Bilirubin Estimation (Almaaqal University PDF)

Almaaqal University Biochemistry Estimation of Serum Bilirubin Dr/ Wael Sobhy Darwish Biochemistry lab 2024  Liver Function Test (LFT) profile Integrity of liver cells Execratory function Synthetic function...

Almaaqal University Biochemistry Estimation of Serum Bilirubin Dr/ Wael Sobhy Darwish Biochemistry lab 2024  Liver Function Test (LFT) profile Integrity of liver cells Execratory function Synthetic function Clinical Lab tests Liver enzymes Proteins Bilirubin, ALP AST, ALT, GGT, ALP TP, Alb, A/G ratio  Definition of bilirubin  Bilirubin is the water insoluble breakdown product of normal heme catabolism  It’s a yellow pigment present in bile ( a fluid made by the liver) , urine and feces.  Heme is found in hemoglobin, a principal component of RBCs [Heme: iron + organic compound “porphyrin”].  Heme source in body:  80% from hemoglobin  20% other hemo-protein: cytochrome, myoglobin)  Direct bilirubin: is conjugated (water soluble bilirubin  Indirect bilirubin: is unconjugated (water insoluble bilirubin)  Total bilirubin = D+ ID Knowing the level of each type of bilirubin has diagnostic important.  Conjugated Bilirubin Unconjugated Bilirubin Direct Indirect Water soluble Water insoluble Found in urine Not found in urine Does not need accelerator Needs accelerator Total bilirubin = Conjugated + Unconjugated bilirubin Typically, only the total bilirubin is reported. If the total bilirubin is abnormal, further testing is done to differentiate the level of direct and indirect bilirubin. Total bilirubin – Conjugated = Unconjugated bilirubin  It is a medical term describes the elevation of bilirubin in blood result in yellow color of skin and sclera. Other symptoms include nausea, vomiting, dark-colored urine and fatigue. Types of Jaundice: according to the cause of jaundice it is classified to three main types:  Pre-hepatic jaundice  Hepatic jaundice  Post-hepatic (most common type)  Clinical Significance Increased Conjugated Bilirubin Biliary obstruction Cancer of the head of the pancreas Increased Unconjugated Bilirubin Autoimmune hemolysis Crigler-Najjer syndrome Gilbert’s syndrome Hemolytic transfusion reaction Hepatitis  High bilirubin levels is common in newborns age (1-3 days). SO, WHAT TYPE OF JUNDUCE IS THIS ???  Note:Your child's doctor must consider the following when deciding whether your baby's bilirubin levels are too high:  How fast the level has been rising  Whether the baby was born early  How old the baby is  New born jaundice treatment: Usually newborn is treated by phototherapy which breakdown bilirubin (IDD) and convert it to the photo isomer form which is more soluble. Bilirubin Toxicity :  Very high bilirubin is danger and toxic it may cause  brain damage effect on muscles, eyes and Leading to death  Specimen & Storage You should not eat or drink for at least 4 hours before the test Bilirubin is very sensitive to and is destroyed by light and heat; therefore specimens should be protected from ambient light prior to and during analysis. Concentrations may decrease by 30% to 50% per hour if exposed to direct sunlight. If separated and stored in the dark, serum or plasma is stable for: – 1 day at 15 - 25 °C – 7 days at 2 - 8 °C – 3 months at - 20 °C (if frozen immediately)  Specimen & Storage Conjugated bilirubin may be determined in either serum or plasma, Urine samples can be analyzed by direct diazo methods, since the polar conjugated bilirubin is not protein bound and is filtered at the glomerulus and excreted into urine.  Procedure for total Bilirubin Calculation Total bilirubin (mg/dl) = A Sample x 10.8 Serum bilirubin levels Normal : up to 1.0 mg/dL Unconjugated (indirect): 0.2 – 0.7 mg/dL Conjugated (direct): 0.25 mg/dL  haemolytic jaundice hepato-cellular jaundice obstructive jaundice Pre-hepatic jaundice Hepatic jaundice Post-hepatic jaundice  Due to increase in RBCs  Due to liver cell damage  Due to obstruction of bile (cancer, cirrhosis or hepatitis) duct which prevents breakdown due to  Conjugation of bilirubin passage of bilirubin into hemolytic anemia. decreased (ID.Bil. ). intestine.  The rate of RBCs lysis and  Blilirubin that is conjugated is  D.Bil will back to liver bilirubin production more not efficiently secreted into bile and then to circulation than ability of liver to but leaks to blood (D.Bil. ) elevating its level in blood Causes  Occur in : and urine. convert it to the  Occur in: conjugated form Cirrhosis (scarring of the liver)  Occur in: Biliary stricture Hepatitis HCC Cancer of the pancreas or Erythroblastosis fetalis gallbladder Hemolytic anemia Gallstones Transfusion reaction Type of Bil. ID.Bil > D.Bil D.Bil, ID.Bil, T.Bil all (High) D.Bil (High)