home Auditorium 8 Low level of total bilirubin in the blood: reasons for the decrease. What is bilirubin in the blood and its normal level in a healthy person?

Low level of total bilirubin in the blood: reasons for the decrease. What is bilirubin in the blood and its normal level in a healthy person?

Bilirubin is a yellow hemoglobin fiery pigment. Bilirubin is released as a result of the decomposition of red blood cells, which have ceased their activity in the body, and is also released as a result of the destruction of myoglobin and cytochromes.

Red blood cell breakdown

The overwhelming proportion of red blood cells disintegrate in the spleen, liver and bone marrow. During the day, one hundredth of the red blood cells disintegrate. They contain hemoglobin, from which about 300 ml of a pigment called bilirubin is produced. Bilirubin is part of the blood, but its concentration should not be higher permissible level. At the moment, the pigment bilirubin and its features, as well as all the causes of failures in bilirubin metabolism, have been carefully studied and described in detail by specialists.

Jaundice – main symptom increased levels of bilirubin (hyperbilirubinemia), therefore, as a rule, diagnosis does not have any particular difficulties.

Acceptable value of bilirubin in the blood:

For a newborn baby, the bilirubin norm does not exceed 150 μmol/l.
For a child, the norm will be 15.4 μmol/l
In an adult, the norm is 4.6-20 μmol/l.

There are many reasons for an increased amount of bilirubin in the blood, but almost all of them are associated with impaired liver function. You must first identify the cause of bilirubin in the blood, since in some cases the content of this pigment can exceed the norm ten times, which represents serious danger for the life and health of the patient and he requires urgent medical care.

Main reasons high content bilirubin in the blood:

Newborns often have increased amount bilirubin. In the vast majority of cases, this occurs due to minor deviations and goes away without medical intervention, but this does not negate the close supervision of a pediatrician.

Symptoms of high bilirubin:

Frequent headaches.
Cardiopalmus.
Periodic increase in body temperature.
The mucous membrane of the eye acquires a yellow tint.
Dizziness.
Pain in the liver area.
Darkening of urine.
Lethargy. Dejected state.
Deterioration or complete absence appetite.
Skin itching.
Unpleasant sensations in the left side, in the hypochondrium, after and during various physical activities.
Yellowing of the skin.
Enlarged spleen.

Ways to lower bilirubin

To use the methods effective reduction the amount of bilirubin in the blood, first you need to establish the main reason for the increase. Some diseases with similar symptoms require complex treatment. If you reduce the amount of bilirubin, but do not eliminate the cause itself, the effect will not be long-term; after a short time, bilirubin will increase again.

Important! If there are signs of jaundice, you should not self-medicate, but immediately seek help from a doctor for an accurate diagnosis.

Medicines that reduce bilirubin levels in the blood:

Antibacterial drugs such as Furazepam and Diazepam.
Drugs that help improve digestion, such as Festal or Mezim.
Choleretic medications, including Allohol and Hovitol.
Medicines for the liver, for example Karsil.
Drugs to combat pathological condition, such as Activated carbon and Enterosgel.
Hepatoprotectors, including Pancreatin.

Attention! Medicines to reduce the amount of this pigment in the blood should be taken only as prescribed by a specialist, depending on the cause of the disease and the patient’s condition. Do not self-medicate, it can harm your health.

Diet for high bilirubin levels

To effectively lower bilirubin in the blood, you need to not only take medications, but also follow a special diet.

The main principles of the diet:

Regular meals. At approximately the same time, four or five times a day.
Do not eat at least two hours before bedtime, ideally four hours.
Small portions of food, do not eat until you feel completely full.
Increase fluid intake to at least two liters. It also includes soups, various drinks and even juicy fruits.
Limited salt intake. No more than ten grams per day. To make it easier to count, pour the required amount of salt into a separate container; when preparing food, do not add salt, add salt directly to the one already in the plate.
Complete exclusion of fried foods, including fried soups.

