4. What is the clinical significance of abnormal total bilirubin values? Correlate with pre-hepatic, hepatic, and post-hepatic jaundice.

Total bilirubin value consists of 3 fractions. These fractions include the unconjugated bilirubin, conjugated bilirubin and the delta bilirubin. Because they compose the total bilirubin, an increase in the total bilirubin value also indicates that one of the factor surpass the normal limit. Abnormal total bilirubin values as a result of an increase of at least one of the fractions, indicates a problem in the bilirubin metabolism. Jaundice is an illness brought about by having high bilirubin values. It can be pre-hepatic, hepatic, or psot-hepatic. Pre-hepatic jaundice is a type of jaundice in which the affected fraction of bilirubin is the unconjugated form which results from abnormalities of the processes prior to the liver metabolism. It is most commonly caused by an increased amount of red blood cell production and the subsequent release of increased amounts of unconjugated bilirubin presented to the liver for processing. Due to the increase in the unconjugated bilirubin, there is also an increase in the total bilirubin. Hepatic jaundice occurs when the problem involves the liver metabolism. In this type, either the unconjugated or conjugated form increases, depending on the specific disorder involved. Disorders such as Gilbert disease and Crigler-Najjar syndrome are characterized as primarily unconjugated hyperbilirubinemias whereas Dubin-Johnson syndrome and Rotor syndrome are characterized as conjugated hyperbilirubinemia. Also, Physiologic jaundice of the newborn results to unconjugated hyperbilirubinemia due to the absence of the enzyme, glucuronyl transferase which is responsible for bilirubin conjugation. Lastly, post-hepatic jaundice is a condition if the problem occurs after liver metabolism. Usually, this is a result of biliary obstructive disease as a result of physical obstructions. In post-hepatic jaundice, both the conjugated and unconjugated form increases which also results to an increase in total bilirubin.

6. What is the delta bilirubin? Describe its characteristics and clinical significance. Delta bilirubin is conjugated bilirubin that is covalently bound to albumin. This fraction of bilirubin is seen only when there is significant hepatic obstruction. Because the molecule is attached to albumin, it is too large to be filtered by the glomerulus and excreted in the urine. This fraction of bilirubin, when present, will react in most laboratory methods as conjugated bilirubin. One condition which results from the presence of delta bilirubin is the Dubin-Johnson syndrome. This syndrome is characterized by hyperbilirubinemia and bilirubinuria.

Reference:

Bishop, M. L., Fody, E. P., Schoeff, L. E. (2010). Clinical Chemistry. Philadelphia: Lippincott Williams & Wilkins

*Daphne, pasensya na ha. Medyo mahaba ata. BTW, salamat