Bilirubin Levels – Normal, High, Low

What is bilirubin ?

Bilirubin is dark yellow substance found in bile. It is a waste product that is released when the liver breaks down old red blood cells. The liver recycles this substance and converts it into bile. When the bile mixes with some bacteria, it attains the dark yellow color and looks like clay. This is the color found in human feces. If a person has damaged liver or infected liver, bilirubin is not excreted by the liver and the excretion is done by the kidneys in the urine. 

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When there is high level of bilirubin, it may indicate that red blood cells could be being destroyed too quickly or the liver has some problems. The high levels of the substance occur because a lot of it is being formed and insufficient amounts are being excreted. Premature babies who have a liver not strong enough to recycle the substance and eliminate,  may suffer from a condition known as jaundice. 

A person with high levels of this substance appears to have symptoms of jaundice where the skin and eyes look yellow in color. It is important for bilirubin test to be performed to determine the levels of the substance in blood. This substance normally passes through the liver and is excreted out of the body in feces and in small amounts through the urine. 

Before bilirubin reaches the liver, it is termed as unconjugated or uncombined but when it eventually reaches the liver, it combines with some sugars and forms conjugated bilirubin, which is a water-soluble substance. The conjugated bilirubin gets out of the liver and heads to the colon where it is converted back to the unconjugated form as it is excreted from the body.

Bilirubin test

A bilirubin test is done to measure the amount of this substance in blood. In the bloodstream, this substance circulates in two forms namely unconjugated and conjugated. Indirect or unconjugated from is not water-soluble and it moves from the bloodstream to the liver where it is changed into water-soluble form. 

Direct or conjugated form of bilirubin can readily dissolve in water and is derived from the indirect bilirubin in the liver. Total and direct bilirubin measurements are obtained directly from the blood sample but for indirect bilirubin, the levels are derived from the measurements of total and direct bilirubin.

 Normal bilirubin levels

The normal levels for bilirubin test range from 0.1 to 1 milligram per deciliter of total bilirubin. Total bilirubin is made up of direct and indirect form of the substance. The normal results of the test may also be indicated by readings that range from 0 to 0.3 milligrams per deciliter of direct bilirubin. However, these results can vary from one laboratory to another. The results may also differ slightly in children and women. Certain foods, medications, and strenuous exercises may also affect the results. 

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Causes of high levels of bilirubin

Causes of high levels of this substance in blood may vary and include infections like cholecystitis and gallbladder. Conditions that affect the function of the liver in processing bilirubin may also cause elevated levels. For example, Gilbert’s syndrome is one of the inherited conditions, which may cause the levels to elevate. Diseases that cause liver damage like cirrhosis, hepatitis, and mononucleosis may also increase the level of bilirubin. This is because the liver is not able to excrete the substance from body as required. 

Blockage of bile ducts can occur due to conditions lie cancer of pancreas and gallstones causing the levels to increase. If there is rapid destruction of red blood cells, as happens in people with sickle cell disease and allergy conditions to blood transfusion, the levels of bilirubin may increase. Medications like antibiotics, birth control pills, and phenytoin may cause an increase in the level of the substance in blood. 

Low levels of bilirubin may be caused by medications such as vitamin C and Phenobarbital. Lower than normal ranges of bilirubin may not be a course for concern but elevated levels may indicate complications in the liver or liver damage. 

Why is a bilirubin test done?

There are different reasons why a bilirubin test may be performed and they include checking for liver function. The test may be performed to check for signs of liver disease such as cirrhosis and hepatitis. Effects of medicines on liver may also necessitate the test to be performed. The test may also be conducted to establish if there is something blocking bile ducts such as gallstones and tumors of the pancreas. 

Bilirubin test also helps diagnose conditions that cause destruction of red blood cells like hemolytic anemia. In babies, the test may help determine if babies with neonatal jaundice require treatment. Drug toxicity may also require bilirubin tests to be done to establish if the liver may have been affected. 

Bilirubin may be lowered by determining the cause. If a disease condition is causing the problem, you may need to work with a healthcare practitioner to help treat the underlying condition. Increased levels of bilirubin as a result of lifestyle changes may require adjusting your diet and adopting healthy feeding habits. You may need to avoid fried food and use less oil to cook your food. 

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