Long-term high bilirubin. Causes of Loss of Important Minerals

One of the key complexes of biochemical blood analysis is the study of pigment metabolism. It can be assessed using indicators of total bilirubin and its individual fractions.

What is bilirubin

This is a pigmented substance that is formed in the human body and circulates through only one metabolic pathway. Its direction includes several consecutive links of the bilirubin cycle.

Among them stand out:

1. The formation of bilirubin. Occurs in the spleen when red blood cells that have completed their life cycle are destroyed. Total bilirubin is formed during the breakdown of hemoglobin. Through the splenic vein, it is directed to the systemic circulation. Through the portal vein, it is brought to the liver, where it is detoxified.
2. Conjugation. This process is based on the connection of bilirubin with glucuronic acid in the liver. This is necessary to neutralize blood bilirubin, since the substance is very toxic.
3. Withdrawal. Associated (conjugated) in the liver, bilirubin is less toxic, so it can be quickly excreted from the body. This happens through its excretion along with bile from the liver into the duodenum 12. Most of it is excreted in the form of stercobilin with feces. The part absorbed in the small intestine is excreted in the form of urobilin by the kidneys along with urine.

Types of bilirubin

The substance bilirubin is present in the body in the form of several fractions:

1. indirect fraction- bile pigment. The indirect fraction is insoluble in water and is able to penetrate the cell membrane. This property explains the toxic effect. This fraction is synthesized in the reticuloendothelial system as a result of enzymatic transformation of heme, which is formed during the breakdown of hemoglobin. After that, the substance binds to proteins, usually albumin, and ends up in the liver.
2. Direct (free) a fraction is formed in the liver by combining with glucuronic acid. This reaction allows the pigment to acquire water-soluble properties, as well as enter the duodenum along with bile. Bilirubin undergoes further changes in the gastrointestinal tract. A small part of it goes back into the blood, after which it is excreted in the urine, passing through the filtration in the kidneys. Basically, as a result, it is transformed into stercobilin, which is part of the feces and gives it a characteristic color.
3. total bilirubin in a biochemical blood test - the result of adding the concentration of free and indirect fractions. The value of this indicator is the main guideline in assessing the exchange of bilirubin, it helps to establish the feasibility of determining the indicators of individual fractions. If total bilirubin is normal, further study of bilirubin fractions is not advisable. If this indicator is increased, it becomes necessary to carefully study the individual fractions of the substance in order to determine the reasons for the increase in bilirubin levels.

How is bilirubin formed and excreted?

Blood test for bilirubin

Biochemical analysis is performed on an empty stomach, the sample is taken from a vein. To obtain reliable results, alcohol and fatty foods should be avoided at least 24 hours in advance.

The result is also affected by:

• Pregnancy;
• Some drugs that affect the coagulation system (Heparin, Warfarin, Aspirin);
• Overeating or a strict diet;
• Cholagogue herbs;
• Caffeinated drinks.

Usually, a blood test to determine the bilirubin index is done in the following cases:

• If symptoms of jaundice occur (this also applies to newborns);
• For the purpose of diagnosing hepatic function in cirrhosis, tumors, hepatitis;
• In the presence of pancreatitis or gallstone disease;
• With poisoning and various toxic effects;
• With the development of hemolytic disease;
• As a control of the effectiveness of therapy.

Biochemical analysis makes it possible to assess the state of bilirubin metabolism. It determines the indicators of total, direct (free) and indirect bilirubin.

Generally accepted norms of bilirubin metabolism

Index	In a child during the first few days of life, µmol/l	In a child during the first two weeks of life, µmol/l	In a child aged after a month of life, µmol/l	In adults, µmol/l
General	24 – 190	28 – 210	3,5 – 20,4	8 – 20,5
Straight	0,5 – 10,2	1 – 12,4	0 – 5,1	0 – 5,1
Indirect	23,5 – 179,8	27 – 197,6	less than 16.5	less than 16.5

Why is high bilirubin dangerous?

Bilirubin is an extremely toxic substance that causes intoxication and disruption of the functioning of the body's organs. Brain tissue is the most sensitive in this regard. The remaining systems (liver, kidneys, heart) are more resistant to exposure and are able to function for a long time with an increased content of bilirubin. The duration of such functioning is determined by hyperbilirubinemia - the degree of severity of the increase.

Patterns and degrees of increase in bilirubin

The degree of increase in bilirubin	State characteristic
A slight excess of the norm	TO this species hyperbilirubinemia refers to an increase in total bilirubin to a level of 50 to 70 µmol / l. This condition does not pose a direct threat to the body, since it does not cause toxic damage to organs. A person is able to live for a long time with a slight excess, but it is imperative to determine the cause of the increase.
A pronounced increase in the norm of bilirubin	In this state, the concentration of bilirubin is in the range from 150 to 170 µmol/l. This condition carries a non-critical danger to the body. Long-term existence with this level of hyperbilirubinemia causes bilirubin intoxication, which must be eliminated as soon as possible.
Severe hyperbilirubinemia	It means a condition when the bilirubin index is elevated to a level of 300 µmol / l. In this state, there is an immediate threat to human life caused by severe intoxication and impaired functioning of organs.
Extremely severe degree of hyperbilirubinemia	In this state, the indicators exceed the concentration of 300 µmol / l and are critical for human life. If the cause of the increase is not eliminated in a few days, the patient will die.

Symptoms of increased hyperbilirubinemia

With increased bilirubin, the following manifestations can be observed:

• Jaundice of the sclera of the eyes and skin. It manifests itself when the concentration of a substance exceeds 50 µmol / l. The intensity and nature of the manifestation are determined by the degree of increase in the concentration of the substance and the causes of the pathology;
• General weakness;
• Bitterness in the mouth;
• itchy skin;
• White stool;
• dark urine;
• Violation of intellectual abilities and memory;
• An increase in the size of the liver and a feeling of heaviness in the right hypochondrium.

How does bilirubin work

Causes of increased bilirubin levels

The main diseases that can increase the level of bilirubin:

Fraction of bilirubin	The main reasons for the increase in bilirubin
The predominant increase in the level of indirect bilirubin due to excessive destruction of red blood cells.	Hemolytic jaundice
	Hemolytic anemia;
	Infectious diseases (eg malaria);
	Hypersplenism and splenomegaly;
	Intoxication of internal and external origin;
	Incompatibility of transfused blood groups;
	Hemolysis and Rhesus conflict in newborns.
A predominant increase in the level of direct bilirubin due to a violation of the function of the outflow of bile.	Obstructive jaundice
	Atresia of the bile outflow system;
	Choledocholithiasis and the presence of stones in the bile ducts;
	Mirizzi syndrome;
	Cholangitis;
	Cancer of the gallbladder and biliary tract;
	Pancreas cancer;
	Chronic pancreatitis;
	Caroli disease.
An increase in the level of total bilirubin with a uniform distribution of fractions. characteristic of liver pathologies.	Parenchymal jaundice
	Liver damage caused by infectious diseases of any localization with sepsis;
	Toxic and viral hepatitis;
	Malignant liver cancer with metastases;
	Cirrhosis of the liver;
	Fatty hepatosis;
	Genetic disorders of enzymes that carry out bilirubin metabolism (Dabin-Jones, Gilbert, Rotor syndromes);
	Budd-Chiari syndrome;
	Pylephlebitis.

