Want to know about a yellow substance in your blood? Let's talk about the bilirubin test!

Oh, have you ever noticed that sometimes, especially in newborn babies, the body turns yellow? Or has a doctor ever told you or someone you know to do a `(Bilirubin)` test? It's normal to feel a little nervous when you hear the word bilirubin. But don't worry! Today, we'll talk about this simply, in a way that you can understand.

What is bilirubin? Let's understand it simply!

Think about it, the red blood cells (also called blood cells) in our bodies are constantly being replaced. When old red blood cells break down, they produce a yellow substance called bilirubin . It's like what's left over when you get rid of old stuff.

Now this bilirubin travels through our blood and goes to the liver. The liver is like a factory in our body, cleaning out unwanted things. The liver collects this bilirubin, combines it with other waste products, and makes a liquid called "bile." You know, this bilirubin is what gives bile its yellow color. Then this bile passes through our intestines and out of the body. Yes, this bilirubin is a big part of what gives your stool its color.

So, what is a bilirubin blood test?

It's very simple. A doctor takes a small sample of blood from a vein in your arm and sends it to a lab to be tested. The lab measures how much bilirubin is in your blood. They look at whether the level is within the normal range, or if it's too high or too low. If the bilirubin level is abnormal, it means that there may be a problem somewhere in the process that starts with the breakdown of those old red blood cells and ends with the bilirubin being removed from the body.

What do bilirubin levels in the blood tell us?

Doctors often do this bilirubin test to check the health of your liver . This is just one of many liver function tests. If these values ​​are high or low, it can indicate that the liver is under some kind of stress. However, abnormal bilirubin levels do not always mean that there is a problem with the liver. Sometimes the problem may lie elsewhere.

Why does this bilirubin level increase? (Hyperbilirubinemia)

There can be several reasons why bilirubin builds up in your blood. Let's take a look at what they are:

• Your red blood cells are breaking down too quickly: Some blood disorders, such as hemolytic anemia, cause red blood cells to break down too quickly, leading to an excess of bilirubin. Think of it like a factory receiving too much product.
• Your liver may have difficulty clearing even the normal amount of bilirubin: Sometimes this can happen if the liver is suddenly exposed to something toxic. Or, the liver may not be working properly due to long-term liver disease (`(Chronic liver disease)`).
• Your biliary system is not releasing bile properly:There may be a blockage in the bile ducts or gallbladder, causing bile to back up into the blood. This can also happen when there are gallstones.

Imagine, if the pipe that brings water into a water tank is enlarged and the pipe that brings water out of the tank becomes clogged, the tank will boil.

Can bilirubin levels be low? (Hypobilirubinemia)

Yes, sometimes bilirubin levels can be low. Some medications can cause it. For example, some antibiotics, birth control pills, sleeping pills, and seizure medications can cause bilirubin levels to drop. However, low bilirubin levels are usually nothing to worry about.

What actually happens to bilirubin inside our bodies?

Bilirubin is a waste product that is removed from old red blood cells. Normally, our bodies excrete it through the intestines. However, it has now been discovered that it has some small benefits as it is excreted. New research suggests that bilirubin acts as an antioxidant and may help protect us from cardiovascular disease.

But, like anything, if it gets too high, it can be toxic . If too much bilirubin builds up in your blood, you may feel uncomfortable. It can also stimulate the nerves under your skin and cause you to itch.

What are the symptoms of high bilirubin?

The main symptom of high bilirubin is jaundice . This is a yellowing of your skin and the whites of your eyes. This is often the first sign that a doctor will look for when checking your bilirubin levels.

Also, when bilirubin levels in the blood increase, it tries to pass out through the urine. This can cause the urine to become dark in color (like the color of tea).

Also, if bilirubin is not excreted properly in the stool, the stool may become light colored (like clay) .

Some people can even scratch their bodies a lot .

How is a bilirubin blood test done?

This is very simple.

• Usually, for an adult, a doctor or nurse will take a small blood sample from a vein in your arm . You may be asked not to eat or drink anything for a few hours before the test. You may feel a little pain when the needle is inserted and removed, but it will go away in a few minutes. The blood sample is then sent to a lab. It takes a while for the report to come back.
• If a newborn baby has jaundice , the doctor will check the bilirubin level to make sure it is not too high. Jaundice is normal for newborns and is usually nothing to worry about. However, if the bilirubin level gets too high, it can be harmful to the baby.Blood is usually taken from babies by pricking their heels with a small needle (heel stick) . This is a common test performed on newborn babies.

What is in the report I receive? What does it mean?

The test report you receive will show the bilirubin levels in your blood in numbers. There are actually two types of bilirubin in your blood: bilirubin that goes to the liver to be cleaned, and bilirubin that comes out of the liver after being cleaned. Your report will show these two types separately, as well as the total bilirubin. It is usually shown in units called milligrams per deciliter (mg/dL).

What is Direct and Indirect Bilirubin? (Conjugated vs. Unconjugated)

Simply put:

• The type of bilirubin that goes to the liver to be cleaned is "Unconjugated" bilirubin . It does not dissolve in water. It goes to the liver bound to a protein called albumin in the blood. This is why it is sometimes called "Indirect" bilirubin in the report. Because it cannot be measured directly. It is found by subtracting conjugated bilirubin from the total bilirubin.
• After the liver cleans this bilirubin, it binds it to a sugar molecule and makes it soluble in water. Only then can it pass through the intestines mixed with bile. This bilirubin cleaned by the liver is called "conjugated" bilirubin . In the report, it is also called "direct" bilirubin , because it can be measured directly.

