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The bilirubin level found in the body reflects the balance between production and excretion. Blood test results are advised to always be interpreted using the reference range provided by the laboratory that performed the test. The SI units are μmol/L. [52] Typical ranges for adults are: [53] 0–0.3 mg/dl – Direct (conjugated) bilirubin level
Cholestasis can be excluded by normal levels of bile acids in plasma, the absence of lactate dehydrogenase, low levels of conjugated bilirubin, and ultrasound scan of the bile ducts. [citation needed] Vitamin B12 deficiency - elevated bilirubin levels (and MCV counts above 90–92) can be associated with a vitamin B12 deficiency. [citation needed]
When total bilirubin levels exceed 40 μmol/L, bilirubin deposition at the sclera, skin, and mucous membranes will give these areas a yellow colour, thus it is called jaundice. [6] The increase in predominantly unconjugated bilirubin is due to overproduction, reduced hepatic uptake of the unconjugated bilirubin and reduced conjugation of bilirubin.
In both settings of hemolysis mentioned above, only low levels of conjugated bilirubin may accumulate in the serum, with the amount falling within the normal limits of 4 percent of total bilirubin as conjugated bilirubin can be efficiently excreted in bile through being secreted across canalicular membrane. [25]
Enterohepatic circulation of drugs. Enterohepatic circulation is the circulation of biliary acids, bilirubin, drugs or other substances from the liver to the bile, followed by entry into the small intestine, absorption by the enterocyte and transport back to the liver.
Gallstones may result from increased saturation of cholesterol or bilirubin, or from bile stasis. Lower concentrations of bile acids or phospholipids in bile reduce cholesterol solubility and lead to microcrystal formation. Oral therapy with chenodeoxycholic acid and/or ursodeoxycholic acid has been used to dissolve cholesterol gallstones.
Normal levels of bilirubin in blood are below 1.0 mg/dl (17 μmol/L), while levels over 2–3 mg/dl (34–51 μmol/L) typically result in jaundice. [4] [9] High blood bilirubin is divided into two types: unconjugated and conjugated bilirubin. [10] Causes of jaundice vary from relatively benign to potentially fatal. [10]
Van den Bergh reaction is a chemical reaction used to measure bilirubin levels in blood. [1] [2] More specifically, it determines the amount of conjugated bilirubin in the blood. The reaction produces azobilirubin. Principle: bilirubin reacts with diazotised sulphanilic acid to produce purple coloured azobilirubin. [3]