How to treat hyperbilirubinemia

An increase in the level of bilirubin is not a separate pathological condition that requires specific treatment. This phenomenon should be considered only as a sign of a number of diseases. And it is necessary to correctly determine the disease that caused the changes in the results of the analysis, since without its treatment it is impossible to normalize bilirubin.

There is only one condition where mild hyperbilirubinemia can be corrected through a special diet or other means - this is a genetic disorder of the enzymes of bilirubin metabolism in the liver. In other cases, it does not make sense to act directly on bilirubin, it is necessary to undergo an examination to detect the disease as early as possible, since complex treatment and even a complex operation may be required.

To reduce the toxic effects of bilirubin, detoxification methods are used (including the introduction of solutions of glucose, gemodez, protein).

The diagnostic significance of a high bilirubin level is maximized by the early detection and correct assessment of the deviation from the norm.

Causes of a decrease in bilirubin levels

A decrease in the level of bilirubin is observed quite rarely. This is usually caused by ischemic damage to the heart. However, this is not a specific sign, and it is not used in the diagnosis of the disease. Also, a decrease in the concentration of bilirubin may occur as a result of taking certain drugs (Ascorbic acid, Phenobarbital, Theophylline).

Often a low level of a substance is recorded as a result of erroneous test results, so in such cases it is advisable to re-examine.

Results

Bilirubin is formed from destroyed red blood cells through the processing of hemoglobin. The content of bilirubin is one of the indicators of the functioning of metabolism, liver and spleen.

Video - liver health: bilirubin test

One of the liver indicators of a biochemical blood test is listed as total bilirubin, which in turn is divided into two more types: direct and indirect. Many have faced the problem of elevated bilirubin and know that its levels rise with various malfunctions in the liver. In addition, an increase in bilirubin is observed in many infants in the first week of life and is accompanied by a slight jaundice. In most cases, an increased level of this indicator is accompanied by violations of the metabolic processes of the liver and is characterized by yellowness of the sclera or skin.

Bilirubin and its features

One of the components of hepatic bile is bilirubin, a dark yellow substance that is formed in the liver cells at the time of the breakdown of erythrocytes, cytochromes and myoglobin.

The main breakdown of erythrocyte molecules is carried out in the liver, in the tissues of the spleen, and a little in the bone marrow. During the day, more than 1% of all red blood cells in the body are destroyed, and the hemoglobin released from them forms approximately 300 mg of bilirubin. It is a pigment that, in certain amounts in the blood, is necessary for the normal functioning of the body as a whole. An increase in the molecules of this substance in the blood indicates a malfunction.

Symptoms and manifestations of hyperbilirubinemia - yellowness of the skin and sclera, which occur against the background of a violation of the metabolic processes of bilirubin, are not a secret for scientists today. Both the structure of molecules and all metabolic processes have been thoroughly studied. Therefore, the diagnosis, as a rule, is not difficult for the doctor.

Mechanism of bilirubin exchange

After the destruction of red blood cells, the resulting bilirubin is a water-insoluble molecule with a high concentration of toxic substances. As it progresses, bilirubin goes through several stages of transformation:

• In blood plasma, bilirubin molecules bind strongly to albumin proteins, which are its vehicle for delivery to the liver tissues. The protein-bilirubin complex cannot overcome the renal filter, so these compounds do not enter the urine.
• In the liver, separation from albumin occurs and bilirubin penetrates into the liver cells, in which it continues its further movement.
• Further, bilirubin molecules bind to glucuronic acid molecules and form bilirubin-diglucuronides - water-soluble direct bilirubin molecules that can overcome the renal barriers and, accordingly, be excreted from the body by the urinary system.
• At the final stage of metabolic processes, excretion occurs, or the excretion of molecules with bile flow. Bilirubin enters the intestine in the form of urobilinogens - molecules of unbound bilirubin. A small amount of the substance is absorbed by the intestinal mucosa, and most of it is excreted in the form of strecobilinogen in the stool.

Norm of bilirubin

So, in the process of metabolism, bilirubin molecules are converted into bound direct bilirubin and unbound, free bilirubin. The level of bilirubin of all three types of compounds in the blood serum and are the starting point for determining the degree of damage.

For indicators of bilirubin, the norm is derived in the content of mmol per liter, this is:

• Unconjugated bilirubin (indirect, unbound, free). These are toxic compounds formed during hemolysis. In a healthy person, the indicator of unconjugated bilirubin should be 16.2 mmol / l.
• Direct bilirubin (conjugated, bound). It is formed in liver cells by binding to glucuronic acid molecules. These are non-toxic, water-soluble compounds that are ready to be removed from the body. The norm of direct bilirubin is 0 - 4.3 mmol / l.
• Indicators of total bilirubin are usually in the range from 0.5 mmol / l to 20.5 mmol / l.

With the development of the disease, the level of one or another indicator of bilirubin increases. The predominance of both direct and indirect connections depends on various pathological processes occurring in the body.

The main symptom of exceeding the level of bilirubin of its norm is the yellowness of the integumentary tissues, which is formed when the level rises more than 34 µmol / l.

In severe pathologies, the indicators of this substance can exceed the permissible norm by tens. This condition is considered critical and requires emergency intervention, as it can lead to a sad outcome.

Symptoms of high bilirubin

The main organ that plays a major role in the transformation of this substance is the liver cells. appear in a person if the liver cannot cope with the processing of the large amount of bilirubin that is formed. In addition, yellowness may appear due to a mechanical violation of the outflow of bile, which has formed an obstacle to the normal excretion of bound bilirubin molecules.

The severity of skin symptoms does not always correspond to the level of bilirubin in jaundice. So in obese people suffering from edema, the yellowness of the skin can be almost imperceptible, while people with normal or low body weight are prone to a more pronounced manifestation of jaundice, even with a slight increase in bilirubin.

Basically, the causes of elevated bilirubin are the result of its excessive formation or a violation at any stage of its transformation. Indicators of the level of bilirubin, exceeding normal numbers, affect the severity of jaundice in various tissues.

