Bilirubin Test: Metabolism to Health Implications – PPT & pdf file
- 1. BILIRUBIN TEST Total, direct, indirect
- 2. Lists: What is bilirubin Bilirubin metabolism Types of bilirubin Bilirubin test Effects of bilirubin on health and disease 1
- 3. •Chemical formula: C33H36N4O6 •Bilirubin (Latin for golden bile) or BR, is a red-orange compound that occurs in the normal catabolic pathway that breaks down heme in vertebrates. •Its breakdown products cause the brown color of feces. A different breakdown product is the main component of the straw-yellow color in urine. What is bilirubin?
- 4. • Reticuloendothelial cells are macrophages They take up RBC and metabolized the hemoglobin present into its individual components; heme and globin. Globin is further broken down into amino acids which are subsequently recycle. Creation of bilirubin
- 5. Bilirubin Conjugation: • In the bloodstream, unconjugated bilirubin binds to albumin to facilitate its transport to the liver. Once in the liver, glucuronic acid is added to unconjugated bilirubin by the enzyme glucuronyl transferase. .
- 6. Bilirubin Excretion: • Once in the colon, colonic bacteria deconjugate bilirubin and convert it into urobilinogen. • Urobilinogen is oxidized by intestinal bacteria and converted to stercobilin and then excreted through feces.
- 7. Types of bilirubin Direct or conjugated bilirubin: In the liver, bilirubin is conjugated with enzyme glucanosyltransferase, making it soluble in water. Indirect or unconjugated bilirubin: This is the bilirubin created from red blood cell breakdown. Total bilirubin: Total bilirubin = direct bilirubin + indirect bilirubin Delta bilirubin: Delta bilirubin is albumin-bound conjugated bilirubin
- 8. Hyperbilirubinemia and jaundice • The production of bilirubin is greater than the ability of the liver to secrete it and Liver failure or obstruction of the hepatic ducts in bilirubin secretion is the causes of hyperbilirubinemia.
- 9. Reasons for unconjugated bilirubin increase 01 Hemolytic anemia 03 Crigler–Najjar syndrome type 1 05 02 Physiological or neonatal jaundice 04 Crigler–Najjar syndrome type 2 06 toxic hyperbilirubinemia Gilbert–Meulengracht syndrome
- 10. Reasons for increased conjugated bilirubin 02 01 Bile duct obstruction Dubin–Johnson syndrome
- 11. Bilirubin test
- 12. Clinical applications Help diagnose jaundice in infants Evaluation of liver function 01 03 Efficacy of phototherapy in infants Diagnosis of biliary obstruction and hemolytic anemia in adults 02 04 11
- 14. Use heel sampling for infants Measurement considerations Avoid hemolysis of blood during sampling Do not shake the tube ,Keep the sample away from sunlight Record drugs that affect the result 01 02 03 04
- 15. Cases of non-acceptance of samples: Severe hemolysis and lipemic of the sample cause measurement errors. Sample storage conditions: Samples should be stored in the dark and Low temperature. At 8 - 2 ° C for 7 days. -20° C for 3 months. 25 -15° C for 2 days. . Sample quality
- 16. Bilirubin measurement method Direct Enzymatic Diazo photometric Serum color Skin reflectometry Malloy Evelyn Jendrassik Grof
- 17. Bilirubin measurement method Bilirubin + sulfonic acid =azobilirubin Total bilirubin With methanol Increase the color of reaction Direct bilirubin Without methanol
- 18. Bilirubin measurement method Why the Jendrassik-Grof method is preferred than the Evelyn Malloy method? insensitive to sample pH changes insensitive to 50-fold variation in protein concentration adequate optical sensitivity even to decreased bilirubin concentrations not affected by Hgb up to 7.5 g/dL;
- 19. Normal range AND Critical range
- 20. The effect of bilirubin on health and disease • Protective effect of bilirubin against oxidative damage. • The strongest internal antioxidant.
- 21. Corona 02 Cancer The effect of bilirubin on health and disease 01 20
- 22. The idea was to study the effect of bilirubin on cancer due to its antioxidant properties. Effect on p53,p27, and inhibition of Rb phosphorylation, so that tumor cells were stopped at G0 / G1. Comparison of bilirubin levels in healthy people and cancer patient. Colorectal cancer (CRC) 21
- 24. Bilirubin and Corona • In a hospital in China, the association between bilirubin levels and mortality was investigated . STB CB CB / UCB Mortality 23
- 25. Conclusion Bilirubin is used as an important factor in the diagnosis of various diseases Antioxidant bilirubin activity The importance of bilirubin as a therapeutic molecule 24
- 26. References • Gazzin S, Vitek L, Watchko J, Shapiro SM, Tiribelli C. A novel perspective on the biology of bilirubin in health and disease. • Trends in molecular medicine. 2016;22(9):758-68. • Rigato I, Ostrow JD, Tiribelli C. Bilirubin and the risk of common non-hepatic diseases. Trends in molecular medicine. 2005;11(6):277-83. • Inoguchi T, Sonoda N, Maeda Y. Bilirubin as an important physiological modulator of oxidative stress and chronic inflammation in metabolic syndrome and diabetes: a new aspect on old molecule. Diabetology International. 2016;7(4):338-41. • Keshavan P, Schwemberger SJ, Smith DL, Babcock GF, Zucker SD. Unconjugated bilirubin induces apoptosis in colon cancer cells by triggering mitochondrial depolarization. • Rosso C, Mezzabotta L, Gaggini M, Salomone F, Gambino R, Marengo A, et al. Peripheral insulin resistance predicts liver damage in nondiabetic subjects with nonalcoholic fatty liver disease. Hepatology. 2016;63(1):107-16. • Barone E, Di Domenico F, Mancuso C, Butterfield DA. The Janus face of the heme oxygenase/biliverdin reductase system in Alzheimer disease: it's time for reconciliation. Neurobiology of disease .2014;62:144-59. • Liu X-m, Chapman GB, Wang H, Durante W. Adenovirus-mediated heme oxygenase-1 gene expression stimulates apoptosis in vascular smooth muscle cells .Circulation. 2002;105(1):79-84. • Lei F, Liu YM, Zhou F, Qin JJ, Zhang P, Zhu L, et al. Longitudinal association between markers of liver injury and mortality in COVID-19 in China.Hepatology. (2020) 72:389–98. doi: 10.1002/hep.31301