Bilirubin is a yellow-green pigment that forms when the hemoglobin breaks down. In the human body, it is contained in the blood and bile. For the exchange and excess of bilirubin, the liver responds directly.
As a rule, high bilirubin manifests itself in the form of diseases, for example jaundice, hepatitis or anemia of the blood.
Based on this, we can say that there are a lot of reasons for increasing bilirubin in the blood in adults, so it is necessary to determine initially why this happened, and what became the impetus for increasing bilirubin.
What is bilirubin, and where does it come from?
Why does an adult diagnose elevated bilirubin, and what does it mean? Hemoglobin is found in red blood cells - the red blood cells of a person, it carries oxygen into the tissues of the body from the lungs. Damaged and old erythrocytes are destroyed in the spleen, liver and bone marrow. In this case, hemoglobin is released and converted into bilirubin.
The newly formed bilirubin is indirect, toxic to the human body, especially for the central nervous system. Therefore, the liver is neutralized by other substances. Bound - direct bilirubin is excreted along with the bile liver and leaves the body in a natural way. The dark color of the stool often indicates changes in the level of bilirubin.
Metabolism of bilirubin is a complex chemical process that constantly occurs in our body, if it is violated at any stage, a change in the level of this substance appears in the blood serum. Therefore, bilirubin is an important indicator of the work of several body systems.
Depending on the type, direct and indirect bilirubin is isolated.
- Indirect is one that is formed as a result of the breakdown of hemoglobin. It is soluble only in fats, therefore it is considered very toxic. He is able to easily penetrate into cells, thereby violating their functions.
- Direct is the one that forms in the liver. It is soluble in water, therefore, it is considered less toxic. Direct bilirubin is excreted from the body together with bile.
Direct bilirubin is safe for the body, as it was previously rendered harmless by liver enzymes. Such a substance calmly exits the body and does not cause any special harm. Bilirubin of the indirect type is very toxic, it was recently formed from hemoglobin and is not bound by liver enzymes.
Norm of bilirubin in the blood
For an adult under 60 years of age, the normal result of the bilirubin test will be:
- 5.1-17 mmol / L - total bilirubin;
- 3.4-12 mmol / l - indirect;
- 1.7-5.1 mmol / l - straight.
Tables of the norm of the level of bilirubin in the blood for both sexes almost does not differ. However, scientists have shown that men are 10 times more likely to have Gilbert's syndrome than women.
Bilirubin common is elevated - what does this mean for an adult?
For what reasons in adults does the amount of total bilirubin in the blood increase, and what does it mean? What factors contribute to this?
In adults, there are a number of main causes:
- accelerated decay of erythrocytes;
- primary biliary cirrhosis;
- other conditions that cause disorders of bile outflow;
- helminthiases and parasites in the body;
- intrahepatic cholestasis;
- of jaundice of pregnant women;
- liver tumors;
- disorders in the production of enzymes responsible for the formation of direct bilirubin;
- viral, bacterial, toxic, medicinal, autoimmune and chronic hepatitis - while the liver becomes unable to excrete bilirubin.
Depending on which process is violated, an increase in one of the bilirubin fractions can be observed in the blood. If an increase in total bilirubin with a uniform distribution of fractions is found, this is most typical for liver diseases.
Causes of increased direct bilirubin
The level of of direct bilirubin in the blood is increased due to a violation of the outflow of bile. As a result, bile is sent to the blood, not into the stomach. The reasons for this are most often the following pathologies:
- hepatitis of viral etiology in acute form( hepatitis A, B, with infectious mononucleosis);
- hepatitis of bacterial etiology( leptospirosis, brucellosis);
- chronic hepatitis;
- autoimmune hepatitis;
- drug-induced hepatitis( as a result of hormone therapy, non-steroidal anti-inflammatory drugs, antitumor drugs and anti-tuberculosis drugs);
- toxic hepatitis( poisoning with fungal poisons, industrial toxic substances);
- cancer of the gallbladder, liver or pancreas;
- biliary cirrhosis;
- syndromes of Rotor, Dabin-Johnson.
Primary increase in the parameters of direct bilirubin. The basis is a violation of the outflow of bile.
Causes of increased indirect bilirubin
Diseases in which is increased indirect bilirubin :
- Syndromes Gilbert, Kriegler-Nayyar, Lucy-Driscola.
