A question about bilirubin

[Guest guest]

Since Daryl came home from hospital his blood tests numbers have been steadily

improving each week. They're still above or below what's considered normal

though. Just this week, his bilirubin in particular has jumped dramatically.

Can anyone tell me what might have caused this and how we might be able to

reduce it? With increased bilirubin comes increased itch! Grrrrr!

anne

The more you give love, the more you have the ability to love.

[Guest guest]

http://www.questdiagnostics.com/kbase/topic/detail/test/hw144350/detail.htm

Bill Asenjo, PhD, CRC

Writer; Consultant

www.billasenjo.com

basenjo@...

Happiness is the absence of striving for happiness.

Chuang-tzu

Re: A question about bilirubin

anne I hope this answers your question about Bilirubin.

Good question!!!!

Bilirubin

Test Overview

Bilirubin is a brownish yellow substance found in bile. Bilirubin is

produced when the liver breaks down hemoglobin, the oxygen-carrying

substance in red blood cells. Bilirubin is then removed from the

body through the stool (feces) and gives stool its normal brown

color.

Bilirubin circulates in the bloodstream in two forms:

Indirect (or unconjugated) bilirubin. This form of bilirubin does

not dissolve in water (it is insoluble). Indirect bilirubin travels

through the bloodstream to the liver, where it is changed into a

soluble form.

Direct (or conjugated) bilirubin. After indirect bilirubin has been

changed by the liver into a form that dissolves in water (soluble),

it is called direct or conjugated bilirubin.

Total bilirubin and direct bilirubin levels are measured directly in

the blood, whereas indirect bilirubin levels are derived from the

total and direct bilirubin measurements.

The most obvious symptom of high bilirubin levels is jaundice, a

condition in which the skin and whites of the eyes appear yellow.

Jaundice is caused by the buildup of bilirubin in the blood and skin

from liver disease (hepatitis), blood disorders (hemolytic anemia),

or blockage of the tubes (bile ducts) that allow bile to pass from

the liver to the small intestine.

Excessive buildup of bilirubin in a newborn baby sometimes causes

brain damage and even death. Therefore, some babies who develop

jaundice may be treated with special lights or a blood transfusion

to reduce their bilirubin levels.

This test is done on a blood sample taken from a vein. In a newborn

baby, the blood sample is usually taken from the heel (heel stick).

Why It Is Done

The bilirubin test is used to:

Evaluate liver function and monitor the development of liver disease

(such as hepatitis or cirrhosis) or the effects of medications that

can damage the liver.

Help determine whether there is blockage of the bile ducts.

Diagnose conditions that cause increased destruction of red blood

cells (such as hemolytic anemia or hemolytic disease of the

newborn).

Determine whether newborn infants with neonatal jaundice need

treatment. These infants may need treatment with special lights,

called phototherapy. In rare cases, blood transfusions may be

needed.

How To Prepare

Adults should avoid eating and drinking for 4 hours before a total

bilirubin test.

How It Is Done

Blood sample from a heel stick

For a heel stick blood sample, several drops of blood are collected

from the heel of the baby. The skin of the heel is first cleaned

with alcohol and then punctured with a small sterile lancet. Several

drops of blood are collected in a small tube. When enough blood has

been collected, a gauze pad or cotton ball is placed over the

puncture site. Pressure is maintained on the puncture site briefly,

and then a small bandage is usually applied.

Blood sample from a vein

The person drawing blood will wrap an elastic band around your upper

arm to temporarily stop the flow of blood through the veins of your

arm. This makes it easier to insert a needle into your vein

properly, because the veins below the band get larger and do not

collapse easily.

The needle site is cleaned with alcohol and the needle is inserted.

More than one needle stick may be needed if the needle is not

properly placed or if the vein cannot supply enough blood.

After the needle is properly placed, a collection tube will be

attached to the needle and blood will flow into it. Sometimes more

than one tube of blood is collected.

When enough blood has been collected, the band around your arm will

be removed. A gauze pad or cotton ball will be placed over the

puncture site as the needle is withdrawn. Pressure is applied to the

puncture site for several minutes, and then a small bandage is often

placed over it.

How It Feels

Blood sample from a heel stick

A brief pain, like a sting or a pinch, is usually felt when the

lancet punctures the skin. While the blood is being collected, there

is very little or no discomfort.

Blood sample from a vein

You may feel nothing at all from the needle puncture, or you may

feel a brief sting or pinch as the needle goes through the skin.

Some people feel a stinging pain while the needle is in the vein.

However, many people do not feel any pain (or have only minor

discomfort) once the needle is positioned in the vein. The amount of

pain you feel depends on the skill of the person drawing the blood,

the condition of your veins, and your sensitivity to pain.

Risks

Blood sample from a heel stick

There is very little risk of a serious problem developing from a

heel stick. A small bruise may develop at the puncture site.

Continued bleeding can be a problem for babies with bleeding

disorders. There is a possibility that a bleeding problem may be

discovered while collecting the blood for the bilirubin test.

Blood sample from a vein

There is very little risk of complications from having blood drawn

from a vein. You may develop a small bruise at the puncture site.