Products contraindicated for:

Meats that are difficult to digest, such as pork, lamb and duck.
Fatty fish.
Raw seafood.
Sweets (chocolate, cocoa and ice cream).
Complex baked goods containing baking soda or baking powder.
Onions, garlic and radishes.
All legumes, sorrel.
Sour fruits and berries.
Hard cheese with high fat content.
Mushrooms.
Nuts.
Rich meat broth.
Alcohol in any quantity.
Sweet, highly carbonated drinks.
Hot, spicy and smoky.
Pickles and various marinades of any production.
Sausages.
Chips.
Fast food.
Vinegar.
Citrus fruit.
Sauerkraut.

Products that reduce the amount of bilirubin in the blood:

Boiled meat and fish.
Cereal porridge. Milk and lungs vegetable soups without frying.
Bread made from second grade flour, preferably dried.
Vegetables.
Vegetable oil. And butter can only be consumed in small quantities.
Natural fruit drinks such as compote, jelly or fruit drink.
Dietary meat, which includes turkey, veal, chicken protein and rabbit meat.

Folk remedies to combat high levels of bilirubin in the blood

Alternative medicine is widely used to reduce bilirubin. Basically, such treatment is based on the use of various herbal decoctions. Briefly about the most popular:

Tincture of birch leaves. A full tablespoon of crushed dry leaves is brewed in one glass of boiling water for about thirty minutes and consumed before bed. This remedy helps remove toxins from the liver, including bilirubin.
A decoction of chamomile flowers, motherwort and St. John's wort. Dry the herb mixture, chop it, infuse one tablespoon of the resulting mixture in one glass hot water. Use twice a day, thirty minutes before meals. The result of this infusion is noticeable after ten days of use.
Decoction of corn silk. The stigma is the fluffy part of the head of cabbage. Infuse 50 grams of corn silk in a glass of boiling water. Strain and top up again until the glass is full. Drink little by little throughout the day.

You need to know how to lower bilirubin in the blood even at the everyday level, because, having received in the results general analysis blood bilirubin value is over 20.5 µmol/l, you must realize that not everything is in order in the body. Such a result should encourage you to go to the doctor to organize an in-depth examination if you do not know your disease, which can “sound” like bilirubin.

Let us recall that bilirubin is a breakdown product of red blood cells (details) and consists of two fractions - unbound and bound (albumin). The analysis results display the total value for both fractions. The unbound fraction of bilirubin poses a danger to the body due to its rather high toxicity.

sudden vertical wrinkles between the eyebrows,
spots (mostly brown or green) especially on right side face or in the temporal part,
feeling oily skin on the forehead,
the appearance of baldness (especially the central part of the head in both men and women) or gray hair,
occurrence of vision problems,
causeless inflammation of the gums and throat,
problems with stool.

All these manifestations may indicate problems with the removal of bilirubin and literally call for a visit to the doctor and a general blood test.

So, you saw in the test results that bilirubin is indeed elevated. It should be understood that the fraction of unbound bilirubin may indicate liver failure or may be associated with Gilbert's syndrome.

An increased level of direct (bound) bilirubin is most often associated with disease of the biliary tract, which indicates a violation of the outflow of bile.

But in the primary results we are given a total value, based on which it is impossible to make an assumption. It is important here whether you know your disease, in which bilirubin may increase, or whether this is news to you.

If this is the first time, then you should not wait or try to reduce bilirubin at home - this can lead to irreparable consequences. Visit your doctor and have him prescribe an in-depth examination. Be guided by the fact that this is necessary first of all for you, and not for the doctor.

If you know of a disease that can increase bilirubin, you should:

start taking medications for a disease you know (this means an exacerbation has occurred). Most often, such diseases include hepatitis or hemolytic anemia.
start taking medications or dietary supplements that will help normalize liver function:
- hepatrin,
- phenobarbital (0.05 - 0.2 g per day for 2 - 4 weeks),
- zixorine (0.05 - 0.2 g per day for 2 - 4 weeks),
- essentiale,
- you can even try Detralex (read in the Pyatigorsk branch of Volga State Medical University in comparison with Karsil),
- hepatoprotectors.
take advantage choleretic agents, which can stimulate the production of bile with its subsequent removal along with excess bilirubin,
tighten your diet, bring it to a level characteristic of your disease,
completely give up alcohol,
cleanse the gallbladder and intestines.