• The sclera of the eyes are most sensitive to increased bilirubin. Usually they turn yellow first, even with a slight increase in bilirubin.
• Further, the mucous membranes of the oral cavity react.
• And only then the yellowness becomes noticeable on the skin. In this case, first of all, a change in pigmentation is noted on the face, feet and palms, and then spreads over all the skin.

The yellowness of the skin is not always associated with high levels of bilirubin in serum. So, carotene-containing foods, such as carrots or tomatoes, can affect the icteric shade of the skin. In addition, jaundice can accompany diabetes mellitus or hyperthyroidism. But with these diseases, the sclera of the eyes do not change their color.

Diseases characterized by elevated levels of bilirubin

There is a high bilirubin in the blood serum in diseases such as:

• acute form of food-borne hepatitis "A" and viral hepatitis "B" with the presence of infectious mononucleosis;
• chronic form of hepatitis "C" and autoimmune types of hepatitis;
• hepatitis of bacterial etiology, such as brucellosis and leptospirosis;
• poisoning with various toxic substances - these can be fungi, hormonal contraceptives, antitumor or anti-tuberculosis drugs;
• jaundice during pregnancy;
• biliary cirrhosis.

Diseases that cause an increase in indirect bilirubin in the blood:

• Anemia of congenital origin, for example, thallasemia, non-spherocytic, spherocytic and sickle cell.
• Autoimmune disorders (acquired anemia) resulting from diseases such as:
  • rheumatoid arthritis,
  • systemic lupus,
  • lymphogranulomatosis,
  • lymphocytic leukemia.
• Diseases of an infectious nature such as typhoid fever, malaria and sepsis.
• Hemolytic anemia caused by taking antibacterial drugs of such groups as:
  • penicillins,
  • Cephalosporins,
  • Levomycetin,
  • Levofloxacin,

as well as aspirin and insulin.

• Crigler-Najjar syndrome.
• Toxic conditions that develop after poisoning with poisons, heavy metal salts, insect or reptile bites.
• Gilbert's syndrome.

Types of jaundice and causes of increased levels of bilirubin in the blood

If bilirubin is noted in the blood with high rates, this can be triggered by three main reasons, such as:

• violation of the rate of destruction of erythrocytes, both slowing down and accelerating;
• obstructed outflow of bile;
• violation of the process of bilirubin metabolism and its removal from the body.

Violation of the breakdown of red blood cells

A significant increase in the level of unbound bilirubin in the blood serum in hemolytic jaundice is explained by an enhanced hemolysis process that develops against the background of hereditary erythrocyte pathologies or some external pathological factors:

• infectious diseases: malaria, typhoid fever, sepsis, mycoplasmosis;
• poisoning with toxic substances: poison of a pale toadstool, lead, poison of reptiles;
• transfusion of incompatible donor blood with the recipient's blood: differences can be not only in group affiliation and Rh factor, but also in the characteristics of formed elements;
• blood cancers (leukemia, myeloma) and liver tumors;
• massive internal hemorrhages, for example, pulmonary infarction or giant hematoma.

Any type of hemolytic jaundice is characterized by symptoms such as:

• bright lemon color of the sclera, mucous membranes and skin;
• general anemia caused by increased death of red blood cells, and against this background, pallor of the skin;
• on palpation, an increase in the spleen is noted, and the borders of the liver are palpated;
• significant darkening of feces and urine against the background of an increased content of urobilin and stercobilin;
• headache attacks, tachycardia and reduced performance against the background of oxygen starvation of tissues.

Difficulty in the flow of bile

With the formation of any obstacle in the way of the outflow of bile, bound bilirubin begins to flow back into the blood, which provokes the development of subhepatic jaundice. This picture is typical for cholelithiasis, acute or chronic form of pancreatitis, malignant tumor of the pancreas, hepatic aortic aneurysm, duodenal diverticulum or gallbladder tumor.

The penetration of conjugated bilirubin back into the blood is expressed in laboratory parameters as an increase in direct bilirubin, the rate of which depends on the free excretion of associated molecules. The most common causes of such a picture are such pathologies as:

• the formation of an internal obstruction in the bile ducts, a tumor, a helminthic lump, stones;
• external compression of the biliary tract by tumor formations on the bladder itself, the head of the pancreas, or swelling of the lymph nodes;
• inflammation of the tissues of the bile ducts complicated by sclerosis or narrowing of the internal lumen;
• anomalies of intrauterine development, severe underdevelopment of the gallbladder and ducts.

Hyperbilirubinemia of conjugated bilirubin is characterized by symptoms such as:

• pronounced jaundice of the skin;
• severe subcutaneous itching and significant scratching against this background;
• a blood test shows high numbers of bound bilirubin, since liver function is not impaired and the influx of bilirubin molecules into the blood comes from two sides;
• the absence of stercobyrin in the feces completely deprives them of their color, while the urine acquires a rich dark color;
• periodic bouts of pain on the right side of the hypochondrium, a picture of hepatic colic;
• dyspeptic disorders such as:
  • nausea, vomiting,
  • bitter burp,
  • loss of appetite,
  • constipation, diarrhea.

Violation of metabolic processes and excretion of bilirubin

Malfunctions in the metabolism of bilirubin lead to its excessive accumulation in the blood, which causes jaundice. A similar situation develops as a hereditary disease or acquired, due to complications of other pathologies.

hereditary jaundice

The main changes in the function of the hepatic stage of bilirubin conversion are impaired binding, transport and excretion of molecules, which causes symptoms of hereditary jaundice, for example:

• Dubin-Johnson Syndrome,
• Gilbert's Syndrome
• Crigler-Najjar syndrome.

More often than other hereditary pathologies, Gilbert's Syndrome occurs. This is not a disease in the full sense of the word, but a state of the body in which there is a slight increase in bilirubin. Pathology does not require special treatment, as it does not threaten life.

The causes of the pathology are hidden in the insufficient enzymatic activity of the liver cells, whose duty is to bind bilirubin and glucuronic acid, which leads to the release of a large amount of unbound bilirubin.

Such a pathology occurs against the background of a defect in the development of the genes of the second chromosome and is transmitted exclusively by inheritance. The frequency of this pathology is not the same in different countries. So in Europe, the syndrome occurs in about 5% of people, and in Africa, this gene disorder is recorded in 36% of the population.

Basically, Gilbert's syndrome does not bother the patient and proceeds without pronounced symptoms. Occasionally, exacerbations of the disease may occur against the background of severe stress, overwork, or alcohol poisoning. The disease does not require special treatment, and the exacerbation subsides on its own after the exclusion of the cause of its occurrence.

Acquired jaundice

The mechanism of development of this pathology lies in the huge amount of formation of total bilirubin, which do not have time to bind liver cells even with increased albumin production. And, accordingly, incomplete excretion of bilirubin from the body.