Do you understand? One before it goes to the liver, and the other after it's cleansed by the liver.

At what level of bilirubin should we be concerned?

There can be slight variations in what each lab considers normal bilirubin levels. But in general, a total bilirubin level between 0.2 and 1.3 mg/dL is considered normal for adults and children . If your level is higher than this, your doctor may do further tests to find the cause. It could indicate a condition that needs attention. However, elevated bilirubin itself is not a serious condition and usually does not require treatment.

However, for newborns, the story is a little different. Normal bilirubin levels in babies can range from 1.0 mg/dL to 12.0 mg/dL. In most cases, hyperbilirubinemia in newborns is expected and will go away on its own. However, doctors will continue to monitor the condition to see if the bilirubin levels are rising too quickly or too low. If they do, it can be a serious condition and be harmful to the baby.

What level of bilirubin is dangerous for a newborn baby?

Doctors recommend starting treatment for newborns based on bilirubin levels.If it exceeds 15 mg/dL within the first 48 hours, or if it exceeds 20 mg/dL after 72 hours. At these levels, the amount of unconjugated bilirubin exceeds the amount of albumin available to bind it. This unconjugated bilirubin can then cross the blood-brain barrier into the newborn's brain and damage the developing brain. This can cause varying degrees of brain damage, a condition called kernicterus .

This risk is not the same for adults and older children. Adults' brains are not as sensitive, and unconjugated bilirubin levels rarely rise as high in adults. Newborns produce bilirubin more quickly than adults, and conjugate it much more slowly.

There are many reasons why conjugated bilirubin ``(Conjugated hyperbilirubinemia)`` can increase in adults. In adults, increased bilirubin can be a sign of a dangerous condition, but bilirubin itself does not pose a major danger (unlike in babies).

What does it mean when your bilirubin level is high?

If your body breaks down red blood cells faster than your liver can clean them up, your unconjugated (indirect) bilirubin levels may increase. This can mean things like:

• Hemolytic disease
• Sickle cell disease
• An adverse reaction to a blood transfusion

Typical causes of increased unconjugated bilirubin in newborn babies:

• Premature birth
• Mismatched blood type between the baby and the mother
• Reaction to certain things in breast milk

If your body has trouble getting rid of bilirubin properly, your conjugated (direct) bilirubin level may be elevated. This could mean that you have biliary disease or gallstones. Examples:

• Gallstones
• Cholecystitis
• Inflammation of the bile ducts (Cholangitis)

Both types of bilirubin can build up in the blood due to conditions that affect your liver's ability to clear bilirubin.

Your total bilirubin level may increase, either when you start a new medication, or when you drink a lot of alcohol, or because of a temporary strain on the liver. Or, it may be due to acute or chronic liver disease. Some causes include:

• Infections like viral hepatitis and mononucleosis.
• Genetic conditions that affect bilirubin metabolism, such as Gilbert's syndrome, Wilson's disease, and Crigler-Najjar syndrome.
• Toxic hepatitis (caused by alcohol or drugs)
• Cirrhosis and chronic liver failure

If there are abnormalities in my test report, what happens next?

A doctor will look at your symptoms and medical history to try to find out what the possible causes are. Each cause has different treatment options. They may order more blood tests and imaging tests to get a better idea of ​​your condition. They may also test your bilirubin levels again to see if they are rising any further. If your newborn's bilirubin levels are too high, they may recommend treatment to lower them.

What are the treatments for increased bilirubin in newborn babies?

The standard treatment for reducing bilirubin levels in newborns is phototherapy . This means that a doctor places your baby under a special light. This light emits a blue-colored light. This light breaks down the bilirubin and makes it water-soluble. This allows it to be excreted from the body without being conjugated in the liver. This stops unconjugated bilirubin from accumulating in the baby's brain tissue.

How do you lower your bilirubin levels?

Your bilirubin levels will decrease if the condition that is causing your bilirubin levels to rise is properly treated and controlled. This depends on the cause. Your doctor will talk to you about options to treat the condition or reduce its effects.

In general, you can reduce the strain on your liver by cutting out alcohol and unnecessary medications (even over-the-counter (OTC) medications as much as possible), and eating a healthy diet.

What is a bilirubin urine test?

You may have a urine bilirubin test as part of a urinalysis. This may be part of a routine health check. Or, your doctor may specifically order this test if you have jaundice or dark urine . Bilirubin in your urine (bilirubinuria) is not normal. However, if your conjugated bilirubin levels are very high, this can happen.

For this test, a doctor will give you a small bottle to collect a urine sample. They will also give you a ``sanitary wipe`` to clean your genital area before you urinate. The bottle will have a mark on it indicating how much urine to collect. Without touching the inside of the bottle, you will collect the sample and give it to the doctor. They will send it to a lab for testing.

The Most Important Thing - Things You Need to Remember (Take-Home Message)

Okay, so we've talked a lot about bilirubin now, haven't we?

If you notice a yellow color in your body or eyes (jaundice), it's a sign that you should definitely see a doctor and get a bilirubin test.Jaundice begins to appear when bilirubin levels reach two to three times the normal level. You may also notice that your urine is dark (tea-colored) at this level.

However, sometimes bilirubin levels can be high without any symptoms. A bilirubin test can help your doctor confirm certain suspected conditions and find out what the cause is.

So, don't be afraid when you hear the word bilirubin. It's part of a normal process in our bodies. However, when its levels change, it's important to find out the cause and get treatment if necessary. If you have any questions, never hesitate to talk to your doctor. They are there to help you.

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