Normal Bilirubin Count and Causes of Elevated Levels

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What is Bilirubin

Bilirubin, once referred to as hematoidin, is a yellow-colored pigment present in the liver. It is a breakdown product of heme catabolism. Heme is present in hemoglobin, a principal element of red blood cells. Physiologically, bilirubin is excreted in urine and bile. Screening or monitoring of gallbladder or liver dysfunction is possible by measuring the total and direct bilirubin in the blood or urine. Normal results for direct bilirubin are: 0 to .3 mg/dL and normal results for total bilirubin are: .3 to 1.9 mg/dL. (Note: mg/dL – milligrams per deciliter). Normal values may differ depending upon the laboratory used.

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
Rotor syndrome: non-itching jaundice, with rise of bilirubin in the patient’s serum, mainly of the conjugated type.

Moderate rise in bilirubin may be caused by

There are certain drugs that can cause an increase in bilirubin test measurements. These drugs include allopurinol, anabolic steroids, some antibiotics, antimalaria medications, azathioprine, chlorpropamide, cholinergics, codeine, diuretics, meperidine, methotrexate, methyldopa, morphine, nicotinic acid, birth control pills, quinidine, steroids, sulfonamides, and theophylline. In addition, there are also some drugs that can lower bilirubin measurements. They include barbiturates, caffeine, penicillin, and high-dose salicylates such as aspirin.

Amplified levels of indirect or total bilirubin could be an indication of the following medical conditions: healing of a hematoma, Crigler-Najjar syndrome, erythroblastosis fetalis, Gilbert’s disease, hemolytic anemia, hemolytic disease of the newborn, hepatitis, physiological jaundice (normal in newborns), Sickle cell anemia, transfusion reaction, and pernicious anemia. Increased levels of direct bilirubin may be a sign of these conditions: Bile duct obstruction, cirrhosis, Dubin-Johnson syndrome (very rare), hepatitis, or intrahepatic cholestasis. One cause for a high bilirubin level is that too much of it is being produced. This happens due to red blood cells breaking open, releasing hemoglobin into the serum.

Very high levels of bilirubin may be caused by

Neonatal hyperbilirubinaemia, where the newborn’s liver is not able to properly process the bilirubin causing jaundice
Unusually large bile duct obstruction, e.g. stone in common bile duct, tumour obstructing common bile duct etc.
Severe liver failure with cirrhosis
Crigler-Najjar syndrome
Dubin-Johnson syndrome
Choledocholithiasis (chronic or acute)

Jaundice, a condition in which the skin and white of the eyes turn yellowish in color, can be caused by a high bilirubin count. Liver disease or bile duct blockage can cause red blood cells to break down at a pace too rapid to be processed by the liver. In these cases, bilirubin builds up, is excreted from the liver, and collects in the blood at a level greater than around 2.5 mg/dL. Extremely high bilirubin measurements will lead to the appearance of bilirubin in the urine.

Can Stress Cause Bilirubin Levels To Elevate

Stress results from any number of internal or external factors known as stressors. Stress can come from any situation that produces negative emotions such as anger, nervousness or frustration. Physiologically, the experience of a state of stress leads the body to release powerful neurochemicals, preparing the individual for the physical action of fight or flight. Prolonged and continual stress can lead to a host of serious health problems.

The connection between stress and elevated levels of bilirubin has been and continues to be examined by doctors, and it has been postulated that patients exhibiting high levels of bilirubin with no identifiable cause may indeed find that psychological stress is to blame.

Tests conducted at the Tokyo Medical and Dental University have shown that stress leads to an increase in the presence of bilirubin metabolites in the urine. Further investigation of this connection was examined at the University of Shizuoka in Japan. Researchers used mice to test the effects of three different types of social stress: confrontation, isolation and crowding. Researchers examining urine samples from the mice found that the urine of mice exposed to these types of psychological stress showed an increase in biopyrrins, which are oxidative metabolites of bilirubin.

Another test, also conducted in Japan, using human test subjects, found that people exposed to the high stress situation of delivering a speech in front of others demonstrated higher urine levels of biopyrrin compared to those not exposed to this stressful situation.

Although the connection between stress and bilirubin levels cannot be made with certainty, a number of other clinical trials have been conducted that have presented similar results as those cited above, namely increasing levels of biopyrrin in the urine with the introduction of stressors. The evidence to date does give merit to the hypothetical link between stress and increased levels of bilirubin in the blood and thus warrants further testing. The conclusions drawn thus far are tenuous at best as it is known that oxidative stress leads to increased levels of bilirubin metabolites in the urine. Psychological stress is but one of many factors leading to oxidative stress. Other factors include alcohol, cigarette smoke, radiation and air pollution.

Bilirubin Tests

A bilirubin test is given by venipuncture. A health care provider first uses antiseptic to clean the area from inside the elbow or the back of the hand. The upper arm is wrapped by an elastic band which applies pressure to the area. The vein swells and the practitioner inserts a needle into the vein. The blood transfers into an airtight tube or vial, then the elastic band is taken off. After this process, the site of the puncture is covered with gauze to stop any bleeding.

In the laboratory, a specialist spins the blood in a centrifuge, separating the liquid part of the blood, the serum, from the blood cells, The bilirubin test is performed on the serum. Some factors can possibly interfere with proper results. For example, lipids in the blood can present misleadingly low bilirubin levels. Moreover, when exposed to light, bilirubin breaks down and produces false measurements.

Resource by L.Fuller

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