This type of jaundice is called parenchymal or hepatic jaundice. This is a common type of pathology, which is characterized by an increase in the level of direct bound bilirubin. A similar condition develops as a complication of certain diseases that adversely affect the parenchymal tissue of the liver, damaging it. As a result, the capture of bilirubin molecules by the liver cells, its binding and removal from the body is disrupted. In addition, if the outflow is disturbed, some of the molecules penetrate back into the bloodstream, causing cholestasis or stagnation of bile. Most often, this picture is observed against the background of hepatitis or cirrhosis of the liver.

Hepatitis is an extensive group of inflammatory liver cell diseases. Hepatitis provocateurs are viruses that infect liver cells (hepatitis "A", "B", "C", "D", "E"). Also, inflammation of the liver can occur against the background of taking medications, alcohol, or autoimmune disorders. The acute form of acquired jaundice, which develops as a complication of a viral infection, is characterized by symptoms such as:

• general intoxication (nausea, fever, tachycardia);
• severe weakness throughout the body;
• pain in the joints and muscles, often accompanied by muscle spasm;
• pain syndrome localized in the right hypochondrium;
• yellowing of the sclera, mucous membranes and skin;
• discoloration of the stool and darkening of the urine;
• significant increase in bilirubin levels compared to the norm.

These diseases have a very poor prognosis. The development of pathology involves an increasing number of parenchyma cells in the process. At the same time, there is a difficulty in the removal of bile, which provokes the appearance of severe itching under the skin, bleeding of the pores, the development of encephalopathy (damage to brain cells).

Against the background of these lesions, without immediate adequate assistance, renal and hepatic insufficiency develops, which is often the cause of death (see).

The chronic form of hepatitis in most cases occurs as a result of acute viral, drug or alcohol intoxication of liver cells. External symptoms of the chronic form are only yellowing of the sclera and skin, as well as blood test indicators. During periods of exacerbation, joint pain, fever, and skin rashes may occur.

Cirrhosis of the liver- This is a serious disease in which liver cells die, and connective tissue forms in their place, unable to perform the necessary functions. In other words, segments of hepatocytes disappear on the liver, the vascular and capillary network is destroyed, extensive foci of connective tissue are formed.

As a result, the liver becomes unable to bind or remove from the body not only bilirubin, but also other compounds to be removed. Cirrhosis occurs mainly as a result of severe inflammatory damage to the liver cells.

Symptoms in this case are characterized by such manifestations as:

• a significant increase in the volume of the liver and spleen;
• skin itch,
• ascites - accumulation of fluid in the abdominal cavity;
• varicose veins of organs such as the esophagus, rectum, anterior abdominal wall;
• pronounced jaundice of the whole body.

Further symptoms of cirrhosis are expressed in the following changes:

• insufficient liver function;
• pronounced signs of brain dysfunction;
• a sharp decrease in blood clotting properties, which leads not only to blood sweating on the skin, but the development of extensive internal hemorrhages in all organs (intestinal, gastric, uterine, pulmonary).

The prognosis of liver cirrhosis is unfavorable, in 70% of cases it is fatal.

Causes of increased bilirubin in newborns

In the first days of life, the body of a newborn tolerates physiologically provided slight jaundice, during this period the rate of bilirubin in newborns slightly increases.

The mechanism of this process is due to the transition of the baby to an independent existence. The child in the first minutes gets into a hostile environment for him and tries to adapt to life in it. In this case, fetal hemoglobin is replaced by adult-type hemoglobin, which, of course, is accompanied by the death of some part of the erythrocytes. After a week, bilirubin in children returns to normal and its indicators do not differ from the generally accepted ones.

In children born before the due date or having with the mother's blood, there may be a significant increase in the level of unbound hemoglobin in the blood. As a result, there are signs of kernicterus with brain damage, which is a severe pathology that threatens life.

Before taking any action to help the newborn, pediatricians determine the cause of the increase in bilirubin. This is necessary so that resuscitation does not aggravate the situation. These can be pathologies such as:

• the breakdown of erythrocytes as a physiological process;
• damage to the liver tissue;
• anomalies in the development of the biliary tract;
• blood incompatibility.

Methods for lowering bilirubin

There is no specific treatment for jaundice, since it is not a disease, but a symptom of other pathologies. Therefore, before taking any action, it is necessary to establish this cause. In any case, you should not take any drugs on your own.

Emergency measures to reduce bilirubin in a clinical setting include intravenous administration of glucose solutions, albumin, drugs that enhance the production of liver enzymes. As well as performing plasmapheresis. Newborns are treated with ultraviolet light and phototherapy.

It is important to remember that jaundice is a symptom of serious and dangerous diseases, therefore, in order to avoid a fatal outcome, you should immediately consult a doctor.

Bilirubin is a bile pigment, one of the components of human bile. The substance got its name from the Latin words bilis (bile) and ruber (red).

The formation of bilirubin occurs as a result of a complex and continuous process of splitting hemoglobin and breaking down red blood cells. This happens in the internal organs: the liver, spleen and bone marrow. The breakdown products are carried into the bile and then removed through the intestines outside the body.

There is little bilirubin in the blood plasma. Its normal level can rise if the outflow of bile is disturbed or problems with the liver appear.

To determine the content of bilirubin, it is necessary to conduct a biochemical blood test.

Types of bilirubin

When studying the composition of the blood, the content of bilirubin is determined:

• general;
• direct (bound, conjugated);
• indirect (unbound, free).

Initially, the spleen produces indirect bilirubin, which is very toxic. It does not dissolve in water and cannot be excreted from the body. Indirect bilirubin can easily penetrate the membrane of any cell and disrupt its normal functioning. Its initial target is the brain, then the entire nervous system is hit. That is why it is important that the concentration of this type of bilirubin does not leave the established limits.

If the level of free bile pigment is normal, then it enters the liver along with the blood, where it is converted into a direct form of bilirubin.

In this state, the substance is low-toxic, it dissolves easily in water, therefore it quickly leaves the body along with feces and urine.

On the basis of medical research, a hypothesis has been developed that bilirubin is the main cellular antioxidant. And if this is true, then controlling the level of the substance and preventing it from going beyond the norm is an important task.

Bilirubin elevated: causes

The reasons that cause excess bilirubin of the norm are combined into the following groups:

• acceleration of the process of destruction of red blood cells;
• failures in the processing of the pigment directly in the liver;
• problems in the outflow of bile.

When red blood cells begin to break down intensively, both hemoglobin and indirect bilirubin sharply increase.

The shortening of the life cycle of red cells is characteristic of a group of blood diseases under common name hemolytic anemia. It is divided into two subgroups:

• hereditary;
• acquired.

I. Hereditary disease is caused by genetic pathologies:

• membranopathia - damage to the structure of erythrocyte membranes;
• fermentopathy - a decrease in the intensity of those enzymes that are important for the life of red blood cells;
• hemoglobinopathy - the structure of hemoglobin is disturbed.

