Direct and indirect bilirubin
The analysis usually determines total bilirubin and its fractions. Indirect (free) bilirubin is the form that circulates in the blood before being processed by the liver. Direct (bound) - already processed by the liver and ready for excretion with bile. Which faction is elevated tells us at what stage the problem arose. The standards depend on the laboratory and are indicated on the form.
- Increased indirect - increased breakdown of red blood cells or impaired binding in the liver
- Increased direct - liver damage or impaired bile outflow
- Both fractions are elevated - hepatitis, cirrhosis and other liver diseases
Reasons for the increase
The causes are conventionally divided into three groups: before the liver (suprahepatic), in the liver itself (hepatic) and after the liver (subhepatic, associated with the bile ducts).
- Gilbert's syndrome is the most common cause of mild elevation of indirect bilirubin
- Hemolytic anemia, large hematomas
- Viral hepatitis A, B, C, E
- Alcoholic liver disease, fatty liver disease, cirrhosis
- Drug-induced liver damage
- Stone in the bile duct
- Tumors of the pancreas and biliary tract
- Physiological jaundice of newborns
Symptoms
With a slight increase in bilirubin, there may be no symptoms - the deviation is found by chance. With significant growth, yellowness of the sclera and then the skin appears. The color of urine and stool helps to understand the cause: dark urine and light stool are characteristic of a violation of the outflow of bile and liver damage, and with hemolysis, the urine is usually dark, but the stool is normal or darker.
- Yellowness of the whites of the eyes and skin
- Dark urine
- Light chair
- Itchy skin
- Weakness, nausea, pain in the right hypochondrium
What examinations are needed
The first step is to repeat the test and evaluate other indicators: liver enzymes, alkaline phosphatase, GGT, complete blood count with reticulocytes. An ultrasound scan of the liver and biliary tract is required. Next, depending on the results, are markers of viral hepatitis, tests for hemolysis, MR cholangiography or CT.
- Bilirubin total, direct, indirect
- ALT, AST, GGT, alkaline phosphatase, albumin, INR
- Complete blood count, reticulocytes, LDH
- HBsAg, anti-HCV, in acute onset - markers of hepatitis A and E
- Ultrasound of the liver and gallbladder
- MR cholangiography or CT if indicated
Treatment
There is no need to reduce bilirubin “at all”—the cause is treated. Gilbert's syndrome does not require treatment. For viral hepatitis, antiviral therapy is prescribed, for a stone in the duct - endoscopic removal of the stone, for drug-induced damage - discontinuation of the drug. “Liver cleansing”, hepatoprotectors and choleretic drugs without examination can not only be useless, but also dangerous if the cause is blockage of the duct.
- Do not self-medicate for jaundice
- Stop drinking alcohol until the cause is determined
- Do not take new medications and dietary supplements without consultation
- Get vaccinated against hepatitis B if you haven't had one
- Comply with re-test deadlines