Bilirubin

[NYgirl]

Well I looked this up for my information.  It's something I haven't seen discussed in here and rather than ask questions FIRST I figured I'd learn about my own results.

My DIRECT bilirubin had numbers for the first time ever this week.  Now that I see WHAT it is it makes sense - since one of the causes is hemolytic anemia and my hgb dropped to 9.3 only.

I thought I would post a quick encapsulate so others could make sure they knew. We talk so much about hemo, alt, ast and ignore the rest.

ANYBODY have any situation with this? I'm going out of normal range now (no shock) and don't know what to expect if it does.

Bilirubin is a breakdown product of hemoglobin.
Bilirubin metabolism begins with the breakdown of red blood cells...hemoglobin, which is broken down to heme and globin. Heme is converted to bilirubin, which is then carried by albumin in the blood to the liver.

Conjugated bilirubin is excreted into the bile by the liver and stored in the gall bladder or transferred directly to the small intestines. Bilirubin is further broken down by bacteria in the intestines to urobilins, which contribute to the color of the feces. A small percentage of these compounds are reabsorbed and eventually appear in the urine, where they are referred to as urobi

[NYgirl]

Jaundice is the discoloration of skin and sclera of the eye, which occurs when bilirubin accumulates in the blood at a level greater than approximately 2.5 mg/dl.


Jaundice occurs because red blood cells are being broken down too fast for the liver to process, because of disease in the liver, or because of bile duct blockage.






WAAAAAAAAAAAAA now not only will I be too skinny, too pastey, have lost half my hair, ribarash scarred but I'm going to be YELLOW?  Oh no I refuse this latest thing! NO WAY!  (Either that or I am going to go tanning...I'll be the darkest Asian person you EVER saw!)  ;)

Does it END?

[mikesimon]

Don't forget to discuss unconjugated or indirect bilirubin NYGirl. The premature destruction of RBCs can cause an elevation in the indirect bilirubin but since most people see total bilirubin they can't know whether, if TBili is elevated, it is due to indirect or direct bilirubin. That's where a fractionalized bilirubin comes in very handy. I'm kidding a bit here but I think it's accurate. If not, set me straight. Mike

[NYgirl]

AH like I have any REAL knowledge of it all LOL.  I am trying to figure out what is what but I never heard of it before...so when I had a real number instead of a zero I was like huh what in the world is this NOW?

Finding out I had a drop from 11.1 to 9.3 in two weeks make sense that it is because of the RBCs. I am dying to go in to the ladies room and look at my eyes and see if they are yellow (I doubt I would have missed that before LOL).

Conjugated bilirubin is excreted into the bile by the liver and stored in the gall bladder or transferred directly to the small intestines.   :)

I feel like I'm taking an open book test - but I can copy & paste ;)

[NYgirl]

Here you go I forgot the first part good thing I read it a few times

In the liver, most of the bilirubin is chemically attached to a glucuronide before it is excreted in the bile. This "conjugated" bilirubin is called direct bilirubin; unconjugated bilirubin is called indirect bilirubin. Total serum bilirubin equals direct bilirubin plus indirect bilirubin.

[Rogirl]

Your situation isn't funny but you always have such a clever way of saying things that I laugh anyway!
I'm thinking of you and hoping your sides clear quickly--your positive attitude is an inspiration and I'm glad to see you back online again. I hope your time away was enjoyable and restful!

[mikesimon]

Here's what I know - if the elevation is indirect bili and you're on TX it's safe and A okay. If direct bili is elevated you may have a bile duct blockage or some hepatic injury or disease. Unconjugated elevation doesn't scare me one bit but direct or conjugated elevation puts me in a panic. Can you guess why I learned this? I bet you can. Mike

[NYgirl]

Thanks Rogirl if you don't keep SOME sense of humor (even if it's as crazy as mine) during all this it would be SO EASY to fall into a big pity party and quit.  So even if I make myself laugh...that's something.  And i can ALWAYS blame it all on the brain fog so it works out for the first time in my life to be a bit strange!  :)

Mike I can tell just how you know about this.  Not many people on here seem to or have discussed it at all which makes me notice a LOT. And that is scary.

Mine is still in the 'normal' range but went up .2 out of nowhere for the first time so it set off SOME flag. I never saw DIRECT BILIRUBIN with any problem before....trying to make sense of things is just too hard some times.  I will ask the doctor tomorrow and since he's a GI he SHOULD have the answer I hope.

Sounds like I might be headed to the ultrasound again.  Well it would explain why I've had pain in the URQ and been telling myself I am a hypochondriac, shut up!

[52TELE]

" I be too skinny, too pastey, have lost half my hair, ribarash scarred but I'm going to be YELLOW? "

I thought you were discribing an old girlfriend of mine.