Hereditary hemolytic anemias, observed most often, are as follows:

• Sickle cell - associated with the production of "wrong" hemoglobin. The structure of its protein is disturbed, and it acquires a crystalline non-standard structure. The shape of the erythrocytes becomes sickle-shaped.
• Cooley's anemia, or thalassemia. The disease is characterized by a decrease in the production of hemoglobin.

II. Hemolytic acquired anemia is characterized by the fact that the body begins to produce antibodies that are hostile to its own red blood cells. Also, the disease appears as a result of exposure to toxic substances.

Materials detrimental to red blood cells include:

• arsenic hydrogen, or arsine, is formed in some production processes and enters the body by air;
• phenylhydrazine - the basis for the production of medicines and azo dyes;
• hyperiz (benzoyl peroxide) - a component in the production of rubbers, acetone, fiberglass.

An increase in indirect bilirubin can also be caused by:

• lack of vitamins, especially B12 (cyanocobalamin). It is the only water-soluble vitamin that can accumulate in the body - it accumulates in the liver, spleen, lungs and kidneys.
• Infectious diseases, namely sepsis, malaria, typhoid fever.
• syphilis in the second and third stages.
• Syndromes Lucy - Driscoll, Gilbert or Crigler - Nayyar.

Such drugs as aspirin, levomycetin, insulin, in the arsenal of their side effects have an increase in bilirubin. Therefore, they should be taken with caution.

In the metabolic processes of bilirubin, an important place is given to the liver. If pathological processes occur in it, then it is not able to completely neutralize the toxic yellow pigment. The result may be ailments that are accompanied by an increase in the concentration of direct bilirubin:

• Viral hepatitis of all types, including drug-induced and alcoholic.
• Cirrhosis of the liver.
• Hereditary jaundice: Rotor and Dabin-Johnson syndromes.

An increase in the level of direct bilirubin can be cholelithiasis associated with problems with the outflow of bile.

Another factor in the increase in the concentration of direct bilirubin is helminthic invasion. The penetration of the body of worms is a common phenomenon, and it should not be underestimated.

Symptoms of elevated bilirubin

With an increase in the concentration of bilirubin, the color of the skin and sclera of the eyes first changes. They acquire a characteristic yellowness. This is especially noticeable on the palms and lower surface of the tongue. This is where jaundice comes in first.

When the process of outflow of bile from the gallbladder is disturbed, the amount of direct bilirubin sharply increases. In addition to jaundice, hepatic colic appears - attacks of acute pain under the right rib.

Elevated bilirubin can irritate the nerve endings of the skin, causing quite pronounced itching.

Additional symptoms are:

• violation of the chair: feces are almost discolored, reminiscent of white clay;
• swollen abdomen, constipation is replaced by diarrhea;
• nausea and "bitter" belching, bouts of vomiting;
• lack of appetite;
• urine darkens.

Often, the accumulation of excess bilirubin causes only severe discomfort in the liver area. Especially it manifests itself after physical exertion, even minor.

If the cause of the increase in bilirubin is hemolytic anemia, then the symptoms are as follows:

• a feeling of discomfort under the left rib, it is caused by an increase in the spleen;
• the temperature rises;
• urine becomes dark, a dark brown, and even black tint is possible - this indicates that red blood cells are being destroyed inside the vessels;
• feeling very tired;
• frequent headaches;
• weakness in the whole body;
• pain in the region of the heart.

In the presence of such symptoms, one cannot do without consulting a doctor and conducting appropriate tests. And this must be done immediately.

Features of increased bilirubin in newborns

For children, the same norm of bilirubin is established as for adults.

But newly born babies have some peculiarities.

In infants, an increase in bilirubin is common. This is due to the active breakdown of fetal hemoglobin, which is different from that produced after birth. The level of bilirubin rises, and the baby develops physiological jaundice.

The baby's liver is not yet fully functioning, because an increase in the amount of pigment causes yellowness of the skin and mucous membranes. This is especially pronounced on the third day of life.

Within a week, bilirubin returns to normal, as the baby's body, its enzyme systems fully adapt to the outside world and begin to fully work. Physiological jaundice in a healthy baby does not harm the body.

But not always bilirubin returns to normal. Newborns may develop pathological jaundice, in which the level of pigment increases significantly. This happens when there is:

• hepatitis of all types - acute viral, bacterial, toxic, chronic.
• severe bowel obstruction;
• intensive destruction of red blood cells due to genetic factors;
• constitutional hepatic dysfunction or Gilbert's syndrome;

Infants should be under the constant supervision of pediatricians in order to diagnose all possible pathologies in time and take therapeutic measures.

Increased bilirubin in pregnant women

In women who are carrying a child, the content of bilirubin should be within the normal range.

The exception is the third trimester. During this period, many pregnant women have an increase in the content of bile pigment.

The main reason for this phenomenon is the appearance of intrahepatic cholestasis of pregnant women. In most cases, after childbirth, the disease lets go.

How to bring bilirubin back to normal

In order to lower bilirubin, first of all, it is necessary to determine the cause of its growth.

There are certain treatments that only a doctor can prescribe.

These include:

• Infusion therapy. Glucose and detoxification medications are injected intravenously. With their help, the body is cleansed not only of excess bile pigment, but also of other decay products. This method is effective. It is used in case of serious condition of the patient.
• Phototherapy, or phototherapy, - the patient is exposed to light coming from artificial sources: lasers, light emitting diodes, fluorescent and dichroic lamps. Under their influence, toxic bilirubin passes into its direct form and leaves the body.

  This method has been successfully used to treat jaundice in newborns.

• Medical treatment- it is necessary when the cause of the growth of bilirubin is a violation of the outflow of bile. A list of pharmacological preparations is determined, the intake of which should normalize the state of the body and regulate the level of bile pigment.
• Correction of the daily diet. To reduce the load on the liver, you need to stop eating fried, fatty, peppery foods, soda, flour and sweets. No alcoholic drinks. Strong coffee and tea are also prohibited. The daily diet should consist of steamed or oven-cooked meals.

Additionally, cleansing medications, in particular activated charcoal and gels that remove toxins, can be prescribed.

When hepatitis is the cause of bilirubin growth, treatment is aimed at neutralizing the virus that caused the disease. The doctor prescribes drugs that should protect the liver. Thanks to the successful treatment of hepatitis, the level of bile pigment is normalized.

With some liver ailments and Gilbert's syndrome, it is possible to prescribe drugs such as zixorin and phenobarbital. The patient taking these medicines should be under the supervision of a doctor in order to control and prevent possible complications and side effects.

Lowering bilirubin: folk remedies

Decoctions made from herbs will help reduce blood levels of bilirubin and reduce the load on the liver.

