Bilirubin: Wikis

  

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Bilirubin
Identifiers
CAS number 635-65-4
PubChem 250
SMILES
InChI
Properties
Molecular formula C33H36N4O6
Molar mass 584.66214
Supplementary data page
Structure and
properties
n, εr, etc.
Thermodynamic
data
Phase behaviour
Solid, liquid, gas
Spectral data UV, IR, NMR, MS
Except where noted otherwise, data are given for materials in their standard state (at 25 °C, 100 kPa)
Infobox references
.Bilirubin (formerly referred to as hematoidin) is the yellow breakdown product of normal heme catabolism.^ Bilirubin is a breakdown end product of heme containing proteins.
  • Questions about Bilirubin - Ask.com 10 February 2010 12:15 UTC www.ask.com [Source type: General]

^ Normal bilirubin production and excretion .

^ Bilirubin is a normal by-product of the breakdown of old red blood cells.

.Heme is found in hemoglobin, a principal component of red blood cells.^ Red blood cells should not be found in normal voided samples.
  • Urinalysis Dipstick Interpretation 10 February 2010 12:15 UTC www.vet.uga.edu [Source type: Academic]

^ Red blood cells contain hemoglobin, which is broken down to heme and globin.
  • Bilirubin - Overview 10 February 2010 12:15 UTC www.umm.edu [Source type: Academic]
  • Bilirubin - blood: MedlinePlus Medical Encyclopedia 10 February 2010 12:15 UTC www.nlm.nih.gov [Source type: Academic]
  • What is Bilirubin? 10 February 2010 12:15 UTC www.medhelp.org [Source type: FILTERED WITH BAYES]
  • Bilirubin - Tests, Test Results & Diagnosis - NY Times Health Information 10 February 2010 12:15 UTC health.nytimes.com [Source type: News]
  • Bilirubin 10 February 2010 12:15 UTC www.clarian.org [Source type: Academic]
  • Bilirubin - Edward Hospital, Naperville IL Area 10 February 2010 12:15 UTC www.edward.org [Source type: Academic]
  • Health Information - Walgreens 10 February 2010 12:15 UTC www.walgreens.com [Source type: FILTERED WITH BAYES]
  • Bilirubin Information on Healthline 10 February 2010 12:15 UTC www.healthline.com [Source type: Academic]
  • HowStuffWorks "Bilirubin - Medical Dictionary" 10 February 2010 12:15 UTC healthguide.howstuffworks.com [Source type: FILTERED WITH BAYES]
  • Bilirubin; Baltimore, Maryland MD 10 February 2010 12:15 UTC www.goodsam-md.org [Source type: Academic]
  • Bilirubin, Health Information, UW Health, University of Wisconsin Hospital, Madison 10 February 2010 12:15 UTC apps.uwhealth.org [Source type: Academic]
  • Bilirubin - blood - Lifespan 10 February 2010 12:15 UTC www.lifespan.org [Source type: Academic]
  • Bilirubin | Medical Tests | UCSF Children's Hospital 10 February 2010 12:15 UTC www.ucsfchildrenshospital.org [Source type: Academic]
  • Health Baltimore - Bilirubin. Bilirubin is a product that results from the ... 10 February 2010 12:15 UTC www.franklinsquare.org [Source type: Academic]
  • Walgreens.com | Health Library | Print - Bilirubin 10 February 2010 12:15 UTC www.walgreens.com [Source type: Academic]
  • Bilirubin - blood Medical Information 10 February 2010 12:15 UTC www.drugs.com [Source type: Academic]
  • Greenville Hospital System 10 February 2010 12:15 UTC www.ghs.org [Source type: Academic]
  • Bilirubin | LIVESTRONG.COM 10 February 2010 12:15 UTC www.livestrong.com [Source type: FILTERED WITH BAYES]
  • SJ/C, Savannah - Bilirubin - blood. Bilirubin is a yellowish pigment found in... 10 February 2010 12:15 UTC www.sjchs.org [Source type: Academic]
  • Bilirubin 10 February 2010 12:15 UTC www.bcbswny.com [Source type: Academic]
  • Bilirubin - blood 10 February 2010 12:15 UTC www.allina.com [Source type: Academic]
  • Bilirubin 10 February 2010 12:15 UTC www.drexelmed.edu [Source type: Academic]
  • St. Luke's Sugar Land Hospital - Your Health Topics 10 February 2010 12:15 UTC stlukessugarland.adam.com [Source type: Academic]
  • Bilirubin - blood - Baylor Health 10 February 2010 12:15 UTC info.baylorhealth.com [Source type: Academic]
  • Bilirubin - Overview 10 February 2010 12:15 UTC health.marylandgeneral.org [Source type: Academic]
  • DHMC | Health Encyclopedia | Bilirubin - blood 10 February 2010 12:15 UTC www.dhmc.org [Source type: Academic]
  • Bilirubin - blood - Medical Testing, Exams, & Health Tests - South Florida Hospital 10 February 2010 12:15 UTC www.mhs.net [Source type: Academic]
  • Bilirubin 10 February 2010 12:15 UTC www.healthcentral.com [Source type: Academic]
  • Bilirubin; Baltimore, Maryland MD 10 February 2010 12:15 UTC www.unionmemorial.org [Source type: Academic]
  • Wilmington/Newark - Bilirubin is a yellowish pigment found in bile, a fluid... 10 February 2010 12:15 UTC www.christianacare.org [Source type: Academic]
  • Bilirubin - blood - Avera Health 10 February 2010 12:15 UTC averaorg.adam.com [Source type: Academic]
  • Bilirubin - blood - Kootenai Health 10 February 2010 12:15 UTC kootenaihealth.adam.com [Source type: Academic]
  • Bilirubin - blood- medco.com 10 February 2010 12:15 UTC www.medcohealth.com [Source type: Academic]
  • Bilirubin - blood - Health Information 10 February 2010 12:15 UTC www.qualityhealth.com [Source type: Academic]
  • Bilirubin - Blood - Health Information Library - Penn State Hershey 10 February 2010 12:15 UTC www.pennstatehershey.org [Source type: Academic]
  • Bilirubin - blood 10 February 2010 12:15 UTC www.saltlakeregional.com [Source type: Academic]
  • Bilirubin - blood 10 February 2010 12:15 UTC forthealthcare.adam.com [Source type: Academic]
  • Bilirubin - blood - Great Falls Clinic 10 February 2010 12:15 UTC gfclinic.adam.com [Source type: Academic]
  • Bilirubin - blood 10 February 2010 12:15 UTC www.memorialhermann.org [Source type: Academic]
  • D-H Manchester | Health Encyclopedia | Bilirubin - blood 10 February 2010 12:15 UTC www.dartmouth-hitchcock.org [Source type: Academic]

^ Bilirubin is released from red blood cells.
  • Liver Problems, Liver Dysfunction, Hypatoxoxicity - Cancer Symptoms, Chemotherapy & Chemo Side Effects 10 February 2010 12:15 UTC www.chemocare.com [Source type: General]

.Bilirubin is excreted in bile and urine, and elevated levels may indicate certain diseases.^ Medicines that may decrease bilirubin levels.
  • Bilirubin - [Medical Test] - Quest Diagnostics Patient Health Library 10 February 2010 12:15 UTC www.questdiagnostics.com [Source type: Academic]
  • New York Health - Bilirubin. bilirubin in a blood sample. Bilirubin is a... 10 February 2010 12:15 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
  • CIGNA - Bilirubin 10 February 2010 12:15 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Citizens Health Information 10 February 2010 12:15 UTC www.citizensmemorial.com [Source type: FILTERED WITH BAYES]
  • Health Information, Drug and Herbal Information and Health News 10 February 2010 12:15 UTC www.cpmc.org [Source type: FILTERED WITH BAYES]
  • Health Information 10 February 2010 12:15 UTC www.mmc.org [Source type: Academic]