But even in the case already known disease and the initiation of actions to reduce bilirubin in the blood, you should visit a doctor and diagnose the cause of the exacerbation and then prescribe treatment.

How to lower bilirubin in the blood

To reduce bilirubin, this issue should be approached comprehensively. In the very simple version, if the increase is related to hereditary factor or congenital disease Liver bilirubin levels most often do not differ much from the norm. Will help symptomatic treatment, based on standard medicines, transition to proper nutrition and on folk recipes.

Of course the best option is to receive a prescription from the attending physician, however, there are different situations in life and the following knowledge can be applied as a temporary solution. Once again - as a temporary solution.

Medications

Attention! It is better to find out the names of the drugs from your attending physician, since this is an individual prescription - one suitable for a person the specified drug, and to another it is in best case scenario will not make any changes. And time passes and the disease does its work.

If bilirubin is increased due to infection in the body and the resulting inflammatory process, then the natural response would be to take antiviral, antibacterial and anti-inflammatory drugs. As a rule, the pharmacist at the nearest pharmacy knows the current infectious situation and will be able to suggest emergency medications.

However, we will refer you again, if possible, to your doctor.

Pay attention to hepatoprotectors that will help the liver normalize its function, since it is the liver that suffers the most during the period of increased bilirubin.

Extremely important! People diagnosed with hepatitis (especially in the active phase) must receive instructions to take hepatoprotectors exclusively from their doctor, because their careless use can lead to cirrhosis of the liver .

If bilirubin is increased in a state of intoxication, antioxidants and sorbents will help, which will help first reduce the concentration of toxins and then improve the excretion of bilirubin.

And if intoxication with unbound bilirubin has gone far, then only intravenous detoxification drugs supplemented with glucose will help.

Doctors' opinion

In the medicines section, we presented society’s view of solving the problem increased bilirubin. However, the medical community, represented by leading doctors medical sciences, for example, Alexey Yakovlev (repeatedly took part in discussions in the media) or RAS academician Vladimir Ivashkin say something else.

So their opinion about cleansing the liver is very skeptical due to the fact that the liver itself is the main cleanser of the body and its cells are configured for recycling work. Moreover, according to Alexey Yakovlev, it makes no sense to talk about the use of hepatoprotectors - there are no such drugs in Western medicine.

And in fact, the hepatoprotectors advertised in the Russian Federation are ordinary dietary supplements that do not give the declared result. That is, consumers actually use dummies (placebos), but for decent money. And the advertised dietary supplements did not work clinical trials, that is, there is no evidence of their effectiveness.

Academician of the Russian Academy of Sciences Vladimir Ivashkin and even referred to the rules of the Salerno School of Health, which speak of the need cheerful character, O peace of mind and moderation in food. It looks like correct recommendations, because it won’t hurt to fast or refrain from overeating.

Nutrition

Every person has some foods that his body does not digest well - give up these foods for a while. Don't eat cold food. Instead of coffee and tea, drink during the fight against increased bilirubin clean water and in increased quantities.

For reference. You can lower the level of conjugated bilirubin with the help of cereals: oatmeal, rice and buckwheat.

Experts include foods that reduce bilirubin:

dairy products (ignore those who have difficulty digesting dairy products),
lean meat,
sweet fruits (unless your blood sugar is okay),
egg white,
vegetable soups,
herbal teas (except black).

How to reduce bilirubin with folk remedies

Before we look at “ folk remedies”, let us recall that the effectiveness of almost all herbal decoctions and their tinctures is confirmed only by the transfer of information (possibly mythical) from generation to generation. On the other hand, this information may be a psychological attitude, which is also not harmful.

For reference. A decoction or tincture prepared according to one recipe may work for one person, but not for another. This can also happen as a result of differences in the quality of raw materials.

It is believed that rose hips, chamomile, oak bark, St. John's wort, birch leaves. A decoction of them (singly or even in a collection), when taken repeatedly during the day, has a positive effect on the removal of excess bilirubin.

