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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.
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]
Bilirubin (BR) (from the Latin for "red bile") is a red-orange compound that occurs in the normal catabolic pathway that breaks down heme in vertebrates.This catabolism is a necessary process in the body's clearance of waste products that arise from the destruction of aged or abnormal red blood cells. [3]
In infants, a bilirubin-albumin molar ratio of >0.8 reflecting insufficient bilirubin binding is considered at risk of developing kernicterus but the indicative value in adults remains unclear. [31] Unbound plasma bilirubin past a threshold exerts neurotoxic effects through triggering diversified metabolic cascades.
The bilirubin present in the plasma is largely unconjugated in this setting as they haven't been taken up and conjugated by the liver. [3] In this case, total serum bilirubin increases while the ratio of direct bilirubin to indirect bilirubin remains 96 to 4 as up to 96%-99% of bilirubin in the bile are conjugated mentioned above. [9] [1]
Choluria (or bilirubinuria) is a symptom defining an abnormal darkness of the urine, mainly due to a high level of conjugated bilirubin. [1] [2] Choluria is a common symptom of liver diseases, such as hepatitis and cirrhosis. It can be described as dark or brown urine, often referred to as the color of Coca-Cola.
Direct bilirubin more than 34 μmol/L (2.0 mg/dL). The signs which help detect pathological jaundice are the presence of intrauterine growth restriction , stigma of intrauterine infections (e.g. cataracts , small head , and enlargement of the liver and spleen ), cephalohematoma , bruising, signs of bleeding in the brain's ventricles.
Azobilirubin is a coloured compound formed by the condensation of diazotized sulfanilic acid with bilirubin in the van den Bergh reaction. [1] The quantity of bilirubin in patients with jaundice can be determined by the formation of azobilirubin in the presence of methanol.