You can reduce the risk of bruising by keeping pressure on the site

for several minutes after the needle is withdrawn.

Rarely, the vein may become inflamed after the blood sample is

taken. This condition is called phlebitis and is usually treated

with a warm compress applied several times daily.

Continued bleeding can be a problem for people with bleeding

disorders. Aspirin, warfarin (Coumadin), and other blood-thinning

medications can also make bleeding more likely. If you have bleeding

or clotting problems, or if you take blood-thinning medication, tell

the person before your blood is drawn.

Test Results

Normal

Normal values may vary from lab to lab.

Bilirubin levels in adults Total bilirubin:

0.3-1.0 milligrams per deciliter (mg/dL)

Direct bilirubin:

0.1-0.3 mg/dL

Indirect bilirubin (total bilirubin level minus direct bilirubin

level):

0.2-0.7 mg/dL

Greater than normal values may mean

High levels of bilirubin in the blood may occur because either too

much bilirubin is being produced or not enough bilirubin is being

eliminated.

Decreased elimination of bilirubin can be caused by some infections

(such as an infected gallbladder, or cholecystitis) or by certain

inherited enzyme deficiencies. Gilbert's syndrome, an inherited

condition that affects how the liver processes bilirubin, is a

common cause of increased blood levels of bilirubin. Although

jaundice may occur in some people with Gilbert's syndrome, the

condition usually is not harmful.

Decreased elimination of bilirubin may result from liver damage

(caused by hepatitis, cirrhosis, or mononucleosis), digestive system

problems that result in excessive reabsorption of bilirubin, or

blockage of the bile ducts (such as from gallstones or pancreatic

cancer).

Because their livers are immature, premature infants may not be able

to eliminate bilirubin properly from the blood and are more likely

to develop jaundice than full-term babies.

Elevated bilirubin levels may be caused by rapid destruction of red

blood cells in the blood, such as from sickle cell disease or an

allergic reaction to blood received during a transfusion (called a

transfusion reaction).

The amounts of both direct and indirect bilirubin can help determine

the cause of the excess bilirubin:

Excessive breakdown of red blood cells increases indirect bilirubin

levels more than direct bilirubin levels.

Blockage of the bile ducts (such from a gallstones or pancreatic

cancer) tends to increase the amount of direct bilirubin more than

indirect bilirubin.

In severe liver damage, direct bilirubin may return to normal or

almost-normal levels, but indirect bilirubin levels will remain high.

Bilirubin levels that may require treatment in full-term, healthy

babies Baby's age

Bilirubin level

Younger than 25 hours:

evidence of jaundice

25 to 48 hours:

greater than 15 milligrams per deciliter (mg/dL)

49 to 72 hours:

greater than 18 mg/dL

Older than 72 hours:

greater than 20 mg/dL

Note: Premature or sick babies may need treatment with bilirubin

levels lower than those listed above.

What Affects the Test

Many medications can affect blood bilirubin levels either by

affecting the liver directly or by interfering with the test method

used to measure bilirubin. Drugs that may increase bilirubin levels

include many antibiotics, some types of birth control pills,

indomethacin (Indocin), phenytoin (Dilantin), diazepam (Valium), and

flurazepam (Dalmane).

Certain medications can lower bilirubin levels. These include

vitamin C (ascorbic acid), phenobarbital, and theophylline

(Elixophyllin).

Caffeine can lower bilirubin levels.

Avoiding food for a long period (fasting) normally lowers indirect

bilirubin levels.

Rough handling, exposure to light, contamination, or inadequate

refrigeration of the blood sample can cause inaccurate test results.

What To Think About

More than half of all babies born in the United States have

physiologic jaundice, the most common cause of neonatal jaundice.

Physiologic jaundice occurs in healthy babies and usually disappears

on its own within a week without causing problems. However, in some

cases, babies with physiologic jaundice require treatment with

special fluorescent lights, or phototherapy, to prevent the unlikely

possibility of brain damage and possible mental retardation.

Bilirubin may also be measured in the urine. Normally urine does not

contain any bilirubin. If bilirubin is detected in urine, additional

testing may be needed to determine the cause. High amounts of

bilirubin in urine may indicate that the bilirubin is not being

removed from the body properly by the liver.

Some hospitals may use a noninvasive device (called a transcutaneous

bilirubin meter) instead of the standard heel stick to evaluate a

newborn's bilirubin level. A transcutaneous bilirubin meter is a

small handheld device that measures bilirubin levels when placed

gently against the skin.

Credits

Author Renée Spengler, RN, BSN

Associate Editor Greer

Specialist Medical Reviewer J. Sexton, MD

> Since Daryl came home from hospital his blood tests numbers have

been steadily improving each week. They're still above or below

what's considered normal though. Just this week, his bilirubin in

particular has jumped dramatically. Can anyone tell me what might

have caused this and how we might be able to reduce it? With

increased bilirubin comes increased itch! Grrrrr!

>

> anne

> The more you give love, the more you have the ability to love.

>

>

[Guest guest]

Thank you so much Janet! I shall pass this on to Daryl and have him think about

taking a Vit C supp. It can't hurt as long as he doesn't take too much.

anne