^ Bilirubin may also be measured in the urine.
  • New York Health - Bilirubin. bilirubin in a blood sample. Bilirubin is a... 10 February 2010 12:15 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
  • CIGNA - Bilirubin 10 February 2010 12:15 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Citizens Health Information 10 February 2010 12:15 UTC www.citizensmemorial.com [Source type: FILTERED WITH BAYES]
  • Health Information 10 February 2010 12:15 UTC www.mmc.org [Source type: Academic]

^ Medicines that may increase bilirubin levels.
  • Bilirubin - [Medical Test] - Quest Diagnostics Patient Health Library 10 February 2010 12:15 UTC www.questdiagnostics.com [Source type: Academic]
  • New York Health - Bilirubin. bilirubin in a blood sample. Bilirubin is a... 10 February 2010 12:15 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
  • CIGNA - Bilirubin 10 February 2010 12:15 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Citizens Health Information 10 February 2010 12:15 UTC www.citizensmemorial.com [Source type: FILTERED WITH BAYES]
  • Health Information, Drug and Herbal Information and Health News 10 February 2010 12:15 UTC www.cpmc.org [Source type: FILTERED WITH BAYES]
  • Health Information 10 February 2010 12:15 UTC www.mmc.org [Source type: Academic]

.It is responsible for the yellow color of bruises, urine, and the yellow discoloration in jaundice.^ This yellow coloring is called jaundice.
  • Jaundice / Kernicterus 10 February 2010 12:15 UTC www.hoptechno.com [Source type: General]
  • Kernicterus Lawsuit Cerebral Palsy Medical Malpractice Lawsuits for Jaundice / High Bilirubin count misdiagnosis. Talk to Cerebral Palsy Lawyer / Attorney 10 February 2010 12:15 UTC www.cerebral-palsy-lawsuits.com [Source type: FILTERED WITH BAYES]

^ Jaundice is a yellow coloring of the eyes and skin.
  • Jaundice - Keep Kids Healthy conditions 10 February 2010 12:15 UTC www.keepkidshealthy.com [Source type: FILTERED WITH BAYES]

^ Bilirubin - A pigment produced in the breakdown of red blood cells that appears as yellow skin coloring (jaundice).
  • NICU A Glossary of Terms Preemie Dictionary 10 February 2010 12:15 UTC www.babylinq.com [Source type: FILTERED WITH BAYES]

It has also been found in plants.[1]

Contents

Chemistry

.Bilirubin consists of an open chain of four pyrrole-like rings (tetrapyrrole).^ Bilirubin consists of an open chain of four pyrrole -like rings ( tetrapyrrole ).
  • Bilirubin: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 10 February 2010 12:15 UTC www.chemie.de [Source type: Academic]

^ Bilirubin's terminal pyrrole rings.
  • Bilirubin's Chemical Formula 10 February 2010 12:15 UTC www3.nsta.org [Source type: FILTERED WITH BAYES]

^ All of these contain an open chain of four pyrrolic rings.
  • Bilirubin: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 10 February 2010 12:15 UTC www.chemie.de [Source type: Academic]

.In heme, by contrast, these four rings are connected into a larger ring, called a porphyrin ring.^ In heme , by contrast, these four rings are connected into a larger ring, called a porphyrin .
  • Bilirubin: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 10 February 2010 12:15 UTC www.chemie.de [Source type: Academic]

^ Heme consists of a ring of four pyrroles joined by carbon bridges and a central iron atom (ferroprotoporphyrin IX).
  • Bilirubin metabolism 10 February 2010 12:15 UTC www.uptodate.com [Source type: Academic]

^ Within macrophages, a free heme group (iron + porphyrin ring) is oxidized by microsomal heme oxygenase into biliverdin and the iron is released (the iron is then stored as ferritin or released into plasma, where it is bound to the transport protein, transferrin).

.Bilirubin is very similar to the pigment phycobilin used by certain algae to capture light energy, and to the pigment phytochrome used by plants to sense light.^ Bilirubin is very similar to the pigment phycobilin used by certain algae to capture light energy, and to the pigment phytochrome used by plants to sense light.
  • Bilirubin: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 10 February 2010 12:15 UTC www.chemie.de [Source type: Academic]

^ When necessary, treatment involves phototherapy, use of a special light to break down bilirubin in the babys skin, or a special type of blood transfusion.
  • Infants Treated for Moderately High Bilirubin Levels at Birth Have Normal Brain Function ; Seattle Washington WA 10 February 2010 12:15 UTC www.swedish.org [Source type: Academic]

^ Light energy helps change the bilirubin that is just under the skin into a different chemical which is more easily passed out of the baby's body (excreted).
  • Pregnancy - Pregnancy Topics - Why is my baby yellow? - neonatal jaundice. 10 February 2010 12:15 UTC www.cyh.com [Source type: General]

.All of these contain an open chain of four pyrrolic rings.^ Bilirubin consists of an open chain of four pyrrole -like rings ( tetrapyrrole ).
  • Bilirubin: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 10 February 2010 12:15 UTC www.chemie.de [Source type: Academic]

^ All of these contain an open chain of four pyrrolic rings.
  • Bilirubin: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 10 February 2010 12:15 UTC www.chemie.de [Source type: Academic]

^ Heme consists of a ring of four pyrroles joined by carbon bridges and a central iron atom (ferroprotoporphyrin IX).
  • Bilirubin metabolism 10 February 2010 12:15 UTC www.uptodate.com [Source type: Academic]

.Like these other pigments, some of the double-bonds in bilirubin isomerize when exposed to light.^ Like these other pigments, bilirubin changes its conformation when exposed to light.
  • Bilirubin: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 10 February 2010 12:15 UTC www.chemie.de [Source type: Academic]

^ Others, like bilirubin, are waste products.
  • AGA | Patient Center | Digestive Conditions | Gallstones 10 February 2010 12:15 UTC www.gastro.org [Source type: FILTERED WITH BAYES]

^ The reactions that occur with light include cis-trans isomerisation about the C 4 -C 5 and C 15 -C 16 double bonds arrowed above, photo-oxidation, and occurrence of an intra-molecular cyclisation (to form lumirubin).
  • The Worldwide Intensivist - A note on Neonatal Jaundice 10 February 2010 12:15 UTC www.anaesthetist.com [Source type: FILTERED WITH BAYES]

.This is used in the phototherapy of jaundiced newborns: the isomer of bilirubin formed upon light exposure is more soluble than the unilluminated isomer.^ More than 50% of the newborn are affected by this.
  • Newborn Jaundice – A Condition That Occurs Due To High Bilirubin Levels! | Newborn Baby Zone 10 February 2010 12:15 UTC www.newbornbabyzone.com [Source type: General]

^ Which of the following bilirubin isomers is formed in the phototherapy process?
  • Bilirubin: E-/Z-, But Not Easy - Case Teaching Notes - Case Study Collection - National Center for Case Study Teaching in Science 10 February 2010 12:15 UTC www.sciencecases.org [Source type: Academic]

^ Phototherapy for neonatal jaundice: Configurational isomers of bilirubin.
  • Bilirubin: E-/Z-, But Not Easy - Case Teaching Notes - Case Study Collection - National Center for Case Study Teaching in Science 10 February 2010 12:15 UTC www.sciencecases.org [Source type: Academic]

.Several textbooks and research articles show incorrect chemical structures for the two isoforms of bilirubin.^ Several textbooks and research articles show incorrect chemical structures for the two isoforms of bilirubin.
  • Bilirubin: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 10 February 2010 12:15 UTC www.chemie.de [Source type: Academic]

