin, prompt a person to see a doctor, and he will find out the origin of incomprehensible symptoms. As a rule, an increase in the bile pigment in the analyzes indicates serious health problems, it does not cross the designated boundaries just like that, and therefore they need to be taken seriously. You should not make attempts to reduce bilirubin on your own, because, even if it succeeds, then not for long. Not folk remedies will help to reduce bilirubin, but the professional approach of official medicine:

Severe hemolysis requires treatment, aimed at eradicating the cause in a hospital (droppers with glucose, the introduction of albumin, therapeutic plasmapheresis);
Little children, just born, are worn for ultraviolet irradiation, which helps to bind the released harmful product and remove it from the body. But this is about the physiological "jaundice". Treatment of nuclear jaundice, unfortunately, is not always doomed to success, therefore, it should be dealt with by specialists all the more;
Some independence is provided for persons with Gilbert's syndrome, but only to go to the clinic, write a prescription for phenobarbital and take it in small doses (approximately ¼ tablets) 1 time per day at night, because even in scanty amounts in healthy young people the drug causes drowsiness. True, some, without going to the doctor, go to the pharmacy and buy Corvalol. And by the way, it helps because it contains phenobarbital. Meanwhile, it should be borne in mind that in this case a person takes not only the remedy he needs, but also other substances that make up Corvalol, including alcohol, which is not very useful for Gilbert's disease (so why get used to it?) .

I would like to believe that we managed to convince the reader not to self-medicate, if suddenly the sclera and skin become unnatural for them, and doubts about their health crept into the soul. It is very easy to go and take a biochemical blood test, where bilirubin will be indicated by a red line, and then go to a doctor who, perhaps, will immediately (or after the examination) establish the cause and prevent serious complications and consequences.

Video: tests for the liver, bilirubin - the program "Live healthy!"

Bilirubin is a breakdown product of proteins, one of the most important components of bile, yellow-brown in color. The main function of bilirubin is to utilize hemoglobin. An increase in the permissible level of the content of a yellow substance in human blood provokes the development of serious diseases - jaundice, hepatitis, and leads to the development of oncological diseases. If the condition worsens, you need to know how to lower bilirubin in the blood with folk remedies at home in order to prevent the development of serious ailments.

Types

Yellow pigment is divided into two types. Depending on the reaction of the substance to the laboratory reagent, bilirubin can be direct and indirect. The direct type of bilirubin means that the substance has been rendered harmless by liver enzymes. The indirect type of bilirubin indicates that the reaction of its ligament with liver cells has managed to pass.

Blood analysis

To quickly identify the type and percentage of yellow pigment in the human body, it is carried out for bilirubin, using material from a vein.

are the same as for any other analysis:

, in the morning.
Before donating blood, you should not eat or drink drinks (with the exception of a small amount of plain water).
There must be at least eight hours between the meal and the delivery of the material.

A person under the age of 60 is: for the direct type from 1.7 to 5.1 mmol per liter of blood, for the indirect type - from 3.4 to 12 mmol / l, the total indicator of the substance is in the range of 5.1-17.

Raise

High levels of yellow matter in the blood are provoked by the following factors:

The process of destruction of red blood cells.
in blood.
Pathological processes in the bile outflow channels.
Diseases of the liver.
Long-term use of medications (particularly heavy antibiotics)
Chronic lack of enzymes in the liver, which are responsible for the breakdown of bilirubin.
Gilbert's syndrome is a congenital disorder of the bilirubin transport process.

Symptoms

Symptoms in human blood:

Lack of appetite.
Pain in the right hypochondrium.
Enlargement of the abdomen.
Feeling of itching on the skin.
Dark colored urine.
Pain in the region of the liver.
Increased fatigue.
Severe headaches.
Accelerated.

If at least a few symptoms of high bilirubin are found, it is necessary to immediately seek medical help to clarify the diagnosis. At home, it is impossible to lower the level of yellow pigment.