You can normalize the bile pigment by drinking tea, which contains:

• chamomile officinalis and mint;
• St. John's wort and motherwort;
• corn silk.

You need to measure out two dessert spoons of a mixture of herbs and pour a glass of boiling water. The infusion should stand covered for about an hour.

The dose of the drink is one glass per day. Half should be drunk on an empty stomach twenty minutes before breakfast. The rest is taken at bedtime.

Effective tincture on birch leaves. First, young birch leaves are dried, then crushed. A tablespoon is poured with one glass of boiling water, infused for a day. Taken before bedtime.

It is not bad to cleanse the liver with the help of an extract from the fruits of milk thistle. The germinated seeds of this plant are effective in the treatment of hepatitis. A tablespoon a day will help heal the liver and reduce elevated bilirubin.

Proper nutrition, moderate physical activity will also help improve the condition of the body and normalize the level of bile pigment.

It is important to avoid stress on the nervous system, that is, to prevent breakdowns and stress.

It is necessary to treat diseases that caused an increase in bilirubin in a comprehensive manner and follow all the doctor's instructions.

Bilirubin is a yellow or light green pigment substance that occurs as a result of the chemical processes of the breakdown of red blood cells. There are two forms of bilirubin that affect metabolic processes in the body in different ways.

Indirect (unbound) bilirubin - is formed as a result of protein breakdown processes and is a toxic substance. Immediately after formation, the toxin enters the bloodstream, where it binds to albumin proteins that deliver the pigment to the liver.

The toxic form of the pigment does not dissolve in water, therefore it is not excreted from the body by the excretory system. Bilirubin can disrupt metabolic processes at the cellular level:

• leads to the destruction of cells due to impaired oxygen metabolism;
• affects the central nervous system, as a result of which nervous disorders develop, and in severe cases coma occurs;
• causes kidney damage - bilirubin infarction.

Direct bilirubin (bound) ceases to be toxic as a result of chemical reactions in the liver and becomes a full-fledged liver enzyme. In the composition of bile, the pigment goes to the small and large intestines, giving a yellow-brown color to the feces.

Total bilirubin is the sum of the direct and indirect forms of the pigment. If liver disease is suspected, a biochemical blood test is mandatory, including indicators of the levels of all forms of the pigment.

The norm of total bilirubin in the blood (table)

The level of direct and indirect bilirubin in the body depends on the proper functioning of the following organs: the spleen, bone marrow, liver, gallbladder and, to a lesser extent, the pancreas, all parts of the intestine.

Normally, the part of direct bilirubin is approximately equal to 25% of the total amount, and, accordingly, indirect - 75%.

Main symptoms

An increase in the level of bilirubin in an adult is manifested depending on the causes of the pathology. If the amount of liver enzyme exceeds the norm, then the following symptoms are observed:

• general weakness;
• nausea, vomiting, loss of appetite;
• rapid weight loss;
• pain in the right hypochondrium;
• intolerance to fatty foods;
• yellowness of the skin and eyes;
• skin itching;
• dark brown urine;
• light, discolored feces;
• violation of the processes of urination (frequent urge with a minimum amount of urine);
• symptoms of cystitis may appear.

Why does an adult have increased total bilirubin

The main reason for the increase in bilirubin in the blood is the inability of the liver to convert the toxin into a safe liver enzyme, as well as impaired transportation and excretion of bile from the body.

Causes of increased indirect bilirubin

An increase in the level of indirect bilirubin can be caused by the following diseases:

Gilbert's syndrome- a hereditary disease in which the enzymatic ability of the liver to convert indirect bilirubin into a direct form is impaired.

Acquired jaundice- occurs due to an overdose of medications or excessive alcohol consumption.

Autoimmune hemolytic anemia- a disease in which antibodies are produced to destroy their own red blood cells. Often, autoimmune anemia occurs in combination with other autoimmune diseases: lupus erythematosus, rheumatoid arthritis, etc.

drug-induced hemolytic anemia resulting from taking medications: antibiotics, insulin, sulfanilamide, levofloxacin, streptomycin.

Toxic hemolytic anemia- the result of poisoning with chemicals that contribute to the destruction of blood (lead, arsenic, blue vitriol, nitrobenzene). This disease can cause bites of spiders, scorpions, snakes.

Sepsis- infection of the blood and bacterial damage to the internal organs of a person. Sometimes the latent process of sepsis after small bacterial infections can last for years without showing acute symptoms.

Causes of increased direct bilirubin

Diseases that can cause an increase in the level of direct bilirubin:

Viral hepatitis. There are several types of acute viral hepatitis: A, B and hepatitis in infectious mononucleosis.

In the case of hepatitis, the liver is affected by a virus or a combination of several types of viruses at the same time. In this case, there is a pronounced intoxication of the body. Viral hepatitis is accompanied by jaundice, dark urine and light stool.

Toxic hepatitis- a disease that can occur after taking such types of drugs as hormonal drugs, anti-tuberculosis drugs, anti-inflammatory, psychotropic drugs, etc., with excessive consumption of alcoholic beverages, with mushroom poisoning. Also, toxic hepatitis occurs after chemical poisoning.

Intrahepatic cholestasis- a disease that is accompanied by a violation of the outflow of bile from the liver into the duodenum. The causes of cholestasis can be both dysfunctions at the cellular level and damage to the ducts.

Impaired bile flow is characterized by an excess of yellow-green pigment in the blood and tissues (which gives the skin and eyes a yellow tint), as well as a deficiency of bile in the intestines. Manifested intrahepatic cholestasis deterioration of health, nausea, indigestion, rapid weight loss, lack of appetite.

cirrhosis. May be asymptomatic for several years. Often the only sign of primary biliary cirrhosis is a gradual increase in bilirubin.

Tumors in the liver. The manifestation of the disease differs in each case depending on the location of the tumor in the organ.

Also, the reasons for the increased content of the liver enzyme in an adult may be violations of the outflow of bile from the duodenum and biliary tract, which occur with the following diseases:

• acute and chronic pancreatitis;
• tumors of the pancreas and duodenum;
• tumors of the bile ducts, blocking the normal circulation and excretion of bile;
• stones in the gallbladder;
• inflammation of the bile ducts (cholangitis), while the ducts swell, disrupting the normal flow of bile.

Principle of treatment

The mechanism of treatment of elevated bilirubin levels in an adult consists of several stages:

• treatment of diseases that lead to an increase in the amount of pigment;
• elimination of intoxication with the help of medications or therapeutic agents.