A decoction of the above-mentioned plants can be infused, but the tincture (not alcoholic) should be consumed no more than twice a day, half a glass, 20 minutes before meals.

Calendula decoction may be suitable for some. Also take several times a day.

You can try fresh beet juice. Drink before meals (half an hour before) small dose(select for yourself experimentally, starting from 50 grams).

Once again to understand the situation about increased bilirubin. The promotion situation, which you can even observe visually if you carefully observe yourself, does not just happen. Increased bilirubin indicates problems with the liver or gall bladder.

Don't treat yourself! Be sure to see a doctor and get tested. This will help identify and begin to eliminate the cause of liver failure.

Bilirubin is a colored pigment produced in the bone marrow or spleen and is part of bile. It is formed as a result of the destruction of red blood cells - blood cells, the average life of which is about 110 days. There are direct and indirect bilirubin. Indirect bilirubin does not dissolve in water, therefore it can be excreted from the body only after it is changed to a soluble form in the liver - direct bilirubin. Today we will dwell in more detail on indirect bilirubin - the norm, the reasons for the increase or decrease in a person’s blood, etc.

Definition

Indirect bilirubin is an unbound and insoluble form of pigment. It has a toxic effect on tissue, so ideally there should be as little of it in the bloodstream as possible. The process of converting indirect bilirubin into direct is called conjugation, therefore the indirect form is also called unconjugated (free).

In general, the names “direct” and “indirect” bilirubin are associated with research methods. Blood, which contains a water-soluble pigment, reacts directly with Ehrlich's reagent. To detect indirect bilirubin in the blood, it is necessary to carry out additional operations, so such research can no longer be called direct.

Norm of indirect bilirubin

Indirect bilirubin concentration is not associated with gender or hormonal imbalances, in other words, the rate of indirect bilirubin in the blood of women and men is the same. However, it depends on age, because children have more of this pigment in their blood the younger they are.

The value of indirect bilirubin is calculated based on the difference between the total and direct values. The norm of indirect bilirubin = total - direct is usually no more than 19 µmol per liter of blood.

To make it easier to navigate the test results, you should know the rate of indirect bilirubin in the blood, direct and total. For newborn children, reference values general content pigments change almost daily:

0-2 days: 57-198 µmol/liter;

2-6 days: 25-206 µmol/liter;

Over 6 days: 5-21 µmol/liter;

In this case, direct and indirect bilirubin in newborns should not exceed 5 µmol/liter and “Total minus 5” µmol/liter, respectively.

Increased indirect bilirubin in the blood: causes

Diseases that can cause an increase in the concentration of insoluble pigment in the blood can be divided into several groups, depending on the damage to systems and organs.

Circulatory system

Indirect bilirubin increases in the blood with increased breakdown of red blood cells, which results in the release of heme protein, which is converted into an insoluble pigment. This deviation occurs in anemia or anemia, when the body has a deficiency of hemoglobin, which it seeks to replenish by destroying red blood cells.

In this case, the patient’s liver can be absolutely healthy, and the process of removing bilirubin from the body occurs as usual. However, the amount of incoming bile pigment is so large that the liver cannot cope with the load, resulting in increased indirect bilirubin in the blood.

If the concentration of indirect bilirubin continues to increase, hemolytic anemia may develop into hemolytic jaundice.

Among the signs hemolytic anemia can be distinguished:

Weakness;
Pallor;
Frequent dizziness;
Enlarged spleen;
Specific blood test results: indirect bilirubin and reticulocytes are increased, direct bilirubin is normal, hemoglobin is decreased;
Specific results of urine analysis: urobilinogen is greatly increased.

It should be clarified that anemia can be congenital or acquired; these types, in turn, are divided into more specific anemia.

An increase in the level of indirect bilirubin can be caused by such infectious diseases, such as malaria, sepsis, etc., taking medicinal complexes, exposure to certain poisons: for example, lead, arsenic, copper salts etc.

In newborns high bilirubin may be due to dangerous hemolytic disease, which often develops in the womb.

Liver

If the functions circulatory system are working properly, but indirect bilirubin is increased, what does this mean? Probably, indirect bilirubin cannot be transformed in the liver into a soluble form and excreted along with waste products. Instead, it accumulates in the blood and tissues.