Treatment

The technique for reducing high bilirubin for each individual case is different. Some patients are prescribed a light diet, others need to take medication. Treatment options depend on the cause of the high bilirubin that led to the elevated levels.

The reason is a violation of the processes of outflow of bile. Treatment of bilirubin includes taking medications that have a choleretic effect. If there is a hereditary factor, it is necessary to carry out complex treatment, which consists of diet, vitamin intake and medication.

When elevated is provoked by infectious diseases of the liver, treatment is carried out with drugs that have antiviral and antibacterial effects that stimulate the immune system.

In the case of the development of Gilbert's syndrome, the patient is prescribed the use of drugs such as Zixorin and Phenobarbital. The course, depending on the complexity of the process - from two weeks to one month. Facilitates the patient's condition by taking enzyme preparations - Mezim, Festal and Pancreatin.

Balancing the level of bilirubin is possible with folk remedies, for example, a decoction of milk thistle. In most cases, medicines with natural ingredients are used - Karsil, Essentiale forte. To speed up the process of removing a substance from the body, adsorbents are used.

Food

In order to reduce the level of bilirubin to acceptable levels, in addition to drugs, one should strictly adhere to it, which will help relieve the load on the liver and normalize its work.

From the diet it is necessary to exclude:

Coffee and coffee drinks.
Alcoholic drinks.
Mushrooms.
Radish.
Fried meals.
Spices.
Salt.
Citrus fruit.
Products with preservatives.
High acid foods.

The basis of the diet for a therapeutic diet should be:

Egg white.
Milk.
Sweet fruits.
Lean meats.
Vegetables.
Kashi (hercules, rice, buckwheat).

From drinks, fruit drinks, herbal teas and mineral water are allowed. Herbal teas are especially used to lower bilirubin in newborns.

It is possible to use traditional medicine to reduce the level of bilirubin in the body only after the permission of the attending physician. With increased bilirubin, it is recommended to use a decoction on birch leaves. To prepare it, you need to pour a tablespoon of chopped dry leaves with a glass of boiling water. Insist half an hour. Take every day, at night. Birch leaves help to improve the patient's condition and remove toxic substances from the liver.

St. John's wort, motherwort and chamomile inflorescences are mixed, crushed, and poured with boiling water (a tablespoon in one glass of water). It turns out herbal tea, which must be left to brew for half an hour. Drink tea every day 20-30 minutes before meals.

Another popular method for dealing with elevated bilirubin is freshly squeezed beetroot juice. Beets have a therapeutic effect, accelerating the process of outflow of bile. You need to drink beetroot juice in one third of a glass, immediately before eating.

A decoction on corn stigmas is also used in case of violation of processes in the liver and an increased content of yellow pigment in the blood. How to prepare a decoction - a pinch of corn stigmas is brewed in one glass of boiled water. The decoction is infused for half an hour. Use half twice a day.

Traditional medicine recipes for lowering bilirubin based on motherwort. A tablespoon of dry grass is infused in a glass of boiling water for 30 minutes. Drink on an empty stomach in a tablespoon.

Effects

As soon as the first signs of a possible increase in bilirubin were discovered, it is necessary to begin emergency measures to reduce it. Ignoring the clinical picture can cause the development of very serious consequences. The high content of the pigment substance in human blood has an extremely negative effect on the work of all functions of the brain, which is under attack by toxic substances.

More than all other organs, the negative impact of increased bilirubin is felt by the liver, in which severe pathological processes begin to occur. To the same extent as the liver, the functionality of the kidneys is affected, which are not able to cope with their work. The low activity of the kidneys makes them extremely vulnerable to various infectious pathogens, which can lead to serious diseases and inflammatory processes.

