TOTAL BILIRUBIN

UVOD STA CU RECI

1. uvod: što je bilirubin(vrsta stanice, sto radi), ,

u kojem sustavu se bilirubin nalazi(opis),
normalne vrijednosti bilirubina u krvi,
forms of bilirubin(other names for bilirubin)

Bilirubin is an orange-yellow pigment, a waste product primarily produced by the normal breakdown
of heme. Heme is a component of hemoglobin, which is found in red blood cells (RBCs). Bilirubin is
ultimately processed by the liver to allow its elimination from the body. It's excreted in urine and bile.
RBCs normally degrade after about 120 days in circulation. As heme is released from hemoglobin, it is
converted to bilirubin.

-This form of bilirubin is also called unconjugated bilirubin. Unconjugated bilirubin is carried by
proteins to the liver; there, sugars are attached (conjugated) to bilirubin to form conjugated bilirubin.
Conjugated bilirubin enters the bile and passes from the liver to the small intestines; there, it is
further broken down by bacteria and eventually eliminated in the stool. Thus, the breakdown
products of bilirubin give stool its characteristic brown color.
-Unconjugated bilirubin—when heme is released from hemoglobin, it is converted to unconjugated
bilirubin. It is carried by proteins to the liver. Small amounts may be present in the blood.
Conjugated bilirubin—formed in the liver when sugars are attached (conjugated) to bilirubin. It enters
the bile and passes from the liver to the small intestines and is eventually eliminated in the stool.
Normally, no conjugated bilirubin is present in the blood.
When I mention something about Total bilirubin, it's both Conjugated and Unconjugated bilirubin

Most (85%) of bilirubin is derived from damaged or degraded RBCs, with the remaining amount
derived from the bone marrow or liver

What are normal bilirubin levels in adults?

Normal values of direct bilirubin range from 0 to 0.4 mg/dL.
Total bilirubin (direct and indirect) range from about 0.2 to 1.2 mg/dL (some lab values range as high
as 1.9 mg/dL). Medical literature sources have minor variations in "normal" levels).
Low levels of bilirubin may be due to certain medications such as theophylline (Elixophyllin, Theo-24),
phenobarbital, and increased vitamin C levels.
Bilirubin is a bile pigment that is orange-yellow in color. It is formed during the normal breakdown of
red blood cells (hemoglobin), and is excreted in the bile. Bilirubin can be classified as indirect (free or
unconjugated) while it is circulating and is considered as direct after conjugation in the liver with
glucuronic acid.

2. razrada: test
kada dolazi do povecane proizvodnje bilirubina,
njegovi simptomi(kod odraslih i kod novorodencadi),
nacin testiranja(na koji nacin, koji sample,pripreme, rizik testa)
sto rezultat moze pokazati
A bilirubin test is used to detect an increased level in the blood. It may be used to help determine the
cause of jaundice and/or help diagnose conditions liver disorders such as liver disease, hemolytic
anemia, and blockage of the bile ducts.
Usually, a chemical test is used to first measure the total bilirubin level (unconjugated plus
conjugated bilirubin). If the total bilirubin level is increased, the laboratory can use a second chemical
test to detect water-soluble forms of bilirubin, called "direct" bilirubin. The direct bilirubin test
provides an estimate of the amount of conjugated bilirubin present. Subtracting direct bilirubin level
from the total bilirubin level helps estimate the "indirect" level of unconjugated bilirubin. The pattern
of bilirubin test results can give the healthcare provider information regarding the condition that may
be present.

For example, unconjugated bilirubin may be increased when there is an unusual amount of RBC
destruction (hemolysis) or when the liver is unable to process bilirubin (i.e., with liver diseases such as
cirrhosis or inherited problems). Conversely, conjugated bilirubin can increase when the liver is able to
process bilirubin but is not able to pass the conjugated bilirubin to the bile for removal; when this
happens, the cause is often acute hepatitis or blockage of the bile ducts.
What do high bilirubin levels in a newborn mean?

High bilirubin levels in a newborn usually is the result of unconjugated bilirubin, and is not a major
problem for many newborns because they soon metabolize the unconjugated bilirubin normally.
These neonates usually clear jaundice within a week. However, very high unconjugated bilirubin
levels over time (weeks) can be neurotoxic and can even cause death or lifelong neurological
problems (kernicterus) in those who survive. Newborn jaundice may be the result of an underlying
problem, for example:
A family history of Gilbert syndrome
Genetic problems
Birth trauma
Maternal drug intake
Viral infection or a problem with bleeding
Liver and/or bile function

When to Get Tested?

When you have signs or symptoms of liver damage, liver disease, bile duct blockage, hemolytic
anemia, or a liver-related metabolic problem, or if a newborn has jaundice
Why Get Tested?
To screen for or monitor liver disorders or hemolytic anemia; to monitor neonatal jaundice
What are symptoms of high bilirubin levels in adults?
In adults, jaundice (yellowish coloration of sclera the eye and/or the skin) and itching are the major
symptoms and signs of elevated bilirubin levels in the blood.
The following are some of the potential underlying causes of elevated bilirubin and associated and
their associated symptoms and signs (this is a short list, not complete list):
What do high bilirubin levels in adults mean?
Red blood cell breakdown is more than usual (for example, a blood transfusion reaction)
Liver scarring
Liver inflammation
Other diseases of the liver such as infections
Dysfunction of the common bile duct
Gallstones
Cancer of the pancreas or gallbladder

Anemia (red blood cell destruction as a cause) symptoms and signs include
weakness,
pallor, and
jaundice.