The reasons for the increase in indirect bilirubin, caused by pathologies of the liver or its enzymatic system, are not so numerous. This:

Gilbert's syndrome;

A genetically transmitted disease in which there is an abnormality in the enzyme glucuronyltransferase, which is responsible for converting indirect bilirubin into a soluble form. Usually manifests itself in adolescence, progresses with improvement and by the age of 50 is practically not observed.

Crigler-Najjar syndrome;

The disease manifests itself in newborns with severe jaundice. Liver cells completely or partially lack the glucuronyl transferase enzyme described above.

Lucy-Driscoll syndrome;

A disease common in young children breastfeeding. In this case, indirect bilirubin is increased in the infant due to the presence of steroid hormone, which blocks the enzyme necessary to convert indirect bilirubin into direct bilirubin.

Acquired non-hemolytic jaundice

They can be caused by taking certain medications that pass through the cells along the same path as indirect bilirubin, thereby displacing the pigment. In other words, enzymes are suppressed and bilirubin accumulates. Such drugs include contraceptives, morphine-containing drugs, and others.

In a person with a normally functioning liver, only a significant excess of the prescribed dosage of the drug can be the reason why indirect bilirubin is elevated in the blood. If there is any syndrome listed above, even the prescribed doses of medication significantly affect the concentration of indirect bilirubin in the blood.

Gallbladder

Since bilirubin is a bile pigment, a significant part of it is contained in this organ. If the outflow of bile from the bladder is disrupted, direct and indirect bilirubin becomes increased.

Reduced bilirubin is accompanied reduced level erythrocytes in the blood. After all, as already mentioned, it is as a result of hemolysis (disintegration) of these blood cells that bile pigment is released.

A low concentration of indirect bilirubin in the blood is not as widely used in the diagnosis of diseases as a high one. However, indirect bilirubin can be reduced as a result of the following conditions in the body:

Kidney failure;
Leukemia;
Tuberculosis;
Exhaustion of the body.

In the same time, decreased performance analysis may be a common mistake. In order for the quantitative ratio of direct and indirect bilirubin in the blood to correspond to the truth, it is necessary to take the test at morning time, on an empty stomach, without emotional and physical stress before donating blood.

Leave comments if you have questions or additions on the topic of indirect bilirubin analysis.

Bilirubin is the main bile pigment in the human body, which is formed from obsolete red blood cells. In previous articles, I already wrote about why this happens. Now we'll talk about a decrease in this indicator in the blood serum. From this article you will learn what are the causes of low bilirubin in the blood and whether a low ratio is a sign of illness.

Reduced total bilirubin in the blood: reasons

Although medical practice Quantifying the increase in bile pigment levels plays a major role in diagnosing jaundice, but a significant decrease in its concentration also has clinical significance.

Bilirubin is characterized circadian rhythm circulation. This means that its content in blood serum depends on the time of day. During the night it is observed gradual increase of this substance in the bloodstream and decreases during the day.

Low bilirubin in the blood is diagnosed in chronic renal failure, acute leukemia, tuberculosis intoxication, nutritional malnutrition, aplastic anemia. In these diseases, the pigment concentration decreases due to the low content of red blood cells and a decrease in their destruction, respectively.

When compared with men, women have lower total bilirubin, which is also due to a smaller number of red blood cells in the blood. Race also plays a role. Bilirubin concentrations are lower in people of African descent than in Europeans.

It is hypothesized that lower than normal total bilirubin may be the result of increased oxidative activity, which leads to excess consumption of endogenous antioxidants. In people of retirement age suffering coronary disease hearts, very often an underestimated amount of bile pigment is detected.

Low direct or indirect bilirubin - what does it mean?

Low bilirubin is considered rare. Causes low bilirubin in the blood are studied by scientists who believe that this phenomenon may have serious health implications.

Often, low levels of both direct and indirect bilirubin are the result of a violation of the blood test. Factors leading to a decrease in the level of direct bilirubin include intake of caffeine containing and alcoholic drinks. The results of the analysis are also affected by the use of glucocorticoids (prednisolone), antibiotics (penicillin), ascorbic acid and phenobarbital.