Reduced level

There are cases when the concentration of the level of a yellow substance in a person's blood is significantly reduced. The causes of low bilirubin are acute, renal failure, intoxication of the body with tuberculosis. In these cases, the change in the amount of bilirubin in the blood is caused by a sharp decrease in red blood cells - erythrocytes. A decrease in bilirubin is an extremely rare occurrence.

Increase during pregnancy and in infants

An increase in yellow pigment in children in the first days of life is a very common phenomenon. The cause of occurrence is the process of destruction of hemoglobin, associated with the peculiarities of labor activity. an infant who has just been born undergoes a rapid process of destruction, in turn, bilirubin begins to rise actively. The so-called "newborn jaundice" does not pose a threat to life and is considered simply a physiological process.

The high percentage of bilirubin in the blood during pregnancy is due to the rapid growth of the fetus, which puts pressure on all organs, including the liver. As a result, the process of outflow of bile is difficult, and bilirubin accumulates. It is strictly forbidden to use medications to relieve symptoms during childbearing. Pregnant women can reduce the amount of the enzyme with herbal teas and a therapeutic diet.

Preventive measures include meticulous hygiene, a proper diet, and avoiding bad habits.

Analysis, during which the content of bile pigments and their fractions in the blood is determined. They are decay metabolites, and their level rises with increased destruction of erythrocytes, dysfunction of the liver and biliary tract.

Research results are issued with a free doctor's commentary.

Research method

Colorimetric photometric method.

Units

µmol/l (micromoles per liter).

What biomaterial can be used for research?

Venous, capillary blood.

How to properly prepare for research?

Do not eat for 12 hours prior to the study.
Eliminate physical and emotional overstrain 30 minutes before the study.
Do not smoke for 30 minutes prior to the study.

General information about the study

Bilirubin is a yellow pigment that is a component of bile and is formed in the spleen and bone marrow during the breakdown of red blood cells. Normally, erythrocytes are destroyed 110-120 days after leaving the bone marrow. At the same time, the metalloprotein hemoglobin is released from dead cells, consisting of an iron-containing part - heme and a protein component - globin. Iron is cleaved from heme, which is reused as a necessary component of enzymes and other protein structures, and heme proteins are converted into bilirubin. Indirect (non-conjugated) bilirubin is delivered by blood to the liver with the help of albumins, where, thanks to the enzyme glucuronyl transferase, it combines with glucuronic acid and forms direct (conjugated) bilirubin. The process of converting water-insoluble bilirubin to water-soluble is called conjugation. The bound fraction of the pigment practically does not enter the bloodstream and is normally excreted in the bile. Bilirubin in the intestinal lumen is metabolized by intestinal bacteria and excreted in the feces, giving it a dark color.

Direct bilirubin is named so in connection with the method of laboratory research. This water-soluble pigment interacts directly with the reagents (Ehrlich's diazo reagent) added to the blood sample. Unconjugated (indirect, free) bilirubin is insoluble in water, and additional reagents are needed to determine it.

Normally, the human body produces 250-350 mg of bilirubin per day. The production of more than 30-35 µmol / l is manifested by yellowness of the skin and sclera. According to the mechanism of development of jaundice and the predominance of bilirubin fractions in the blood, suprahepatic (hemolytic), hepatic (parenchymal) or subhepatic (mechanical, obstructive) jaundice is distinguished.

With increased destruction of red blood cells (hemolysis) or impaired liver uptake of the bile pigment, the content of bilirubin increases due to the unconjugated fraction without an increase in the level of associated pigment (adrenal jaundice). This clinical situation is observed in some congenital conditions associated with a violation of bilirubin conjugation, for example, in Gilbert's syndrome.

If there is an obstruction to the exit of bile into the duodenum or violations of bile secretion in the blood, direct bilirubin rises, which is often a sign of obstructive (mechanical) jaundice. With obstruction of the biliary tract, direct bilirubin enters the bloodstream, and then into the urine. It is the only fraction of bilirubin that can be excreted by the kidneys and stain urine dark.

