When we talk about bilirubin, we’re referring to a type of bile acid that stems from the breakdown of hemoglobin in recycled red blood cells, a process that occurs in the spleen.
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Bilirubin and metabolism
With a yellowish-orange hue, hemoglobin from red blood cells is recycled in the spleen and later conjugated in the liver. The resulting substance is stored in the gallbladder, becoming part of bile. Meanwhile, red blood cells exit the circulatory system approximately 120 days after their formation due to their fragile nature. Their cell membrane breaks, releasing hemoglobin. This hemoglobin separates into two parts: the globin molecule and the heme group.
Bilirubin exhibits low solubility in water, but when it reaches the liver and binds with glucuronic acid, it becomes somewhat more soluble. In the intestine, bilirubin undergoes transformation due to the action of intestinal bacteria, resulting in various urobilinogen pigments, which impart the yellow and brown color characteristic of urine and feces.
Clinical values and bilirubin analysis
Serum is where the quantities of conjugated ―or direct― bilirubin and unconjugated ―or indirect― bilirubin are chemically determined. The former is bound to glucuronic acid and is eliminated after being part of bile. Its standard value ranges from 0 to 0.3 mg/dL in adults. Unconjugated bilirubin, on the other hand, is bound to albumin but has not undergone the proper degradation process. In adults, its value is approximately between 0.1 and 0.5 mg/dL.
Albumin serves as a transporter throughout the body. The binding affinity between albumin and bilirubin is extremely high, and generally, free unconjugated bilirubin ―i.e., not bound to albumin― is rarely observed in plasma. Occasionally, it may bind to high-density lipoproteins, minimizing glomerular filtration and preventing its deposition in tissues.
As an “extra substance,” there’s also total bilirubin. This is the sum of direct and indirect bilirubin. In the case of total bilirubin, the normal range is between 0.3 and 1.0 mg/dL.
Based on these figures, multiple pathologies can be identified. Most often, tests are conducted to assess liver health and detect hepatic or biliary problems. One of the most common abnormalities is jaundice, the yellowing of the eyes and skin caused by elevated levels of bilirubin in the body.
If we discuss unconjugated bilirubin, it will never be found in urine. However, dark urine occurs when there’s an excretion of excess water-soluble conjugated bilirubin. In some cases, this could be indicative of liver or biliary disease.
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