Indirect bilirubin

Hemoglobin Reticulocyte count Serum bilirubin (total) Serum bilirubin (indirect) Serum haptoglobin Serum iron Urinary iron Fecal stercobilinogen... 

Increased nonconjugated (indirect) bilirubin Shortened red cell survival time as measured by injection of autologous Cr-labeled red cells... 

Increased total, direct, and indirect bilirubin concentrations indicate defects in transport, conjugation, or excretion of bilirubin. 

Hemolytic anemias tend to be normocytic and normochromic and to have increased levels of reticulocytes, lactic dehydrogenase, and indirect bilirubin. 

Conditions that increeise indirect bilirubin Hemolysis... 

Jaundice (yellow color of skin, whites of the eyes) may occur when blood levels of bilirubin exceed normal (icterus). Jaundice may be characterized by an increase in unconjugated (indirect) bilirubin, conjugated (direct) bilirubin, or both. Accumulation of bilirubin (usually unconjugiated) in the brain (kernicterus) may result in death. When conjugated bilirubin increases, it may be excreted, giving a deep yeUow-red color to the urine. Examples of conditions associated with increased bilirubin and jaundice include the following. 

Viral hepatitis or cirrhosis produces an increase in both direct and indirect bilirubin. Aminotransferase levels will also be elevated. 

Above l.Omg/m the liver is unable to handle the increased amounts of red blood cell breakdown products and indirect bilirubin levels rise. Elevations of liver function enzymes may occur, particularly in new employees or those recently exposed to higher levels. There are suggestions of marked individual susceptibility to liver damage, with most not showing effects unless exposures considerably exceed l.Omg/mk ... 

Hyperbilirubinemia Most patients taking atazanavir experience asymptomatic elevations in indirect (unconjugated) bilirubin related to inhibition of UDP-glucuronosyl transferase (UGT). This hyperbilirubinemia is reversible upon discontinuation of atazanavir. 

Chemical evidence of choleostasis, such as an increase in direct, relative to indirect, bilirubin Increased alkaline phosphatase A reduction of esterified cholesterol Moderately increased aminotransferases... 

B4. Berger, H. J., Quantitative analysis of direct and indirect bilirubin in the sera of domesticated animals. Zentr. Veterinarmed. 3, 273-280 (1956). 

H5. Hijmans van den Bergh, A. A., and Muller, P., Ueber eine indirecte Diazoreak-tion auf Bilirubin. Biochem. Z. 77, 90-103 (1916). 

J3. Jirsova, V., Jirsa, M., and Janovsky, M., Importance of the quantitative determination of direct and indirect bilirubin in hemolytic disease of newborn. Acta Tediat. 47, 179-186 (1958). 

T2. Talafant, E., The nature of direct and indirect bilirubin. V. The presence of glucuronic acid in the directly reacting bile pigment. Collection Czechosloc. Chem. Communs. 22, 661-663 (1957). 

Yl. Yamaoka, K., and Kosaka, K., Studies on bile pigments. I. On the nature of indirect and direct bilirubin. Proc. Japan. Acad. 27, 715-720 (1951). 

Conjugated and unconjugated bilirubin concentrations in serum may be measured via the van den Bergh reaction. The conjugated bilirubin reacts directly with diazotized sulfanylic acid and is thus termed "direct bilirubin." Unconjugated (albumin-bound) bilirubin does not react with the reagent unless the serum is treated with alcohol, and its concentration is thus termed "indirect bilirubin." The determination of direct and indirect serum bilirubin, as well as... 

A patient has highly elevated serum indirect bilirubin and urine urobilinogen and a very slightly elevated serum direct bilirubin. What is the most likely diagnosis ... 

As there is a lot of urine urobilinogen, the liver must be conjugating the bilirubin, and it is moved into the intestinal tract where urobilinogen is formed. An increase in serum indirect (unconjugated) bilirubin indicates hemolytic disease. 

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