^ This can be done by measuring two different chemical forms of bilirubin—direct (or conjugated) and indirect (or unconjugated) bilirubin.
  • High bilirubin found in blood..........? - Yahoo! Answers 10 February 2010 12:15 UTC answers.yahoo.com [Source type: General]

^ Blood tests may show abnormal results which indicate liver dysfunction with increased bilirubin (a chemical marker in the blood for jaundice).
  • Biliary Atresia - C.L.A.S.S. 10 February 2010 12:15 UTC www.classkids.org [Source type: FILTERED WITH BAYES]

[2]

Function

.Bilirubin is created by the activity of biliverdin reductase on biliverdin, a green tetrapyrrolic bile pigment which is also a product of heme catabolism.^ Bilirubin is a product of heme metabolism.
  • Jaundice in Older Children and Adolescents -- Pashankar and Schreiber 22 (7): 219 -- Pediatrics in Review 10 February 2010 12:15 UTC pedsinreview.aappublications.org [Source type: Academic]

^ Bilirubin, which is a bile pigment, is generally regarded as waste product of haem catabolism.
  • Serum bilirubin concentration in a Belgian population: the association with smoking status and type of cigarettes -- Hoydonck et al. 30 (6): 1465 -- International Journal of Epidemiology 10 February 2010 12:15 UTC ije.oxfordjournals.org [Source type: Academic]

^ Heme is oxidized to biliverdin which is then reduced to bilirubin.
  • Pediatrics | Paediatrics | Pediatric Education | Paediatric Education - PediatricEducation.org » 2008 » April » 21 10 February 2010 12:15 UTC www.pediatriceducation.org [Source type: Academic]

.Bilirubin, when oxidized, reverts to become biliverdin once again.^ Heme is oxidized to biliverdin which is then reduced to bilirubin.
  • Pediatrics | Paediatrics | Pediatric Education | Paediatric Education - PediatricEducation.org » 2008 » April » 21 10 February 2010 12:15 UTC www.pediatriceducation.org [Source type: Academic]

^ Bilirubin, when oxidized, reverts to become biliverdin once again.
  • Bilirubin: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 10 February 2010 12:15 UTC www.chemie.de [Source type: Academic]

^ According to this hypothesis, when a molecule of bilirubin acts as an antioxidant, it is itself oxidized to biliverdin.
  • Bilirubin Benefits: Cellular Protection by a Biliverdin Reductase Antioxidant Cycle -- Sedlak and Snyder 113 (6): 1776 -- Pediatrics 10 February 2010 12:15 UTC pediatrics.aappublications.org [Source type: Academic]

.This cycle, in addition to the demonstration of the potent antioxidant activity of bilirubin, has led to the hypothesis that bilirubin's main physiologic role is as a cellular antioxidant.^ Bilirubin is an antioxidant of possible physiological importance.
  • Bilirubin Possesses Powerful Immunomodulatory Activity and Suppresses Experimental Autoimmune Encephalomyelitis -- Liu et al. 181 (3): 1887 -- The Journal of Immunology 10 February 2010 12:15 UTC www.jimmunol.org [Source type: Academic]
  • Unconjugated Bilirubin Inhibits VCAM-1-Mediated Transendothelial Leukocyte Migration -- Keshavan et al. 174 (6): 3709 -- The Journal of Immunology 10 February 2010 12:15 UTC www.jimmunol.org [Source type: Academic]

^ The potent immunosuppressive effects of bilirubin cannot be attributed to its antioxidant activity.
  • Bilirubin Possesses Powerful Immunomodulatory Activity and Suppresses Experimental Autoimmune Encephalomyelitis -- Liu et al. 181 (3): 1887 -- The Journal of Immunology 10 February 2010 12:15 UTC www.jimmunol.org [Source type: Academic]

^ One possible physiologic role for bilirubin is as an antioxidant.
  • Bilirubin Benefits: Cellular Protection by a Biliverdin Reductase Antioxidant Cycle -- Sedlak and Snyder 113 (6): 1776 -- Pediatrics 10 February 2010 12:15 UTC pediatrics.aappublications.org [Source type: Academic]

[3][4]

Metabolism

.Erythrocytes (red blood cells) generated in the bone marrow are disposed of in the spleen when they get old or damaged.^ They are derived from the bone marrow from the larger cells known as megakaryocytes.
  • Dr Sandra Cabot's Liver Doctor - Love your Liver and Live Longer 10 February 2010 12:15 UTC www.liverdoctor.com [Source type: FILTERED WITH BAYES]

^ The yellow pigment is from bilirubin , a byproduct of old red blood cells.
  • Bilirubin | LIVESTRONG.COM 10 February 2010 12:15 UTC www.livestrong.com [Source type: FILTERED WITH BAYES]

^ Bilirubin is released from red blood cells.
  • Liver Problems, Liver Dysfunction, Hypatoxoxicity - Cancer Symptoms, Chemotherapy & Chemo Side Effects 10 February 2010 12:15 UTC www.chemocare.com [Source type: General]

.This releases hemoglobin, which is broken down to heme as the globin parts are turned into amino acids.^ Red blood cells contain hemoglobin, which is broken down to heme and globin.
  • Bilirubin - Tests, Test Results & Diagnosis - NY Times Health Information 10 February 2010 12:15 UTC health.nytimes.com [Source type: News]
  • Bilirubin 10 February 2010 12:15 UTC www.clarian.org [Source type: Academic]
  • Bilirubin - Edward Hospital, Naperville IL Area 10 February 2010 12:15 UTC www.edward.org [Source type: Academic]
  • Health Information - Walgreens 10 February 2010 12:15 UTC www.walgreens.com [Source type: FILTERED WITH BAYES]
  • Bilirubin, Health Information, UW Health, University of Wisconsin Hospital, Madison 10 February 2010 12:15 UTC apps.uwhealth.org [Source type: Academic]
  • Bilirubin - blood - Lifespan 10 February 2010 12:15 UTC www.lifespan.org [Source type: Academic]
  • Bilirubin | Medical Tests | UCSF Children's Hospital 10 February 2010 12:15 UTC www.ucsfchildrenshospital.org [Source type: Academic]
  • Health Baltimore - Bilirubin. Bilirubin is a product that results from the ... 10 February 2010 12:15 UTC www.franklinsquare.org [Source type: Academic]
  • Walgreens.com | Health Library | Print - Bilirubin 10 February 2010 12:15 UTC www.walgreens.com [Source type: Academic]
  • Bilirubin - blood Medical Information 10 February 2010 12:15 UTC www.drugs.com [Source type: Academic]
  • Bilirubin | LIVESTRONG.COM 10 February 2010 12:15 UTC www.livestrong.com [Source type: FILTERED WITH BAYES]
  • Bilirubin 10 February 2010 12:15 UTC www.bcbswny.com [Source type: Academic]
  • Bilirubin 10 February 2010 12:15 UTC www.drexelmed.edu [Source type: Academic]
  • St. Luke's Sugar Land Hospital - Your Health Topics 10 February 2010 12:15 UTC stlukessugarland.adam.com [Source type: Academic]
  • Bilirubin - blood - Baylor Health 10 February 2010 12:15 UTC info.baylorhealth.com [Source type: Academic]
  • DHMC | Health Encyclopedia | Bilirubin - blood 10 February 2010 12:15 UTC www.dhmc.org [Source type: Academic]
  • Bilirubin - blood - Medical Testing, Exams, & Health Tests - South Florida Hospital 10 February 2010 12:15 UTC www.mhs.net [Source type: Academic]
  • Wilmington/Newark - Bilirubin is a yellowish pigment found in bile, a fluid... 10 February 2010 12:15 UTC www.christianacare.org [Source type: Academic]
  • Bilirubin - blood - Avera Health 10 February 2010 12:15 UTC averaorg.adam.com [Source type: Academic]
  • Bilirubin - blood - Hillcrest Health System 10 February 2010 12:15 UTC hillcrest2.adam.com [Source type: Academic]
  • Bilirubin - blood - Kootenai Health 10 February 2010 12:15 UTC kootenaihealth.adam.com [Source type: Academic]
  • Bilirubin - blood- medco.com 10 February 2010 12:15 UTC www.medcohealth.com [Source type: Academic]
  • Bilirubin - blood - Health Information 10 February 2010 12:15 UTC www.qualityhealth.com [Source type: Academic]
  • Bilirubin - Blood - Health Information Library - Penn State Hershey 10 February 2010 12:15 UTC www.pennstatehershey.org [Source type: Academic]
  • Bilirubin - blood 10 February 2010 12:15 UTC www.saltlakeregional.com [Source type: Academic]
  • Bilirubin - blood 10 February 2010 12:15 UTC forthealthcare.adam.com [Source type: Academic]
  • Bilirubin - blood - Great Falls Clinic 10 February 2010 12:15 UTC gfclinic.adam.com [Source type: Academic]
  • Bilirubin - blood 10 February 2010 12:15 UTC www.memorialhermann.org [Source type: Academic]
  • D-H Manchester | Health Encyclopedia | Bilirubin - blood 10 February 2010 12:15 UTC www.dartmouth-hitchcock.org [Source type: Academic]