An increase in bilirubin due to direct and indirect fractions indicates liver disease with impaired capture and release of bile pigments.

An increase in indirect bilirubin is often observed in newborns in the first 3 days of life. Physiological jaundice is associated with increased breakdown of erythrocytes with fetal hemoglobin and insufficient maturity of liver enzyme systems. With prolonged jaundice in newborns, it is necessary to exclude hemolytic disease and congenital pathology of the liver and biliary tract. With a conflict between the blood groups of the mother and the child, an increased breakdown of the baby's red blood cells occurs, which leads to an increase in indirect bilirubin. Unconjugated bilirubin has a toxic effect on the cells of the nervous system and can lead to brain damage in the newborn. Hemolytic disease of the newborn requires immediate treatment.

In 1 out of 10 thousand infants, atresia of the biliary tract is detected. This life-threatening pathology of the child is accompanied by an increase in bilirubin due to the direct fraction and requires urgent surgical intervention and, in some cases, liver transplantation. Newborns are also likely to have hepatitis with an increase in both direct and indirect bilirubin.

Changes in the level of bilirubin fractions in the blood, taking into account the clinical picture, allow us to assess the possible causes of jaundice and determine the further tactics of examination and treatment.

What is research used for?

For differential diagnosis of conditions accompanied by yellowness of the skin and sclera.
To assess the degree of hyperbilirubinemia.
For the differential diagnosis of neonatal jaundice and to identify the risk of developing bilirubin encephalopathy.
For the diagnosis of hemolytic anemia.
To study the functional state of the liver.
For the diagnosis of violations of the outflow of bile.
To monitor a patient taking drugs with hepatotoxic and / or hemolytic properties.
For dynamic monitoring of patients with hemolytic anemia or pathology of the liver and biliary tract.

Whenappointedanalysis?

With clinical signs of pathology of the liver and biliary tract (jaundice, dark urine, discoloration of the stool, itching of the skin, heaviness and pain in the right hypochondrium).
When examining newborns with severe and prolonged jaundice.
If hemolytic anemia is suspected.
When examining patients who regularly consume alcohol.
When using drugs with possible hepatotoxic and / or hemolytic side effects.
When infected with hepatitis viruses.
In the presence of chronic liver diseases (cirrhosis, hepatitis, cholecystitis, cholelithiasis).
With a comprehensive preventive examination of the patient.

What do the results mean?

Reference values

total bilirubin

Direct bilirubin: 0 - 5 µmol/l.
Indirect bilirubin is a calculated indicator.

Causes of an increase in the level of total bilirubin

1. Predominantly due to indirect bilirubin (indirect hyperbilirubinemia associated with excessive hemolysis or impaired capture and binding of free bilirubin by the liver)

autoimmune hemolysis.
hemolytic anemia.
pernicious anemia.
Sickle cell anemia.
Congenital microspherocytosis.
Thalassemia.
Embryonic type of hematopoiesis.
Gilbert's syndrome.
Crigler-Najjar Syndrome.
posttransfusion reaction.
Transfusion of incompatible blood types.
Sepsis.
Hemorrhagic infarction of the lung.
Hemorrhage in tissue.

2. Predominantly due to direct bilirubin (direct hyperbilirubinemia associated with biliary obstruction or impaired excretion of conjugated bilirubin by the liver)

Choledocholithiasis.
Cholelithiasis.
Viral hepatitis.
Sclerosing cholangitis.
Biliary cirrhosis of the liver.
Cancer of the head of the pancreas.
Dubin-Johnson Syndrome.
Rotor syndrome.
Atresia of the biliary tract.
Alcoholic liver disease.
Pregnancy.

3. Due to direct and indirect bilirubin (parenchymal jaundice with impaired bilirubin uptake and bile secretion)

Viral hepatitis.
Alcoholic liver disease.
Cirrhosis.
Infectious mononucleosis.
Toxic hepatitis.
Echinococcosis of the liver.
Abscesses of the liver.
Metastases or massive tumors of the liver.