To reduce total bilirubin in the body, drugs of the following pharmacological groups are used:

• sorbents - bind and remove toxic substances from the body (Sorbex, Enterosgel, Atoxil, Carbolong, Polysorb);
• choleretic agents - activate the secretion of bile (Galsten, hepabene, Cholecin, Holosas, Urosan);
• enzyme preparations - reducing the load on the liver (Mezim, Festal, Pancreatin);
• hepatoprotectors - drugs that activate chemical processes and stimulate metabolic processes in liver cells (Heptral, Essentiale, Karsil, Phosphogliv).

To reduce the level of indirect bilirubin with high intoxication, the following treatment methods are used:

• Phototherapy is a physiotherapeutic procedure using ultraviolet rays. Under the influence of the spectrum of light, the toxin is converted into a safe form of pigment and excreted in the urine.
• Introduction of infusion solutions. To purify the blood with an increased level of bilirubin, droppers with glucose solutions are used, which favorably affect the metabolism and contribute to the rapid removal of bilirubin.
• Blood transfusion. If a high level of toxins poses a threat to human life, then a blood transfusion procedure is used.

How to lower bilirubin folk remedies

At home, a decrease in bilirubin in the blood can be done using traditional medicine such as infusions and decoctions of medicinal herbs.

Herbal infusion. It is necessary to take 1 teaspoon of dried chamomile flowers, St. John's wort and mint, then pour a glass of boiling water. Take an infusion 2 times a day for half a glass. The tool activates the secretion of bile and helps to cleanse the body.

Infusion of corn stigmas. 2-3 tablespoons of corn stigmas are poured into 500 ml of boiling water and left overnight. The next day, take a medicinal infusion of 100 grams 5 times a day before meals. Corn stigmas are able to cleanse the liver, kidneys and improve the functioning of the biliary system.

Rosehip decoction. A glass of rose hips must be poured with 2 liters of boiling water and boiled for 5 minutes over low heat. After the decoction should be infused all night. Take the decoction as a tea. You can use the product in unlimited quantities. Rosehip stimulates the excretory system and cleanses the body of excess bilirubin.

Diet

If the level of bilirubin in the blood is greatly increased, then it is necessary to adjust the diet in order to facilitate the work of the liver and kidneys. Eat small, frequent meals and drink plenty of fluids.

Exclude from the diet:

• alcoholic and carbonated drinks;
• salted, smoked and pickled products, semi-finished meat products;
• fried foods;
• conservation;
• all kinds of cheeses;
• ketchup, mayonnaise, mustard;
• radish, green onion, sorrel;
• cocoa, pastries from rich dough;
• refined sugar;
• citrus fruits, sour apples, cherries, red currants, sour grapes.

To eliminate excess bilirubin, the diet should consist of dietary products, the digestion of which does not put an excessive burden on the liver:

• non-acidic dairy products;
• milk soups;
• cereals and soups from cereals;
• lean meat;
• not sour vegetables;
• sweet fruits;
• herbal teas.

Medical nutrition is prescribed for a period of three to six months.

The patient becomes anxious when the doctor prescribes to donate blood for bilirubin. When is such an analysis needed, what are the standards for its indicators? The most basic thing is what do the increased or decreased values ​​mean? This issue should be dealt with in order to start timely treatment.

What is bilirubin

This name has a bile pigment - a substance that is released as a result of the breakdown of red blood cells that have completed their work in the body. The exchange of bilirubin consists of two stages:

• First, an indirect fraction appears - a form of pigment, insoluble. It is characterized by high toxicity.
• Further, it enters the liver, it is purified and converted into a water-soluble form - a direct fraction. The pigment enters the bile, helps the digestion of fats in the intestines, and is excreted from the organs with urine and feces.

Bilirubin total

When receiving the results of a biochemical study, the patient does not know what the data in the blood test shows. The question arises - why are there three different numbers? It is generally accepted that the total indicator includes direct and indirect bilirubin - their total value. All three results of the analysis are important. According to the results of the data, the ratio of both fractions, the doctor makes a conclusion about the diagnosis.

The total bilirubin test is prescribed when symptoms of liver disease are observed. Analysis is necessary if:

• transferred hepatitis;
• the use of drugs that adversely affect the liver;
• the need to control the treatment process;
• drug addiction;
• jaundice in newborns;
• needs for the prognosis of the course of the chronic form of the disease.

Bilirubin direct

This fraction is also called conjugated or free. The liver, which is responsible for removing indirect toxins, may fail. Its main reason is the wrong outflow of bile. It ceases to be excreted, the pigment enters the bloodstream, can crystallize. The ducts are clogged with deposits, which exacerbate the situation. When the indicators of direct bilirubin rise, the reasons for this are:

• cholelithiasis;
• neoplasms;
• cirrhosis of the liver;
• hepatitis.

indirect bilirubin

Nature provides that red blood cells - erythrocytes - are periodically replaced by new ones. At the same time, the old ones are destroyed, releasing hemoglobin. Under the influence of enzymes, it is transformed into indirect or unconjugated bilirubin. This substance is toxic, it can penetrate the cell membrane, destroying them. The reasons for its deviations from the normal value:

• violation of hematopoietic processes - hemolytic anemia;
• liver disease;
• infections;
• the impact of drugs;
• heredity.

Bilirubin is normal

What is bilirubin in a biochemical blood test, why is it necessary that the indicators meet the standards? A change in the number of this pigment upward or downward is a signal of the presence of body problems - liver diseases, anemia. By studying the analysis for bilirubin, its indicators are compared with the normative values, which remain unchanged throughout life in adults. An exception is newly born babies, for whom there are values ​​for the initial days of life.

The norm of bilirubin in newborns

To avoid the serious consequences of the appearance of jaundice, mandatory monitoring and comparison with the norm of bilirubin in newborns is carried out. The indicators vary greatly depending on the situation - a full-term baby or not, the age of the baby by the hour. The indicator is - µmol / l:

• up to a day - less than 103;
• up to 48 hours - no higher than 170;
• from three to five days - less than 205;
• at the age of more than a month - it is aligned with adult data.

The norm of bilirubin in the blood of women

It is assumed that the performance standards do not change with age. An overestimated amount of bile pigment in the blood of women is often not associated with diseases, their value is influenced by the characteristics of the organism. Indicators can be distorted when using diets, a sharp change in climate - large temperature changes. Influenced by the period of menstruation, medication, pregnancy. The norm of bilirubin in the blood of women is taken indicators - µmol / l:

• general - 3.3-19.0;
• direct - 0.95-4.2;
• indirect - 5.6-17.1.

Bilirubin - the norm in men

An increased content of bile pigment in the blood is more often observed in men, which is associated with lifestyle disorders. For them, the appearance of alcohol intoxication, drug use, and malnutrition are not uncommon. An increase in values ​​is caused by: side effects of drugs, lack of vitamin B12, chronic liver diseases, bile stasis. The norm of bilirubin in the blood in men is - µmol / l:

• general - 8.5-19.8;
• direct - 0.22-8.1;
• indirect - no more than 20.0.