^ Heme (the part of the cell that carries iron) is broken down into bilirubin.

^ (In animals hemoglobin is broken down to heme, and then converted to bilirubin.
  • Plants | Causes of Color 10 February 2010 12:15 UTC www.webexhibits.org [Source type: FILTERED WITH BAYES]

.The heme is then turned into unconjugated bilirubin in the reticuloendothelial cells of the spleen.^ When they do this, the heme is changed into bilirubin.
  • Is a bilirubin level of 2.1 dangerous? - Yahoo!7 Answers 10 February 2010 12:15 UTC au.answers.yahoo.com [Source type: General]

^ The heme is then turned into unconjugated bilirubin in the macrophages of the spleen.
  • Bilirubin: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 10 February 2010 12:15 UTC www.chemie.de [Source type: Academic]

^ Instead the conjugated bilirubin is converted back into the unconjugated form by the enzyme b-glucoronidase and a large proportion is reabsorbed through the enterohepatic circulation.
  • Bilirubin: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 10 February 2010 12:15 UTC www.chemie.de [Source type: Academic]

.This unconjugated bilirubin is not soluble in water.^ Unconjugated (indirect) bilirubin is insoluble in water.
  • Side effects – increased bilirubin, jaundice 10 February 2010 12:15 UTC www.i-base.info [Source type: FILTERED WITH BAYES]

^ Unconjugated bilirubin is insoluble in water but soluble in fats.
  • Jaundice in the Adult Patient - January 15, 2004 - American Family Physician 10 February 2010 12:15 UTC www.aafp.org [Source type: Academic]

^ During phototherapy, photons react with bilirubin in the extravascular space, producing water-soluble isomers that diffuse back into the circulation and are subsequently excreted in the bile.
  • Effect of Position Changing on Bilirubin Levels During Phototherapy 10 February 2010 12:15 UTC www.nature.com [Source type: Academic]

.It is then bound to albumin and sent to the liver.^ Because this bilirubin is water insoluble, it must be transported to the liver bound to albumin.
  • Bilirubin, Total and Direct - ClinLabNavigator.com 10 February 2010 12:15 UTC www.clinlabnavigator.com [Source type: Academic]

^ Bilirubin is lipophylic and is bound to serum albumin in circulation from the RE system to the liver.
  • Jaundice in Older Children and Adolescents -- Pashankar and Schreiber 22 (7): 219 -- Pediatrics in Review 10 February 2010 12:15 UTC pedsinreview.aappublications.org [Source type: Academic]

^ Bilirubin is produced from the breakdown of hemoglobin, transported to the liver bound to albumin, and conjugated with carbohydrates by hepatocytes.
  • Urinalysis Dipstick Interpretation 10 February 2010 12:15 UTC www.vet.uga.edu [Source type: Academic]

.In the liver it is conjugated to glucuronic acid by the enzyme Glucuronosyltransferase, making it soluble in water.^ Bilirubin is conjugated in the liver with glucuronic acid to form the more water-soluble bilirubin diglucuronide.
  • Laboratory Tests: Testing for Hepatic and Biliary Disorders: Merck Manual Professional 10 February 2010 12:15 UTC www.merck.com [Source type: Academic]

^ Conjugation with glucuronic acid.

^ Once in the liver it conjugates with glucuronic acid made from the sugar glucose.
  • bilirubin (biochemistry) -- Britannica Online Encyclopedia 10 February 2010 12:15 UTC www.britannica.com [Source type: Academic]

.Much of it goes into the bile and thus out into the small intestine.^ Then it goes into the intestines and the kidneys, and then it goes out of the body.
  • Jaundice and Your Baby -- familydoctor.org 10 February 2010 12:15 UTC familydoctor.org [Source type: General]

^ The bile then goes through the bile duct into the intestine.
  • LIVER TERMS AND DEFINITIONS 10 February 2010 12:15 UTC www.classkids.org [Source type: Academic]

^ It then goes into the bile to be stored in the gall bladder or sent to the intestines.
  • Side effects – increased bilirubin, jaundice 10 February 2010 12:15 UTC www.i-base.info [Source type: FILTERED WITH BAYES]

.Some of the conjugated bilirubin remains in the large intestine and is metabolised by colonic bacteria to urobilinogen, which is further metabolized to stercobilinogen, and finally oxidised to stercobilin.^ Bilirubin is further metabolized by bacteria in the intestines to urobilins, which contribute to the color of the feces.

^ In the distal ileum and colon, bacteria covert conjugated bilirubin to stercobilinogen.
  • Bilirubin, Total and Direct - ClinLabNavigator.com 10 February 2010 12:15 UTC www.clinlabnavigator.com [Source type: Academic]

^ Urobilinogen is formed by bacteria in the small intestine and in the colon.

.This stercobilin gives feces its brown color.^ (Bilirubin is what gives feces its brown color.
  • Jaundice signs, symptoms and treatment on MedicineNet.com 10 February 2010 12:15 UTC www.medicinenet.com [Source type: FILTERED WITH BAYES]

^ (Bilirubin is what gives stool a brown color).
  • Newborn Jaundice - Symptoms, Diagnosis, Treatment of Newborn Jaundice - NY Times Health Information 10 February 2010 12:15 UTC health.nytimes.com [Source type: FILTERED WITH BAYES]

^ Bile pigments are what gives feces it's characteristic brown color.
  • Liver Disorders 10 February 2010 12:15 UTC www.thedca.org [Source type: Academic]

.Some of the urobilinogen is reabsorbed and excreted in the urine along with an oxidized form, urobilin.^ A small percentage of these compounds are reabsorbed and eventually appear in the urine, where they are referred to as urobilinogen.