What can influence the result?

Intravenous administration of a contrast agent 24 hours before the study distorts the result.
Exposure to sunlight or artificial light for 1 hour or more, eating fatty foods reduces the content of bilirubin in the sample.
Prolonged fasting, intense physical activity contribute to an increase in bilirubin levels.
Nicotinic acid and atazanavir increase the content of indirect bilirubin.
Drugs that increase total bilirubin: allopurinol, anabolic steroids, antimalarials, ascorbic acid, azathioprine, chlorpropamide, cholinergics, codeine, dextran, diuretics, epinephrine, isoproterenol, levodopa, monoamine oxygenase inhibitors, meperidine, methyldopa, methotrexate, morphine, oral contraceptives, phenazopyridine, phenothiazides, quinidine, rifampin, streptomycin, theophylline, tyrosine, vitamin A.
Drugs that reduce total bilirubin: amikacin, barbiturates, valproic acid, caffeine, chlorine, citrate, corticosteroids, ethanol, penicillin, protein, anticonvulsants, salicylates, sulfonamides, ursodiol, urea.

Important Notes

direct bilirubin- one of the parts of total bilirubin, which is part of bile. This is a pigment that is produced in the liver. It appears as a result of the breakdown of proteins such as hemoglobin, cytochrome and myoglobin. The breakdown occurs in the bone marrow, spleen and liver, from where the resulting products are excreted from the body through bile.

In what cases are they sent for tests showing bilirubin?

There are several main signs, because of which they are most often sent for testing this indicator:

liver disease;
delay in the release of bile;
suspicion of jaundice.

The norm of direct bilirubin is 0-3.4 µmol/l. Do not eat before testing. You can only drink clean water. At the same time, several factors can affect the result: fatty foods, fasting, many medications (antibiotics, oral contraceptives, barbiturates, and others). Because of all this, bilirubin indicators are often not accurate.

Elevated direct bilirubin

Elevated levels of direct bilirubin indicate some pathology of the liver.

In addition, problems with the outflow of direct bilirubin may appear due to:

taking hepatotoxic drugs;
fatty hepatosis of pregnant women;
cancer of the liver;
and cholangitis;
hereditary diseases.

Gallstone obstruction is a blockage of the bile ducts, which occurs as a result of a corresponding disease. It can also occur due to problems with the pancreas, obstructive jaundice, biliary cirrhosis.

Decreased direct bilirubin

Low bilirubin is rare in medical practice. The reasons for such indicators are still being studied by scientists from all over the world - they believe that this phenomenon in the future will have a serious impact on human health in general.

Most often, the low level of this indicator is the result of an incorrect delivery of the analysis itself. There are several main factors influencing the change in results:

consumption of alcoholic or caffeinated beverages;
taking glucocorticoid drugs, antibiotics and even ascorbic acid.

The mechanisms that lead to a decrease in bilirubin are not yet fully understood. To obtain a more accurate blood test for direct bilirubin, you need:

The day before going to the laboratory, give up fatty, fried (heavy) food so as not to burden the liver, ideally, eat baked or steamed vegetables, boiled chicken, cereals.
Half a month before donating blood, stop taking medications, or try to limit their number as much as possible, since pills often increase the concentration of substances, which will greatly complicate the task.
During the day, give up physical activity, including sports, as this affects the functioning of the liver.
Avoid emotional stress - stress can change blood counts.

If from the analyzes it became known about the underestimated results of bilirubin, then first you need to remember whether all the warnings were followed. If, nevertheless, one of the points was violated, the tests must be taken again. When confirmed, we can already safely say that this is a deviation from the norm.

Many scientists argue that low rates are directly related to heart disease, in particular ischemia. This is a serious disease, therefore, when such results are obtained, it is urgent to go to a cardiologist, where it will be necessary to take new tests.