Causes and symptoms of elevated bilirubin
Content:
- What is bilirubin?
- Causes of elevated bilirubin
- Symptoms of elevated bilirubin
- Diagnosis of elevated bilirubin
- Treatment of elevated bilirubin
What is bilirubin?
Bilirubin is a unique bile pigment with a rather bright reddish brown color. It is an important product of hemoglobin catabolism. It is known that the main part of bilirubin itself is always formed in the liver. Its excessive accumulation in the blood or a significant appearance in the urine of humans is of great diagnostic value. These conditions are called hyperbilirubinemia and bilirubinuria.
A small molecule of bilirubin contains four pyrrole simple rings that are connected linearly to each other. The determined molecular weight of bilirubin is 548.68. Ordinary pure bilirubin can be characterized as a crystalline substance. It is always hardly soluble in water, glycerin, ether, and also slightly soluble in alcohol, while it is slightly better in chlorobenzene, chloroform and various diluted alkali solutions.
Since bilirubin is a special breakdown product of erythrocytes, it is continuously formed in the body. In the tissues and in the blood, only an indirect type of bilirubin is initially formed, in other words, a toxic substance. It is practically insoluble in water, and therefore is not excreted from the human body at all. It is believed that normally this indirect bilirubin always enters the liver with the blood, where its direct form is formed.
Such a substance obtained is further soluble in water, due to which it is easily excreted from the human body along with feces or urine. It should be mentioned that it is the substance bilirubin that gives human stool such a characteristic brown color.
| Children 1-3 days old | Children 3-6 days old | Children after a month | Adults | |
| General | 24 to 190 μmol / L | From 28 to 210 μmol / L | 3.5 to 20.4 μmol / L | 8 to 20.5 μmol / L |
| Straight | 0.5-10.2 | 1-12.4 | 0-5.1 | 0-5.1 |
| Indirect | 23.5-179.8 | 27-197.6 | Up to 16.5 | Up to 16.5 |
Find out more: The norm of bilirubin in the blood
Causes of elevated bilirubin
A significant increase in the content of bilirubin in human blood is due to such reasons as an increase in the intensity of hemolysis of erythrocytes, a serious damage to the liver parenchyma with the inevitable disruption of its important bilirubin-excretory function, a significant violation of the outflow of bile from all bile ducts into the human intestine, a strong loss of the enzyme link, which is always provides the necessary biosynthesis of bilirubin glucuronides.
In addition, an increase in bilirubin can provoke a serious violation of the hepatic secretion of direct conjugated bilirubin into bile, a significant increase in the intensity of hemolysis, which is observed with various hemolytic anemias. You should be aware that hemolysis can often be increased in malaria, B12-deficiency anemias, massive hemorrhages in various tissues of the body, crush syndrome, otherwise called unconjugated hyperbilirubinemia, and in dangerous pulmonary infarctions.
With a fairly strong increase in a certain concentration of bilirubin in the blood in a person, first of all, a slightly yellowish characteristic shade of the skin and sclera of the eyes often appears, while the urine becomes darker in color. Since at a very high concentration, bilirubin always seeps into the tissues of the human body, which leads to staining of tissues in a yellowish-gray hue.
In most cases, the accumulation of bilirubin is often accompanied by severe discomfort after various physical activities in the right hypochondrium. Fatigue, fever, and weakness may also occur. When these specific symptoms occur, it is advisable to go to the hospital to have the bilirubin level tested.
Moreover, if the rate of this substance is greatly increased, then the next step is to immediately find out the causes of this condition, followed by the appointment of the necessary treatment.
In tiny newborns, blood is always drawn from the heel for analysis, while in adults, blood is drawn from a vein. It is recommended to do this analysis in the morning and on an empty stomach. To obtain correct objective results, you should not drink for 4 hours before donating blood directly.
A significant increase in bilirubin in the blood is caused by such conditions and diseases of the liver and blood as anemia, problems with the gallbladder, disorders of the formation of bilirubin in the liver, helminthic invasion and vitamin B12 deficiency.
Congenital or acquired anemia often leads to a significant acceleration of the process of direct destruction of red blood cells in humans, due to which the level of bilirubin rises. In this case, all the other links of the chain in this case are not broken at all. This anemia is characterized by an increase in the indirect type of bilirubin. Acquired hemolytic anemia can develop due to autoimmune and many other malaria-like diseases.