^ Conjugated bilirubin is then excreted through the biliary tract into the duodenum, where it is metabolized into urobilinogens (some of which are reabsorbed and resecreted into bile), then into orange-colored urobilins (most of which are eliminated in feces).
  • Laboratory Tests: Testing for Hepatic and Biliary Disorders: Merck Manual Professional 10 February 2010 12:15 UTC www.merck.com [Source type: Academic]

^ It induces photoisomerization of bilirubin, forming lumirubin which is water soluble and excreted in the urine.
  • Case Based Pediatrics Chapter 10 February 2010 12:15 UTC www.hawaii.edu [Source type: Academic]

.Normally, a tiny amount of bilirubin is excreted in the urine, accounting for the light yellow color.^ No bilirubin is present in normal urine.
  • Bilirubin-Dr. Wu's liver diseases (Hepatitis, ...) 10 February 2010 12:15 UTC olddoc.tmu.edu.tw [Source type: Academic]

^ The yellow color of the skin is caused by excess amount of bilirubin in the skin of the newborn.
  • Baby Jaundice 10 February 2010 12:15 UTC www.achildbirth.com [Source type: FILTERED WITH BAYES]

^ Bilirubin is not normally found in the urine.
  • Bilirubin - urine 10 February 2010 12:15 UTC www.phoebeputney.com [Source type: FILTERED WITH BAYES]
  • FloridaHealthFinder.gov | Health Encyclopedia | Bilirubin - urine 10 February 2010 12:15 UTC www.floridahealthfinder.gov [Source type: FILTERED WITH BAYES]
  • Bilirubin - urine - Valley Baptist Health System 10 February 2010 12:15 UTC valleybaptist.adam.com [Source type: FILTERED WITH BAYES]
  • Bilirubin - Urine - Tests, Test Results & Diagnosis - NY Times Health Information 10 February 2010 12:15 UTC health.nytimes.com [Source type: News]
  • Bilirubin - urine - Adventist HealthCare 10 February 2010 12:15 UTC www.adventisthealthcare.com [Source type: FILTERED WITH BAYES]

.If the liver’s function is impaired or when biliary drainage is blocked, some of the conjugated bilirubin leaks out of the hepatocytes and appears in the urine, turning it dark amber.^ Many appear to impair the secretory function of the hepatocytes.

^ Only conjugated bilirubin is found in urine.
  • Urinalysis Dipstick Interpretation 10 February 2010 12:15 UTC www.vet.uga.edu [Source type: Academic]

^ Impaired conjugation of bilirubin .
  • Hyperbilirubinemia, Unconjugated: eMedicine Gastroenterology 10 February 2010 12:15 UTC emedicine.medscape.com [Source type: Academic]

.The presence of this conjugated bilirubin in the urine can be clinically analyzed, and is reported as an increase in urine bilirubin.^ Only conjugated bilirubin is found in urine.
  • Urinalysis Dipstick Interpretation 10 February 2010 12:15 UTC www.vet.uga.edu [Source type: Academic]

^ Conjugated bilirubin - urine; Direct bilirubin - urine .
  • FloridaHealthFinder.gov | Health Encyclopedia | Bilirubin - urine 10 February 2010 12:15 UTC www.floridahealthfinder.gov [Source type: FILTERED WITH BAYES]
  • Bilirubin - urine - Adventist HealthCare 10 February 2010 12:15 UTC www.adventisthealthcare.com [Source type: FILTERED WITH BAYES]
  • Bilirubin - urine - Medical Testing, Exams, & Health Tests - South Florida Hospital 10 February 2010 12:15 UTC www.mhs.net [Source type: FILTERED WITH BAYES]

^ If the liver’s function is impaired, or when there is a hemolytic anemia (increased destruction of red blood cells), or biliary drainage blocked, some of the conjugated bilirubin appears in the urine, turning it dark amber.
  • Bilirubin: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 10 February 2010 12:15 UTC www.chemie.de [Source type: Academic]

.However, in disorders involving hemolytic anemia, an increased number of red blood cells are broken down, causing an increase in the amount of unconjugated bilirubin in the blood.^ When red blood cells break down and are recycled they release bilirubin from their hemoglobin.

^ Jaundice can develop when red blood cells break down and bilirubin is left.
  • Jaundice / Kernicterus 10 February 2010 12:15 UTC www.hoptechno.com [Source type: General]

^ Diagnose conditions that cause increased destruction of red blood cells , such as hemolytic anemia or hemolytic disease of the newborn .
  • Bilirubin 10 February 2010 12:15 UTC www.webmd.com [Source type: General]
  • New York Health - Bilirubin. bilirubin in a blood sample. Bilirubin is a... 10 February 2010 12:15 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
  • CIGNA - Bilirubin 10 February 2010 12:15 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Exempla Healthcare Online Library 10 February 2010 12:15 UTC www.exempla.org [Source type: FILTERED WITH BAYES]
  • Citizens Health Information 10 February 2010 12:15 UTC www.citizensmemorial.com [Source type: FILTERED WITH BAYES]
  • Health News and Information 10 February 2010 12:15 UTC www.billingsclinic.com [Source type: FILTERED WITH BAYES]
  • Health Information 10 February 2010 12:15 UTC www.mmc.org [Source type: Academic]

.As stated above, the unconjugated bilirubin is not water soluble, and thus one will not see an increase in bilirubin in the urine.^ Conjugated bilirubin is water soluble and therefore able to be excreted in urine.
  • Jaundice in the Adult Patient - January 15, 2004 - American Family Physician 10 February 2010 12:15 UTC www.aafp.org [Source type: Academic]

^ For information on that test, see: Bilirubin - urine .
  • Health Information - Walgreens 10 February 2010 12:15 UTC www.walgreens.com [Source type: FILTERED WITH BAYES]
  • Bilirubin - blood - Lifespan 10 February 2010 12:15 UTC www.lifespan.org [Source type: Academic]
  • Bilirubin - blood Medical Information 10 February 2010 12:15 UTC www.drugs.com [Source type: Academic]
  • Bilirubin | LIVESTRONG.COM 10 February 2010 12:15 UTC www.livestrong.com [Source type: FILTERED WITH BAYES]
  • St. Luke's Sugar Land Hospital - Your Health Topics 10 February 2010 12:15 UTC stlukessugarland.adam.com [Source type: Academic]
  • Wilmington/Newark - Bilirubin is a yellowish pigment found in bile, a fluid... 10 February 2010 12:15 UTC www.christianacare.org [Source type: Academic]
  • Bilirubin - blood - Avera Health 10 February 2010 12:15 UTC averaorg.adam.com [Source type: Academic]
  • Bilirubin - blood - Health Information 10 February 2010 12:15 UTC www.qualityhealth.com [Source type: Academic]
  • Bilirubin - blood - Great Falls Clinic 10 February 2010 12:15 UTC gfclinic.adam.com [Source type: Academic]

^ For information on that test, see: Bilirubin - urine.
  • Bilirubin - blood - Abington Memorial Hospital 10 February 2010 12:15 UTC amh.adam.com [Source type: Academic]

.Because there is no problem with the liver or bile systems, this excess unconjugated bilirubin will go through all of the normal processing mechanisms that occur (e.g., conjugation, excretion in bile, metabolism to urobilinogen, reabsorption) and will show up as an increase in urine urobilinogen.^ This conjugation reaction is essential for bilirubin excretion into bile.
  • Bilirubin, Impaired Conjugation: eMedicine Gastroenterology 10 February 2010 12:15 UTC emedicine.medscape.com [Source type: Academic]

^ Bilirubin is used by the liver, to make bile.
  • Liver Problems, Liver Dysfunction, Hypatoxoxicity - Cancer Symptoms, Chemotherapy & Chemo Side Effects 10 February 2010 12:15 UTC www.chemocare.com [Source type: General]

^ When the blood bilirubin levels are increased, it may be a sign of a liver or blood problem.
  • Liver Problems, Liver Dysfunction, Hypatoxoxicity - Cancer Symptoms, Chemotherapy & Chemo Side Effects 10 February 2010 12:15 UTC www.chemocare.com [Source type: General]