- Infectious diseases - typhoid fever, sepsis, malaria.
- Congenital hemolytic anemia - spherocytic, nesferocytic, sickle cell, thallasemia, Marciyafawa-Michele disease.
- Toxic hemolytic anemia - poisons poisoning, insect bites, snakes, mushroom poisoning, lead, arsenic, copper salts( copper sulfate).Medicinal hemolytic anemia - induced by the use of cephalosporins, insulin, aspirin, NSAIDs, levomycetin, penicillin, levofloxacin, etc.
- Acquired hemolytic anemia autoimmune - develops against the background of systemic lupus erythematosus( symptoms, treatment), rheumatoid arthritis, lymphatic leukemia, lymphangranulomatosis( symptoms, treatment), etc.
Primary increase in the indices of indirect bilirubin. The basis is excessive destruction of erythrocyte cells.
The liver is most important in the production of bilirubin. With pathologies of this organ, the normal process of neutralizing free bilirubin and its transition to a direct state becomes impossible. Among liver diseases, in which bilirarin metabolism is disrupted, there is cirrhosis, hepatitis A, B, C, B and E, alcoholic and medicinal hepatitis, liver cancer.
The level of both types of bilirubin increases , which is manifested by the following symptoms:
- discomfort and heaviness in the right side due to augmentation of the liver;
- faded color of feces and dark - urine;
- faintness, belching after eating, especially severe discomfort from fatty and heavy foods;
- loss of strength, dizziness, apathy;
- increase in body temperature( with hepatitis of viral nature).
May reveal other causes of increased bilirubin levels. These include the hereditary deficiency of liver enzymes, this pathology is called Gilbert's syndrome. In patients, the level of bilirubin in the blood is significantly increased, so the skin and eye sclera often have a yellow tint.
In diseases of the biliary system, for example, cholelithiasis, the patient usually displays the following symptoms:
- jaundice of the skin and sclera;
- pain in the right upper quadrant( with hepatic colic very intense);
- bloating, stool( diarrhea or constipation);
- discoloration of feces and darkening of urine;
- itching itch.
Unlike blood and liver diseases, in this situation, the amount of direct( bound) bilirubin that has already been rendered harmless by the liver is increased.
Extrahepatic causes of
Development of superhepatic jaundice is caused by increased destruction of red blood cells. This increases the predominantly free fraction. Among the diseases are:
- hemolytic and B12-deficient anemia;
- extensive hematomas;
- exposure to toxic substances on blood cells;
- response to transfusion of foreign blood or organ transplant;
When the metabolism of bilirubin is disturbed, its quantitative indices in the bloodstream can become large. This is expressed by jaundice, or by staining the mucous membranes and skin in yellow.
- If the concentration of bile pigment in the serum reaches 85 μmol / l, then is said to be a mild form of enhancement.
- The moderate-to-severe is jaundice with an index of 86-169 μmol / l, heavy - with figures above 170 μmol / l.
Depending on the type of jaundice, its manifestations are of a different nature. The skin can acquire a bright yellow, green or saffron-yellow hue. In addition, with increased bilirubin, there is a darkening of the urine( it becomes the color of dark beer), a strong itching of the skin.
Other symptoms may include:
- bitterness in the mouth;
- darkening of urine;
- white color of feces;
- general weakness;
- memory and intellectual disabilities;
- enlargement of the liver in size and severity in the right hypochondrium.
How to treat elevated bilirubin in the blood
You can reduce bilirubin only after determining the cause of the increase. This means that you will have to pass tests for viral hepatitis, liver tests( determining the activity of asth, alkaline phosphatase, etc.), to undergo ultrasound of the liver and more specific studies.
In this case, treatment in adults is mainly etiotropic, that is, it affects the leading disease. For example, if the patency of the bile ducts is impaired, stone or tumor removal is necessary, in some cases stenting of the ducts is effective.
With strongly elevated bilirubin due to the expressed hemolysis of erythrocytes, infusion therapy with the introduction of glucose, albumin, and also plasmapheresis is shown. With jaundice of newborns, phototherapy is very effective, in which ultraviolet irradiation of the skin contributes to the conversion of free toxic bilirubin into a bound, easily excreted from the body.