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 OTHER NAMES
- Entire Bilirrubina,
- Not combined Bilirrubina, bilirrubina brought together,
- Direct Bilirrubina, bilirrubina indirect.
DEFINITION
The bilirrubina is a product derived from the metabolism of the hemoglobin. On having degraded itself, the red blood corpuscles liberate the hemoglobin that the group is metabolized to two molecules heme and the group globina, the group heme transforms in biliverdina and there is in bilirrubina which he is called "not brought together" or innuendo. On having spent for the liver this bilirrubina, it conjugates with acid glucurónido transforming in bilirrubina "brought together" or direct. The liver segregates this direct bilirrubina across the biliary routes towards the intestine, on having been metabolized by the intestinal flora, one turns in urobilinas that give the brown color to the dregs. Part of these urobilinas is re-absorbed and can appear in the urine in the shape of urobilinógeno. When the bilirrubina rises, the skin and the textiles take a yellow color that is called a jaundice. Which is the origin of the high bilirrubina we can know if it is a problem of liver (elevation of not combined bilirrubina) or of the biliary routes (elevation of the combined bilirrubina). When a routine analysis is realized the entire bilirrubina measures herself (direct more indirect), 70 it corresponds to 85 % to not combined or indirect bilirrubina.
WHY IS THIS STUDY REALIZED?
It is realized in the context of other hepatic tests (GOT, GPT, GGT, fosfatasa alkaline) and is used to evaluate problems or alterations of the liver and biliary routes. In the patients there measures itself to jaundice the entire bilirrubina the direct one and the innuendo. When the combined or direct fraction is raised, more than 50 % of the entire bilirrubina, it is that there is a problem in the biliary route for calculations, inflammation or tumors. When the direct or combined bilirrubina is a minor of 20 %, the hipebilirubinemia is of the type indirect or not brought together and can stem from hepatitis ó to an increase of destruction of red blood corpuscles (hemólisis).
SKILL OF ACHIEVEMENT
It is necessary to be on an empty stomach at least 4 hours before the determination. There are medicines that alter the results and raise the bilirrubina as they are: Alopurinol, steroids, antibiotics, antimaláricos, azatioprina, clopropamida, colinérgicos, codeine, diuretics, metrotexate, metildopa, morphine, contraceptive oral, fenotiazinas, rifampicina, salicilatos, sulfonamidas and the teofilina. On the other hand there can diminish his level in blood the barbiturate ones, the caffeine and the penicillin.
There are factors that interfere in the measurement of bilirrubina, the blood hemolizada, the content in fats and the light can alter his correct analysis. It is possible to realize the capture in an appropriate place (consultation, clinic, hospital) but sometimes it is realized in the proper domicile of the patient.
- To realize the capture it is needed of locating an appropriate vein and in general there are used the veins placed in the flexura of the elbow. The person entrusted to take the sample will use sanitary gloves, a needle (with a syringe or pipe of extraction).
- It will put a tortor (tape of gum - latex) in the arm so that the veins retain more blood and turn out to be more visible and accessible.
- It will clean the area of the prick with an antiseptic one and by means of a palpación it will locate the appropriate vein and will gain access to her with the needle. They will release the tortor.
- When the blood flows for the needle the sanitary one will realize an aspiration (by means of the syringe or by means of the application of a pipe with gap).
- On having finished the capture, it extracts the needle to itself and the area is pressed with a cotton or similar torunda to favor the coagulation and it will indicate him to itself that flexione the arm and the area pressed with a Band-Aid supports for some hours.
- The abstracted blood moves to the analysis laboratory in a special pipe for biochemistry, which contains an anticoagulant product. In general more than 10 milliliters of blood are not usually necessary for a standard battery of biochemical parameters.
PROBLEMS AND POSSIBLE RISKS
- The securing by means of a prick of the vein can produce certain pain.
- The possible difficulty in finding the appropriate vein can give place to several pricks
- Appearance of a haematoma (bruise or cardinal) in the extraction area, is due usually to the fact that the vein has not closed well after the later pressure and blood has kept on going out producing this problem. Type Hirudoid can apply an ointment to itself ® or Trombocid ® in the area.
- Inflammation of the vein (phlebitis), sometimes the vein turns out to be shaken, well be for a cause merely physically or why it has become infected. It will have to support the relaxed area a few days and type Hirudoid can apply an ointment to itself ® or Trombocid ® in the area. If the problem persists or appears fever will have to consult it with his doctor.
NORMAL VALUES OF BILIRRUBINA
| Direct Bilirrubina |
0,1 to 0,3 mg/100 ml |
| Indirect Bilirrubina |
minor of 1,0 mg/ml |
| Entire Bilirrubina |
0,3 to 1,0 mg/100 ml |
In these values there can be certain differences for the skill or for proper criteria of normality of concrete laboratories, sometimes in the status of values and other times for the units to which one alludes.
EVALUATION OF ABNORMAL RESULTS
The developing levels of entire and indirect bilirrubina ó not brought together can indicate:
- Anemia hemolítica
- Fetal Eritroblastosis
- Gilbert's illness
- Physiological jaundice of the newborn baby
- Other anemias
- Problems in the blood transfusions
- Resolution of one big haematoma
The developing levels of direct bilirrubina ó combined can indicate:
- Cirrhosis
- Hepatitis
- Obstruction of biliary route (colangitis, colelitiasis)
- Tumors of biliary routes
- Syndrome of Dubin-Jhonson
- Syndrome of Rotor
TO SEE ALSO
WHAT DOCTOR CAN TREAT ME?
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