.This difference between increased urine bilirubin and increased urine urobilinogen helps to distinguish between various disorders in those systems.^ In some cases, however, especially in infants who are premature and/or have associated hemolytic disorders, abnormal accumulation of bilirubin in the central nervous system is a cause of bilirubin encephalopathy, which may contribute to increased morbidity and adverse neurologic sequelae ( 1 , 2 ).
  • Perturbation of membrane dynamics in nerve cells as an early event during bilirubin-induced apoptosis -- Rodrigues et al. 43 (6): 885 -- Journal of Lipid Research 10 February 2010 12:15 UTC www.jlr.org [Source type: Academic]

^ However, in some cases the bilirubin will continue to increase and can then act like a poison ( toxin ) to the nervous system, especially the brain.
  • Jaundice - Keep Kids Healthy conditions 10 February 2010 12:15 UTC www.keepkidshealthy.com [Source type: FILTERED WITH BAYES]

^ Normal values may vary between different labs but are within the following ranges.
  • Side effects – increased bilirubin, jaundice 10 February 2010 12:15 UTC www.i-base.info [Source type: FILTERED WITH BAYES]

Toxicity

.Unconjugated hyperbilirubinaemia in a neonate can lead to accumulation of bilirubin in certain brain regions, a phenomenon known as kernicterus, with consequent irreversible damage to these areas manifesting as various neurological deficits, seizures, abnormal reflexes and eye movements.^ Very high levels of serum bilirubin lead to its accumulation in the brain, causing kernicterus.
  • Bilirubin Benefits: Cellular Protection by a Biliverdin Reductase Antioxidant Cycle -- Sedlak and Snyder 113 (6): 1776 -- Pediatrics 10 February 2010 12:15 UTC pediatrics.aappublications.org [Source type: Academic]

^ Kernicterus is a type of brain damage caused by high levels of bilirubin.
  • Newborn Jaundice - March of Dimes 10 February 2010 12:15 UTC www.marchofdimes.com [Source type: FILTERED WITH BAYES]

^ Kernicterus is a neurologic syndrome resulting from deposition of unconjugated bilirubin in the brain.

.The neurotoxicity of neonatal hyperbilirubinemia manifests because the blood-brain barrier has yet to develop fully, and bilirubin can freely pass into the brain interstitium, whereas more developed individuals with increased bilirubin in the blood are protected.^ In older children and adults, the "blood-brain barrier" is more developed and prevents bilirubin from crossing this barrier to the brain cells.
  • Bilirubin Test | HealthSheets | Wellness Library | Mount Nittany Medical Center 10 February 2010 12:15 UTC www.mountnittany.org [Source type: Academic]

^ Hyperbilirubinemia: Too much bilirubin in the blood.
  • Glossary of Medical Terms 10 February 2010 12:15 UTC www.barcnetwork.org [Source type: Academic]

^ Combined bilirubin/albumin molecules are too large to pass through the blood-brain barrier and thus the brain can be protected.
  • Crigler Najjar Syndrome 10 February 2010 12:15 UTC carmonet.50webs.com [Source type: FILTERED WITH BAYES]

.Aside from specific chronic medical conditions that may lead to hyperbilirubinaemia, neonates in general are at increased risk since they lack the intestinal bacteria that facilitate the breakdown and excretion of conjugated bilirubin in the feces (this is largely why the feces of a neonate are paler than those of an adult).^ This may lead to increased absorption of unconjugated bilirubin.
  • Hyperbilirubinemia, Unconjugated: eMedicine Gastroenterology 10 February 2010 12:15 UTC emedicine.medscape.com [Source type: Academic]

^ Bilirubin is further broken down by bacteria in the intestines, and those breakdown products contribute to the color of the feces.
  • Bilirubin Medical Information 10 February 2010 12:15 UTC www.drugs.com [Source type: Academic]
  • Health Information - Walgreens 10 February 2010 12:15 UTC www.walgreens.com [Source type: FILTERED WITH BAYES]
  • Bilirubin - blood - Lifespan 10 February 2010 12:15 UTC www.lifespan.org [Source type: Academic]
  • Health Baltimore - Bilirubin. Bilirubin is a product that results from the ... 10 February 2010 12:15 UTC www.franklinsquare.org [Source type: Academic]
  • Bilirubin - blood Medical Information 10 February 2010 12:15 UTC www.drugs.com [Source type: Academic]
  • Bilirubin | LIVESTRONG.COM 10 February 2010 12:15 UTC www.livestrong.com [Source type: FILTERED WITH BAYES]
  • Medical Tests | Bilirubin 10 February 2010 12:15 UTC www.ucsfhealth.org [Source type: Academic]
  • Bilirubin - blood 10 February 2010 12:15 UTC www.allina.com [Source type: Academic]
  • St. Luke's Sugar Land Hospital - Your Health Topics 10 February 2010 12:15 UTC stlukessugarland.adam.com [Source type: Academic]
  • Bilirubin - blood - Baylor Health 10 February 2010 12:15 UTC info.baylorhealth.com [Source type: Academic]
  • Bilirubin - blood - Medical Testing, Exams, & Health Tests - South Florida Hospital 10 February 2010 12:15 UTC www.mhs.net [Source type: Academic]
  • Wilmington/Newark - Bilirubin is a yellowish pigment found in bile, a fluid... 10 February 2010 12:15 UTC www.christianacare.org [Source type: Academic]
  • Bilirubin - blood - Avera Health 10 February 2010 12:15 UTC averaorg.adam.com [Source type: Academic]
  • Bilirubin - blood - Abington Memorial Hospital 10 February 2010 12:15 UTC amh.adam.com [Source type: Academic]
  • Bilirubin - blood 10 February 2010 12:15 UTC forthealthcare.adam.com [Source type: Academic]

^ Aside from specific chronic medical conditions that may lead to hyperbilirubinaemia, neonates in general are at increased risk since they lack the intestinal bacteria that facilitate the breakdown and excretion of conjugated bilirubin in the feces (this is largely why the feces of a neonate are paler than those of an adult).
  • Bilirubin: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 10 February 2010 12:15 UTC www.chemie.de [Source type: Academic]

.Instead the conjugated bilirubin is converted back into the unconjugated form by the enzyme β-glucuronidase and a large proportion is reabsorbed through the enterohepatic circulation.^ Circulating bilirubin starts changing into a non-toxic form.
  • P.I.C.K. - Resource Center - FAQ 10 February 2010 12:15 UTC www.pickonline.org [Source type: General]

^ In the liver it is converted into bilirubin conjugates bilirubin mono and diglucuronides .
  • Standard Operating Procedures for CLINICAL CHEMISTRY � Bilirubin � Jendrassik and Grof Method 10 February 2010 12:15 UTC www.searo.who.int [Source type: Academic]

^ Conjugated bilirubin can also be broken down again into an unconjugated form that reenters the blood stream.
  • Jaundice - Keep Kids Healthy conditions 10 February 2010 12:15 UTC www.keepkidshealthy.com [Source type: FILTERED WITH BAYES]

Blood tests

.Bilirubin is broken down by light, and therefore blood collection tubes (especially serum tubes) should be protected from such exposure.^ The circulation of the blood will bring the bilirubin to the lighted area where it will be broken down.
  • Your Baby, Jaundice and Phototherapy 10 February 2010 12:15 UTC www.med.umich.edu [Source type: General]

^ After red blood cells are broken down, bilirubin is made.
  • Neonatal Jaundice - Patients - American College of Gastroenterology 10 February 2010 12:15 UTC www.gi.org [Source type: FILTERED WITH BAYES]

^ Bilirubin is broken down by light, and therefore blood collection tubes (especially serum tubes) should be protected from such exposure.
  • Bilirubin: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 10 February 2010 12:15 UTC www.chemie.de [Source type: Academic]