[mikesimon]

Gee, I didn't read your post carefully enough or I wouldn't have been so cavalier. I don't know what you're bilirubin is but a slight elevation in direct bilirubin wouldn't set me off. My total bilirubin has increased .6 in the last month but I assume it is from my RBC destruction and, as such the elevation is from my indirect bili and not specifically liver related. Do you see your indirect bilirubin too? If you don't I would suspect that you may actually be seeing Total Bili and it's misnamed. Generally when I see a fractionalized bilirubin both inirect and direct are set forth as well as total bilirubin which is the 2 numbers added together. Without specifically requesting a fractionalized I only get Total Bili on my labs. I hope that you're not too upset NY - I should have read more closely. Mike

[OnAPrettyPoison]

At least you are keeping your sense of humor!  Honestly, when I had acute hepatitis (non-a, non-b) in the early 80's I never noticed that my eyes were yellow, it was so gradual I didn't pick it up, a nurse that I worked with did and she insisted I go to the doctor.  My skin never turned yellow though.  Have you talked to your doctor?  I know you have had your share of challenges in treatment, I hope this isn't a new one.

[returntosender]

Here is good explanation from old Sci.Med post, dont think it is copyrighted.  Looks to me like your levels of direct jost get in the normal range from abnormal range.  Maybe a good sign?

"When you have impaired liver function, there are dramatic increases in the bilirubin levels in your blood.  Bilirubin cannot be excreted in bile, stools, or urine without being in the "direct" form, or conjugated (water-soluble), and that's why the liver changes it into this form.  When the liver is unable to do this job, the indirect bilirubin stays in the
blood circulation, which can cause jaundice.  Babies after birth sometimes become jaundiced because their liver is immature and has to handle a large amount of destroyed red blood cells, common after birth (creates lots of heme).  When there the direct bilirubin cannot be excreted from the liver
into the bile ducts or from the biliary tract, bilirubin can get reabsorbed from the liver into the blood and also produces high levels of bilirubin in your blood.  The bilirubin is already water-soluble because it has been to the liver, so it can be removed by the kidneys and into the urine (which is
why your urine turns dark).  Stools, on the other hand, will be a light colour because no bilirubin is getting to the intestines (which means stools will be light coloured).

Specific Causes of Increased Indirect Bilirubin
- hemolysis (hemoglobinopathies, spherocytosis, autoimmunity, transfusion reaction)
- red blood cell degradation (hemorrhage into soft tissues or body cavities, inefficient erythropoiesis, pernicious anemia)
- defective hepatocellular uptake or conjugation (viral hepatitis, hereditary enzyme deficiencies [Gilbert, Crigler-Najjar syndromes], hepatic immaturity in newborns)

Specific Causes of Increased Direct Bilirubin
- intrahepatic disruption (viral hepatitis, alcoholic hepatitis,
chlorpromazine, cirrhosis)
- bile duct disease (biliary cirrhosis, cholangitis, biliary atresia)
- extrahepatic bile duct obstruction (gallstones, carcinoma of gallbladder,
bile ducts, or head of pancreas, bile duct stricture, from inflammation or surgical misadventure)

Average Normal Reference Values of Bilirubin
Total Bilirubin
Newborn (2.0-6.0 mg/dl)
48 hours (6.0-7.0 mg/dl)
5 days (4.0-12.0 mg/dl)
1 month old to adult (0.3-1.2 mg/dl)

Indirect bilirubin (unconjugated)
1 month old to adult (0.3-1.1 mg/dl)

Direct bilirubin (conjugated)
1 month old to adult (0.1-0.4 mg/dl)

Factors That May Interfere With Levels in Test
- prolonged exposure of person (and blood sample) to sunlight or ultraviolet light reduces bilirubin levels in blood
- failure of the person to follow the dietary restrictions before the test (fasting normally lowers indirect bilirubin levels and in Gilbert's syndrome, chronically elevated levels of indirect bilirubin will increase dramatically when fasting)
- many drugs can elevate bilirubin levels (for example steroids,
sulfonamides, sulfonylureas, barbiturates, antineoplastic drugs [for interest, treatment of viral hepatitis is in this category], propylthiouracil, allopurinol, antibiotics, gallbladder dyes, caffeine, theophylline, indomethacin, and any drugs that are considered hepatoxic).It is recommended (check with doctor) that these drugs be withheld for 24 hours before test, if possible"

[NYgirl]

LOL we're cool pleasE don't worry.  You know how I get with test results. I swear this disease has turned me in to a FREAK it's like every point up and down MUST be investigated thoroughly - why? I don't know!

[sunspot]

When I had acute hepatitis in the late 60’s my bilirubin was about 6. My eyes yellowed first and then my skin. If you have any kind of tan, you won’t see the yellow. Look under the tan line. I thought it looked cool. What the heck, I was 17 years old.

[mikesimon]

Really, a freak about labs and stuff like that there? I wouldn't know anything about that. I'm very cool about my numbers....NOT!!!!!!! Take care and good luck. Mike