A significant violation of the formation of direct bilirubin in the liver is considered the second most important possible cause of the disease. These include all types of cancer, hepatitis and cirrhosis. Along with this, hereditary diseases, Gilbert's syndrome, when the correct production of liver enzymes is greatly impaired, is characteristic of an increase in the level of bilirubin. To find out the reason, it is necessary to do specific additional analyzes.
Gallbladder problems can also trigger this condition. With a serious violation of the outflow of bile from the gallbladder itself, an increased level of direct bilirubin is often observed. Among other things, in rather rare cases, we can say that taking certain medications, due to their side effects, can change the level of this bile pigment in the blood.
Nor should you underestimate the prevalence of dangerous worm infections. Numerous types of parasites in the human body can often give, in addition to the main symptoms of infection, an increase in the level of bilirubin. A significant deficiency of vitamin B12 can also trigger the disease.
Symptoms of elevated bilirubin
The main symptoms of elevated bilirubin include headache, nausea, dizziness, itching, increased fatigue, as well as noticeable yellowness of the skin and mucous membranes. Since bilirubin, which is formed outside the liver, is always combined with serum albumin, it is transported by the blood and necessarily captured by the liver.
It should be noted that a significant part of it, about 75% in the liver, binds to the important glucuronic acid, while the formation of a bilirubin-glucuronate paired compound, or, in other words, bilirubin glucuronide, occurs. Then about 15% of the bilirubin forms a typical pairing with sulfuric acid. This form is called bilirubin sulfate.
Diagnosis of elevated bilirubin
To accurately determine the amount of bilirubin in urine, the Harrison test is always used, which is a qualitative reaction based on the oxidation of bilirubin when it interacts with Fouche's reagent to biliverdin. It is necessary to combine trichloroacetic acid in a certain proportion with ferric chloride. In addition, Harrison's test is also considered a sensitive quality sample (sensitivity varies from 0.5 to 1.7 mg / 100 ml).
Find out more: Liver Repair - List of Hepatoprotectors
Treatment of elevated bilirubin
To know how to quickly lower the level of bilirubin in the blood of a person, you first need to find out the specific reason for the increase. The optimal treatment method can only be prescribed by a doctor, since each of them has its own specific indications.
Infusion therapy is the main method of reducing bilirubin in the blood. It involves the intravenous infusion of detoxification drugs and glucose, which helps to remove bilirubin and its breakdown products from the patient's body. Modern specialists usually resort to this effective measure in case of serious serious conditions.
Another technique can be noted phototherapy, which is irradiation of the patient with special harmless lamps. Toxic indirect bilirubin is destroyed under their influence, turning into its direct simple form, and then easily excreted from the body. As a rule, this phototherapy is often used when it is necessary to quickly reduce the bilirubin level in infants. For them, this measure is the most effective.
When the reason for the increase in bilirubin is precisely in serious violations of the excretion of bile, then in most cases certain pharmaceutical preparations are prescribed that help to normalize this process. Another way to note is a change in daily diet.
In addition to cleansing preparations, it is recommended to use activated charcoal and special gels that remove toxins. It is necessary to reduce the load on the liver, which implies the elimination of fried and spicy foods, as well as sugary carbonated drinks from the diet.
If the increase in bilirubin is caused by hepatitis, then first of all, drugs are prescribed that can fully protect the patient's liver. Direct treatment of hepatitis itself stimulates a decrease in bilirubin.
Find out more: Signs, symptoms and genotypes of hepatitis C, causes of infection
With the wrong treatment, the risk of complications is very high. For example, the dangerous Gilbert's syndrome and many other serious liver diseases in most cases are successfully treated with Phenobarbital. If all the links of such a chain work normally, then the elimination of bilirubin from the body does not cause any difficulties.
This cleansing process also removes waste products from the patient and renews tissue. With an excessive concentration of bilirubin in the blood, the symptoms of the disease should not be ignored, timely treatment will allow a person to heal quickly.
Author of the article: Alekseeva Maria Yurievna | Therapist
Education: From 2010 to 2016 Practitioner of the therapeutic hospital of the central medical-sanitary unit No. 21, city of elektrostal. Since 2016 she has been working in the diagnostic center No. 3.