Bilirubin (in blood) is in one of two forms:
Abb. Name(s) Water Soluble? Reaction
"BC" "Conjugated" or
"Direct bilirubin"
Yes (bound to glucuronic acid) Reacts quickly when dyes (diazo reagent) are added to the blood specimen to produce azobilirubin "Direct bilirubin"
"BU" "Unconjugated" or "Indirect bilirubin" No Reacts more slowly. Still produces azobilirubin. Ethanol makes all bilirubin react promptly then calc: Indirect bilirubin = Total bilirubin - Direct bilirubin
.Total bilirubin ("TBIL") measures both BU and BC. Total and direct bilirubin levels can be measured from the blood, but indirect bilirubin is calculated from the total and direct bilirubin.^ A small sample of blood is tested for the measure of bilirubin level.
  • Newborn Jaundice – A Condition That Occurs Due To High Bilirubin Levels! | Newborn Baby Zone 10 February 2010 12:15 UTC www.newbornbabyzone.com [Source type: General]

^ Your doctor will need to measure the level of bilirubin in your baby's blood.
  • Infant jaundice 10 February 2010 12:15 UTC www.cnn.com [Source type: General]

^ This test measures the amount of unconjugated (indirect) bilirubin in blood.
  • Serum unconjugated bilirubin measurement 10 February 2010 12:15 UTC www.allina.com [Source type: FILTERED WITH BAYES]

.Indirect bilirubin is fat soluble and direct bilirubin is water soluble.^ This fat-soluble bilirubin is converted into water-soluble bilirubin in a liver.
  • Apparatus For Denaturating Bilirubin And Bilirubin Dialyzer - Patent application 10 February 2010 12:15 UTC www.faqs.org [Source type: Reference]

^ Some vitamins are soluble in fats, some in water.

^ This form of bilirubin is called conjugated, direct reacting or water soluble bilirubin.

Measurement methods

.Originally the Van den Bergh reaction was used for a qualitative estimate of bilirubin.^ Serum bilirubin measurements are based on the van den Bergh reaction: a direct reaction gives conjugated bilirubin; the addition of methanol allows a complete reaction, which measures total bilirubin (conjugated plus unconjugated), while the difference represents unconjugated bilirubin (an indirect value).
  • Diagnostic Tests 10 February 2010 12:15 UTC pbcers.org [Source type: Academic]

^ Therefore, many colorimetric assays for bilirubin commonly use diazotized sulfanilic acid or other diazotized reagents to form colored azobilirubin reaction products.

^ The bilirubin was at least 90 percent unconjugated according to van den Bergh's test and 99 percent unconjugated on the basis of high-performance liquid chromatography.
  • NEJM -- The Genetic Basis of the Reduced Expression of Bilirubin UDP-Glucuronosyltransferase 1 in Gilbert's Syndrome 10 February 2010 12:15 UTC content.nejm.org [Source type: Academic]

.There are a variety of methods to measure bilirubin.^ For total, direct, and indirect bilirubin measures, there was no significant association with any botanical group independently.
  • Gilbert's Syndrome Mutations 10 February 2010 12:15 UTC www.gilbertssyndrome.com [Source type: Academic]
  • Cruciferae Interact with the UGT1A1*28 Polymorphism to Determine Serum Bilirubin Levels in Humans -- Peterson et al. 135 (5): 1051 -- Journal of Nutrition 10 February 2010 12:15 UTC jn.nutrition.org [Source type: Academic]

^ Method and apparatus for optical measurement of bilirubin in tissue .
  • Method and system for determining ... - Google Patent Search 10 February 2010 12:15 UTC www.google.com [Source type: Academic]

^ Another method used to measure total bilirubin in the blood uses a device held onto the skin and does not require a needle stick.
  • Jaundice - Keep Kids Healthy conditions 10 February 2010 12:15 UTC www.keepkidshealthy.com [Source type: FILTERED WITH BAYES]

[5]
.Total bilirubin is now often measured by the 2,5-dichlorophenyldiazonium (DPD) method, and direct bilirubin is often measured by the method of Jendrassik and Grof.^ Serum bilirubin measurements are based on the van den Bergh reaction: a direct reaction gives conjugated bilirubin; the addition of methanol allows a complete reaction, which measures total bilirubin (conjugated plus unconjugated), while the difference represents unconjugated bilirubin (an indirect value).
  • Diagnostic Tests 10 February 2010 12:15 UTC pbcers.org [Source type: Academic]

^ This method uses a blank channel, which runs together with the sample channel to correct for endogenous factors in the sample interfering with total bilirubin concentrations.
  • Serum bilirubin concentration in a Belgian population: the association with smoking status and type of cigarettes -- Hoydonck et al. 30 (6): 1465 -- International Journal of Epidemiology 10 February 2010 12:15 UTC ije.oxfordjournals.org [Source type: Academic]

^ For total, direct, and indirect bilirubin measures, there was no significant association with any botanical group independently.
  • Gilbert's Syndrome Mutations 10 February 2010 12:15 UTC www.gilbertssyndrome.com [Source type: Academic]
  • Cruciferae Interact with the UGT1A1*28 Polymorphism to Determine Serum Bilirubin Levels in Humans -- Peterson et al. 135 (5): 1051 -- Journal of Nutrition 10 February 2010 12:15 UTC jn.nutrition.org [Source type: Academic]

[6]

Blood levels

.There are no normal levels of bilirubin as it is an excretion product, and levels found in the body reflects the balance between production and excretion.^ What is a normal bilirubin level?
  • P.I.C.K. - Resource Center - FAQ 10 February 2010 12:15 UTC www.pickonline.org [Source type: General]

^ Bilirubin is an excretion product, and the body does not control levels.
  • Bilirubin: Encyclopedia of chemistry, analytics & pharmaceutics with 64,557 entries. 10 February 2010 12:15 UTC www.chemie.de [Source type: Academic]

^ No bilirubin is present in normal urine.
  • Bilirubin-Dr. Wu's liver diseases (Hepatitis, ...) 10 February 2010 12:15 UTC olddoc.tmu.edu.tw [Source type: Academic]

.Different sources provide reference ranges which are similar but not identical.^ Any value outside the specified Reference Range should be reported to your health care provider.

Some examples for adults are provided below (different reference ranges are often used for newborns):
μmol/L mg/dL
total bilirubin 5.1–17.0 [7] 0.2-1.9,[8] 0.3–1.0,[7] 0.1-1.2[9]
direct bilirubin 1.0–5.1 [7] 0-0.3,[8] 0.1–0.3,[7] 0.1-0.4[9]
Reference ranges for blood tests, comparing blood content of bilirubin (shown in blue near center) with other constituents.
Mild rises in bilirubin may be caused by:
  • Hemolysis or increased breakdown of red blood cells
  • Gilbert's syndrome - a genetic disorder of bilirubin metabolism which can result in mild jaundice, found in about 5% of the population
Moderate rise in bilirubin may be caused by:
Very high levels of bilirubin may be caused by:
Cirrhosis may cause normal, moderately high or high levels of bilirubin, depending on exact features of the cirrhosis
.To further elucidate the causes of jaundice or increased bilirubin, it is usually simpler to look at other liver function tests (especially the enzymes alanine transaminase, aspartate transaminase, gamma-glutamyl transpeptidase, alkaline phosphatase), blood film examination (hemolysis, etc.^ The other type of test is a transcutaneous bilirubin test.
  • P.I.C.K. - Resource Center - FAQ 10 February 2010 12:15 UTC www.pickonline.org [Source type: General]

^ Too much bilirubin causes jaundice.
  • Glossary of Medical Terms 10 February 2010 12:15 UTC www.barcnetwork.org [Source type: Academic]

^ Alkaline phosphatase: Increased levels of this hepatocyte enzyme suggest cholestasis.
  • Laboratory Tests: Testing for Hepatic and Biliary Disorders: Merck Manual Professional 10 February 2010 12:15 UTC www.merck.com [Source type: Academic]

) or evidence of infective hepatitis (e.g., hepatitis A, B, C, delta, E, etc).

