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Haemolytic Screen
 
 

Bilirubin

 
 
 
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Overview

Bilirubin is a breakdown product of haem that is conjugated in hepatocytes with glucuronic acid and then excreted in bile.
    • Normal Range

    • Total bilirubin - <1 mg/dL or <20 μmol/L
    • Direct (conjugated) bilirubin - <0.3 mg/dL or <7 μmol/L
  • Significance

  • Haemolysis results in unconjugated (indirect) hyperbilirubinaemia, as free haemoglobin is metabolised to haem and then bilirubin.
  • Causes of Elevated Bilirubin

  • Unconjugated (Indirect)

  • Haemolysis - immune, thrombotic microangiopathy, mechanical, inherited, infection, hypersplenism, drugs
  • Haematoma resorption
  • Drugs - choramphenicol, probenecid, irinotecan
  • Neonatal - neonatal jaundice, jaundice of prematurity
  • Inherited conjugation disorders - Gilbert syndrome, Crigler-Najar syndrome
  • Unconjugated /Conjugated

  • Acute hepatitis - viral hepatitis, HSV, EBV, CMV, VZV, alcoholic hepatitis, drug-induced hepatitis, ischaemic hepatitis, autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, Wilson’s disease
  • Cirrhosis - chronic hepatitis B or C, alcoholic liver disease, non-alcoholic fatty liver disease, autoimmune hepatitis, primary biliary cirrhosis, chronic bile duct obstruction, primary sclerosing cholangitis, haemochromatosis, Wilson’s disease, alpha-1 antitrypsin deficiency, hepatocellular carcinoma, sarcoidosis, glycogen storage disease type IV, methotrexate, methyldopa, amiodarone, Budd-Chiari syndrome, right heart failure
  • Conjugated (Direct)

  • Intrahepatic cholestasis - primary biliary cirrhosis, primary sclerosing cholangitis, sepsis, HCC, liver metastases, cystic liver disease, intrahepatic cholestasis of pregnancy, cystic fibrosis, total parenteral nutrition, viral / alcoholic hepatitis, amyloidosis, sarcoidosis, augmentin, isoniazid, rifampicin, chlorpromazine
  • Extrahepatic cholestasis - choledocholithiasis, bile duct stenosis, bile duct strictures, primary sclerosing cholangitis, bile duct / ampullary / pancreatic malignancy
  • Inherited secretion disorders - Dubin-Johnson syndrome, Rotor’s syndrome
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