Viral hepatitis symptoms and signs include

fatigue,
mild fever,
muscle aches,
nausea and vomiting, and
jaundice.

Biliary obstruction symptoms and signs include

light-colored stools,
dark urine,
itching,
pain in the right side of the abdomen,
nausea,
vomiting, and
jaundice.

Signs and symptoms of infections (for example, malaria) include

recurrent fever/chills, and
weakness.

Genetic diseases (for example, sickle-cell disease, and hereditary spherocytosis) have symptoms and
signs of abdominal pain, and/or abnormal red blood cells.

Liver (hepatic) causes (for example, cirrhosis, liver cancers, drugs, toxins, Gilbert's and Crigler-Najjar
syndromes) include symptoms and signs of abnormal liver enzymes, and
liver masses.

High bilirubin level in the newborns usually is indicated by jaundice of the skin, usually appearing on
the face and forehead first, and later spreading to the trunk and extremities. Other changes such as
drowsiness, seizures and altered crying may occur if high levels persist. Some newborns may have
petechiae, an enlarged spleen and anemia due to hemolysis and can progress to develop neurologic
problems or even death.

What are the symptoms of high bilirubin levels in newborns?

In both physiologic jaundice of the newborn and hemolytic disease of the newborn, only
unconjugated (indirect) bilirubin is increased.
In much less common cases, damage to the newborn's liver from neonatal hepatitis and biliary
atresia will increase conjugated (direct) bilirubin concentrations as well, often providing the first
evidence that one of these less common conditions is present.

Sample Required?
In adults, a blood sample drawn from a vein in the arm; in newborns, a blood sample from a heelstick;
non-invasive technology is available in some healthcare facilities that will measure bilirubin by using
an instrument placed on the skin (transcutaneous bilirubin meter)
Test Preparation Needed?
You may need to fast (nothing but water) for several hours before the test; fasting requirements vary
by laboratory; ask your lab or healthcare provider for instructions.
How is the sample collected for testing?
In adults, blood is typically collected from a vein in the arm using a needle. In newborns, blood is often
collected from a heelstick. Heelstick is a technique that uses a small, sharp blade to cut the skin on the
infant's heel so that a few drops of blood can be collected in a small tube. Non-invasive technology
that measures bilirubin through the skin is available in some healthcare facilities; this instrument is
called a transcutaneous bilirubin meter.

How do I prepare for the bilirubin test?

 In general, patients are often asked to fast (only drink water) for several hours before
the test.
 Avoid strenuous exercise before the test as this may elevate bilirubin levels.
 Avoid drugs such as caffeine, penicillin, salicylates, and others as they can decrease
bilirubin levels.

What is the prognosis for an adult with elevated bilirubin levels?

The prognosis in an adult with high bilirubin levels may range from good to poor, depending
upon the underlying cause of the elevation. For example, most hepatitis A patients recover
completely while patients with liver cancer or cirrhosis may have a poorer outcome.

What is the prognosis for newborns?

In general, newborns have a good outcome if the bilirubin levels decrease quickly (over a few
days); however, the prognosis is not good if the newborn has persistently high bilirubin levels

3. zaključak: prevencija
treatment

What is the treatment for elevated bilirubin in adults?

The treatment for elevated bilirubin in adults is to first determine the underlying cause for example,
clot reabsorption,
hemolytic anemia, and
liver and/or bile problems.
Experts suggest avoiding alcohol consumption to prevent further liver toxicity.

Can high levels of bilirubin be prevented?

High levels of bilirubin may be prevented in neonates by appropriate treatment. Primary

therapy for newborns is phototherapy, followed by exchange transfusions and intravenous
immunoglobulin. Your newborn's pediatrician will help manage your newborn's bilirubin
levels.

Management of high levels of bilirubin in adults vary with the underlying cause. In general,
though, adults with elevated bilirubin levels are urged not to drink alcohol, and to avoid any
compounds that may harm or stress the liver's function. Your health-care professional can
help you determine what you should do, and what you should avoid depending on your
underlying problem that is causing the elevated bilirubin levels.

DIET
Eat Nutrient-Rich Foods

Your liver processes the nutrients you eat into energy and filters out toxins in your blood. Eating a
diet filled with nutrient-rich foods can help your liver function properly and may help your body
better process bilirubin to keep levels within an acceptable range. Nutrient-rich foods for a healthy
liver include whole grains; fruits; vegetables; lean sources of protein such as fish, poultry and beans;
low-fat dairy; and healthy fats such as oils.

Limit your intake of foods high in unhealthy fat such as fried and fast food, and foods with added
sugar such as soda, cakes and cookies. Getting high amounts of unhealthy fat and sugar in your diet
may increase fat deposits and inflammation in your liver. The American Liver Foundation
recommends you limit your intake of salt as well. Alcohol can also damage the liver, so women
should have no more than one alcoholic drink a day and men no more than two.

http://www.webmd.com/digestive-disorders/bilirubin-15434#2