Elevated bilirubin in the blood - what does it mean

The numbers of test indicators begin to rise - this means that the metabolism of the bile pigment is disturbed in the body. High bilirubin provokes the appearance of serious diseases. This is facilitated by:

• violation of the outflow of bile;
• pathology of the hematopoietic system;
• the presence of tumors;
• the formation of stones;
• the presence of large hematomas;
• organ transplant;
• the presence of helminths;
• liver diseases - hepatitis, cirrhosis;
• cholecystitis;
• transfusion of someone else's blood;
• vitamin deficiency;
• exposure to toxins.

Elevated bilirubin in a newborn

Mothers are very worried - the baby has jaundice in the first days of life. Meanwhile, this is a physiological process if the child was born full-term. In the womb, he produces his own hemoglobin. At birth, adaptation to other conditions of life occurs, the synthesis of a new type begins - an adult. The change in the form of hemoglobin is accompanied by the active destruction of erythrocytes. Approximately on the fifth day, the tests come back to normal.

High bilirubin in a newborn is dangerous if the baby was born prematurely - jaundice may appear, which is life-threatening. The situation requires urgent treatment, otherwise complications are inevitable:

• physical abnormalities;
• liver damage;
• violation of the nucleus of the brain;
• hearing loss;
• eye muscle pathology;
• physiological breakdown of red blood cells;
• anomalies of the biliary tract.

Bilirubin increased overall

It is important for a doctor to have the results of all indicators - the general and the constituent fractions - by the ratio of data, you can accurately determine what problem the body has, and make the correct diagnosis. What does it mean when total bilirubin is elevated in a biochemical analysis? This reports the presence of such problems:

• acceleration of the breakdown of red blood cells caused by blood diseases;
• the presence of helminths in the body;
• primary biliary cirrhosis.

An overestimated value of the total indicator in the data of biochemical analysis signals that the following are likely:

• cholelithiasis;
• a disorder in the production of an enzyme responsible for the formation of a direct bilirubin fraction in the liver;
• pregnancy;
• the presence of tumors that violate the discharge of bile;
• hepatitis that upsets the liver: viral, drug, bacterial.

Bilirubin direct elevated

The main reason that direct bilirubin is elevated is a disordered outflow of bile, which stops being excreted from the body. The liver stops working properly, the coloring pigment spreads through the body with blood. The situation leads to the appearance of jaundice, in which there are:

• yellowing of the mucous membrane, sclera, skin;
• vomit;
• loss of appetite;
• bloating;
• hepatic colic;
• diarrhea;
• dark urine;
• constipation.

Increased indirect bilirubin

When the body's work fails, in which there is an increase in indirect bilirubin, the toxic pigment, entering the cells, begins to yellow skin coloration. This is caused by a lack of enzymes that are able to convert the pigment into a direct fraction. In this case, symptoms are observed:

• discomfort in the side on the right;
• the temperature rises;
• the spleen is enlarged;
• increased fatigue;
• dark urine;
• dizziness;
• weakness;
• pallor;
• belching bitter;
• headache.

Elevated bilirubin during pregnancy

If a woman who is expecting a child has not previously had problems with bilirubin levels, then their slight excess in this case does not dictate treatment. The situation can be caused by squeezing the uterus in the later stages of the liver, gallbladder. Indicators stabilize after childbirth. To protect yourself, to exclude liver disease, it is advisable to undergo an ultrasound scan.

What does elevated bilirubin mean in a pregnant woman? Such results are provoked by stress, malnutrition, nervous strain. They can signal pathologies:

• fatty degeneration of the liver;
• toxicosis;
• cholelithiasis;
• infectious diseases;
• side effects of drugs;
• acute viral hepatitis;
• blockage of the bile ducts.

Elevated bilirubin - causes

Doctors identify three main reasons why bilirubin is elevated:

• Liver diseases - cirrhosis, hepatitis. This also includes pathologies of the pancreas, the formation of tumors. An important point is the side effects from taking drugs that have a toxic effect on the liver.
• A disorder of the outflow of bile caused by defects in the development of the gallbladder - blocking of the ducts by stones, squeezing by neoplasms.
• The occurrence of problems in the hematopoietic system - hereditary factors, accelerated destruction of red blood cells, hemolytic anemia.

How to lower bilirubin in the blood

A quick way to reduce bilirubin levels in infants is phototherapy - treatment with sunlight or artificial light. For adults, you must first find the cause in order to make the right recommendations. How to lower bilirubin in the blood? Advise for recovery at home: diet, physical activity, elimination of stress. Medicines are prescribed:

• choleretic;
• hepatoprotectors;
• antioxidants;
• antiviral;
• immunomodulators;
• antibacterial;
• vitamins;
• folk recipes.

Diet with increased bilirubin in the blood

Proper nutrition becomes an assistant in the normalization of the bilirubin index. How to lower the level of bilirubin in the blood with a diet? It is required to make a change in technology - to give preference to steaming, boiling, and also organize meals in small portions several times a day. It will be useful to use:

• vegetable soups;
• dairy products;
• sweet fruits;
• lean meat;
• herbal teas;
• compotes;
• fruit drinks;
• rice
• oatmeal;
• buckwheat;
• egg white.

A diet with increased bilirubin in the blood involves eliminating the use of cold food, limiting salt. It is necessary to remove from the diet:

• smoked products;
• black bread;
• carbonated water;
• canned blanks;
• coffee;
• spicy seasonings, sauces;
• sweets;
• baking;
• millet;
• alcoholic drinks;
• fruits containing acid;

Low bilirubin in the blood - what does it mean

When the body begins to produce red blood cells in an amount less than normal, their destruction is less active. This causes a decrease in the concentration of bilirubin pigment. This situation occurs infrequently, therefore, it requires close attention - serious pathologies may occur. It is necessary to undergo an examination to establish the causes of such values, to determine the method of treatment in order to increase the indicators.

Low bilirubin in the tests may mean that the preparation for their delivery was violated. Perhaps the patient had eaten before this or the study was carried out in the evening, when there is a physiological decrease in values. A decrease in biochemical analysis indicators can inform about the presence of:

• leukemia;
• ischemic heart disease;
• renal failure;
• tuberculosis;
• during pregnancy - kidney problems.

Reduced bilirubin in the blood - causes

When there is low bilirubin in the blood, the reasons lie in the problems of hematopoiesis: the production of red blood cells is reduced. This is facilitated by:

• drinking caffeinated drinks;
• alcohol abuse;
• aplastic anemia;
• tuberculosis intoxication;
• chronic renal failure;
• alimentary exhaustion;
• acute leukemia;
• taking medications - Phenobarbital, vitamin C, antibiotics, glucocorticoids.

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