Urine tests

.Urine levels of bilirubin may also be clinically significant.^ Medicines that may decrease bilirubin levels.
  • Bilirubin - Yahoo! Health 10 February 2010 12:15 UTC health.yahoo.com [Source type: FILTERED WITH BAYES]
  • New York Health - Bilirubin. bilirubin in a blood sample. Bilirubin is a... 10 February 2010 12:15 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
  • CIGNA - Bilirubin 10 February 2010 12:15 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Exempla Healthcare Online Library 10 February 2010 12:15 UTC www.exempla.org [Source type: FILTERED WITH BAYES]
  • Citizens Health Information 10 February 2010 12:15 UTC www.citizensmemorial.com [Source type: FILTERED WITH BAYES]
  • Health News and Information 10 February 2010 12:15 UTC www.billingsclinic.com [Source type: FILTERED WITH BAYES]
  • Health Information 10 February 2010 12:15 UTC www.mmc.org [Source type: Academic]

^ Bilirubin may also be measured in the urine.
  • Bilirubin - Yahoo! Health 10 February 2010 12:15 UTC health.yahoo.com [Source type: FILTERED WITH BAYES]
  • New York Health - Bilirubin. bilirubin in a blood sample. Bilirubin is a... 10 February 2010 12:15 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
  • CIGNA - Bilirubin 10 February 2010 12:15 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Exempla Healthcare Online Library 10 February 2010 12:15 UTC www.exempla.org [Source type: FILTERED WITH BAYES]
  • Citizens Health Information 10 February 2010 12:15 UTC www.citizensmemorial.com [Source type: FILTERED WITH BAYES]
  • Health News and Information 10 February 2010 12:15 UTC www.billingsclinic.com [Source type: FILTERED WITH BAYES]
  • Health Information 10 February 2010 12:15 UTC www.mmc.org [Source type: Academic]

^ Medicines that may increase bilirubin levels.
  • Bilirubin - Yahoo! Health 10 February 2010 12:15 UTC health.yahoo.com [Source type: FILTERED WITH BAYES]
  • New York Health - Bilirubin. bilirubin in a blood sample. Bilirubin is a... 10 February 2010 12:15 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
  • CIGNA - Bilirubin 10 February 2010 12:15 UTC www.cigna.com [Source type: FILTERED WITH BAYES]
  • Exempla Healthcare Online Library 10 February 2010 12:15 UTC www.exempla.org [Source type: FILTERED WITH BAYES]
  • Citizens Health Information 10 February 2010 12:15 UTC www.citizensmemorial.com [Source type: FILTERED WITH BAYES]
  • Health News and Information 10 February 2010 12:15 UTC www.billingsclinic.com [Source type: FILTERED WITH BAYES]
  • Health Information 10 February 2010 12:15 UTC www.mmc.org [Source type: Academic]

[10]

Jaundice

.Jaundice may be noticeable in the sclera (white) of the eyes at levels of about 30-50 μmol/l, and in the skin at higher levels.^ Jaundice (yellowing of the gums, whites of the eyes or skin).
  • Liver Disorders 10 February 2010 12:15 UTC www.thedca.org [Source type: Academic]

^ When bilirubin levels are high, the skin and whites of the eyes may appear yellow ( jaundice ).
  • Bilirubin - Yahoo! Health 10 February 2010 12:15 UTC health.yahoo.com [Source type: FILTERED WITH BAYES]
  • New York Health - Bilirubin. bilirubin in a blood sample. Bilirubin is a... 10 February 2010 12:15 UTC www.svcmc.org [Source type: FILTERED WITH BAYES]
  • Citizens Health Information 10 February 2010 12:15 UTC www.citizensmemorial.com [Source type: FILTERED WITH BAYES]
  • Health Information 10 February 2010 12:15 UTC www.mmc.org [Source type: Academic]
  • Health Library - 10 February 2010 12:15 UTC www.bozemandeaconess.org [Source type: News]

^ Bilirubin accumulates, causing jaundice, a yellowing of the skin and the whites of the eyes.
  • At Gene Therapy's Frontier, the Amish Build a Clinic 10 February 2010 12:15 UTC partners.nytimes.com [Source type: FILTERED WITH BAYES]

.Jaundice is classified depending upon whether the bilirubin is free or conjugated to glucuronic acid into Conjugated jaundice or Unconjugated jaundice.^ Conjugation with glucuronic acid.

^ This is achieved by glucuronic acid conjugation of the propionic acid side chains of bilirubin.
  • Bilirubin, Impaired Conjugation: eMedicine Gastroenterology 10 February 2010 12:15 UTC emedicine.medscape.com [Source type: Academic]

^ Total Bilirubin Total bilirubin in serum and plasma is the sum of unconjugated bilirubin (Bu), mono- and di-glucuronide conjugated bilirubin (Bc), and delta bilirubin (DELB), a bilirubin fraction covalently bound to albumin.
  • Laboratory Services - Center for Community Health - Office of Public Health - Louisiana Department of Health and Hospitals 10 February 2010 12:15 UTC www.dhh.louisiana.gov [Source type: Academic]

[citation needed]

See also

References

  1. ^ sciencenews.org
  2. ^ "Bilirubin's Chemical Formula". http://www3.nsta.org/main/news/stories/college_science.php?news_story_ID=48991. Retrieved 2007-08-14. 
  3. ^ Baranano DE, Rao M, Ferris CD, Snyder SH (2002). "Biliverdin reductase: a major physiologic cytoprotectant". Proc. Natl. Acad. Sci. U.S.A. 99 (25): 16093–8. doi:10.1073/pnas.252626999. PMID 12456881. 
  4. ^ Liu Y, Li P, Lu J, Xiong W, Oger J, Tetzlaff W, Cynader M. (2008). "Bilirubin possesses powerful immunomodulatory activity and suppresses experimental autoimmune encephalomyelitis". J. Immunol. 181 (3): 1887–97. PMID 18641326. 
  5. ^ Watson D, Rogers JA (May 1961). "A study of six representative methods of plasma bilirubin analysis". J. Clin. Pathol. 14: 271–8. doi:10.1136/jcp.14.3.271. PMID 13783422. PMC 480210. http://jcp.bmj.com/cgi/pmidlookup?view=long&pmid=13783422. 
  6. ^ Rolinski B, Küster H, Ugele B, Gruber R, Horn K (1 October 2001). "Total bilirubin measurement by photometry on a blood gas analyzer: potential for use in neonatal testing at the point of care". Clin. Chem. 47 (10): 1845–7. PMID 11568098. http://www.clinchem.org/cgi/content/full/47/10/1845. 
  7. ^ a b c d Golonka, Debby. "Digestive Disorders Health Center: Bilirubin". WebMD. pp. 3. http://www.webmd.com/digestive-disorders/Bilirubin-15434?page=3. Retrieved 2010-01-14. 
  8. ^ a b MedlinePlus Encyclopedia CHEM-20
  9. ^ a b "Laboratory tests". http://www.sh.lsuhsc.edu/fammed/OutpatientManual/content.html. Retrieved 2007-08-14. 
  10. ^ MedlinePlus Encyclopedia Bilirubin - urine

Simple English

Bilirubin is a product that comes from the breakdown of hemoglobin. Its levels are higher in certain diseases and it causes the yellow color of bruises and the brown color of feces. Total and direct bilirubin are usually measured to look for or to monitor liver or gallbladder problems. [[File:|thumb|heme]] [[File:|300px|thumb|bilirrubin observe the N-rings]]



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