To date, the mechanisms leading to the fact that bilirubin becomes below normal have not yet been fully studied. Its decrease may be a significant marker for assessing the overall antioxidant status human body. It is quite possible that in the future this indicator will make it possible to predict the occurrence and characteristics of the course of certain diseases.

Bilirubin is the most important bile pigment in humans, which has a red-yellow color. It is considered a product of the breakdown of hemoglobin and proteins in the blood such as cytochromes, catalase, peroxidase and myoglobin. About 85% of bilirubin comes from red blood cell hemoglobin. From 1 gram of hemoglobin approximately 35 mg of bilirubin is formed. This pigment is excreted from the human body along with bile. It is this bile pigment that colors our bruises yellow. In this article, we will try to understand in more detail what direct and indirect bilirubin are, what are the differences between them and how bilirubin should be treated.

What is the difference between direct and indirect bilirubin?

Direct bilirubin can be excreted from the human body due to its excellent solubility. Its excretion occurs through the liver along with bile into the intestines and in small quantities through the kidneys with urine. Direct bilirubin is formed only in liver cells - hepatocytes.

Indirect bilirubin is much more toxic than direct bilirubin. Bilirubin is almost water-insoluble. It dissolves well in fats, for this reason, if excretion fails, it first accumulates in adipose tissue. Indirect bilirubin occurs in the Kupffer cells of the liver. Indirect bilirubin can be removed from the body only through transformation into direct bilirubin.

Comparing these two factions, it is clear that they are in no way similar to each other.

Factors that increase bilirubin in the blood.

The most basic reasons that can provoke an increase in bilirubin in the blood are:

Increased rate of destruction of red blood cells;

All kinds of disturbances in the process of bilirubin processing;

Impaired flow of bile;

Hemolytic anemia;

Hereditary deficiency of enzymes in the liver;

Cholelithiasis;

Jaundice and hepatic colic.

Symptoms of increased bilirubin.

An increase in bilirubin and factors that can cause this state. An increase in the level of bilirubin in the blood above 27 µmol/l leads to the formation of jaundice. There are several degrees of severity of jaundice: 1) light form- up to 85 µmol/l; 2) average - 86-169 µmol/l; 3) severe form of jaundice - more than 170 µmol/l). Increased bilirubin may manifest itself as the following:

Yellow skin color;

Increased body temperature;

Headache;

Great fatigue;

Darkening of urine to dark brown;

Unpleasant sensations in the area of the left side chest.

Other signs of increased bilirubin: jaundice, hepatic colic, vomiting, bloating and diarrhea, decreased appetite, itching skin, discoloration of stool.

The above symptoms are the most common with increased bilirubin in the blood. Now we will consider with you how to treat such a disease.

How to lower bilirubin?

There are no universal remedies that reduce bilirubin by 100% today. It is possible to lower bilirubin levels only after identifying the main reason for its increase. For these purposes, it is necessary to carry out some analyzes.

To determine the degree of hyperbilirubinemia;

For the diagnosis of hemolytic anemia;

To diagnose urinary outflow disorders;

For the purpose of monitoring a patient who is taking medications with hepatotoxic properties.

Also, during treatment, the patient needs to completely change his diet. Spicy, salty, smoked foods and alcohol are excluded from it. It is forbidden to eat fried, fatty foods, drink strong tea and sweet soda, and eat all kinds of sweets. In order to “free” the liver, gallbladder and cleanse the intestines, you need to eat vegetables and fruits (fresh, boiled and baked), you should also include dairy products. During the treatment of increased bilirubin, the same drugs are used traditional medicine. For example, it is very useful to drink during treatment, tincture of motherwort, infusion of chamomile decoction and St. John's wort herb. These products will help cleanse and significantly improve the liver.

If you have increased direct bilirubin, then in this case the cause is hidden in a violation of the outflow of bile. If indirect bilirubin is increased, then often this is just an indicator of a diseased liver or Gilbert's syndrome. After surgical treatment of the main disease, bilirubin levels will decrease significantly.