Bile pigments

Liver

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Measures bilirubin pigments.

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Bile Pigments - Comprehensive Medical Test Guide

Why is it done?
- Measures breakdown products of hemoglobin metabolism, specifically bilirubin and its conjugated and unconjugated forms in blood and urine
- Detects jaundice or icterus - yellowing of skin, sclera, and mucous membranes due to elevated bile pigment levels
- Evaluates liver function and assesses hepatic metabolism capacity
- Investigates biliary obstruction and cholestasis conditions affecting bile flow
- Diagnoses hemolytic anemia and excessive red blood cell destruction
- Ordered when patient presents with jaundice, dark urine, pale stools, or abdominal pain
- Monitors liver disease progression or response to treatment in patients with known hepatic conditions
- Part of routine liver function tests (LFTs) during comprehensive metabolic panels and annual physicals
Normal Range
- Total Bilirubin: 0.1 to 1.2 mg/dL (1.7 to 20.5 µmol/L)
- Direct (Conjugated) Bilirubin: 0.0 to 0.3 mg/dL (0 to 5.1 µmol/L)
- Indirect (Unconjugated) Bilirubin: 0.1 to 0.9 mg/dL (1.7 to 15.4 µmol/L)
- Urinary Bilirubin: Negative or trace amounts
- Urinary Urobilinogen: 0.1 to 1.0 mg/dL or 0 to 4 mg/24 hours
- Note: Reference ranges vary by laboratory; patient-specific results should be compared against the lab's established reference values
- Normal results indicate appropriate hemoglobin breakdown and hepatic conjugation of bilirubin with proper excretion
- Elevated total bilirubin above 1.2 mg/dL may cause visible jaundice, typically noticeable when levels exceed 2-3 mg/dL
Interpretation
- Elevated Total Bilirubin: Indicates jaundice; pattern of elevation determines underlying cause
- Predominantly Unconjugated Hyperbilirubinemia: Suggests hemolytic anemia, Gilbert syndrome, Crigler-Najjar syndrome, or impaired hepatic uptake; usually absent from urine
- Predominantly Conjugated Hyperbilirubinemia: Indicates post-hepatic obstruction, cholestasis, hepatocellular injury, or excretion defects; appears in urine due to water-soluble nature
- Elevated Urinary Bilirubin: Indicates conjugated hyperbilirubinemia exceeding renal threshold; suggests liver disease or biliary obstruction
- Elevated Urinary Urobilinogen: Suggests increased bilirubin production from hemolysis, hepatocellular disease, or portal hypertension
- Decreased Urinary Urobilinogen: May indicate complete biliary obstruction preventing bile pigment reaching intestines for urobilinogen formation
- Factors Affecting Results: Hemolysis during collection, prolonged fasting, pregnancy, medications (oral contraceptives, rifampicin), diet composition, and time of day variation
- Clinical Significance Pattern: Rapid rise in conjugated bilirubin with normal alkaline phosphatase suggests hepatocellular necrosis; elevation with elevated alkaline phosphatase indicates cholestasis
Associated Organs
- Primary Organs: Liver (primary metabolic and conjugation site), biliary system (gallbladder and bile ducts), and spleen (site of hemoglobin breakdown)
- Conditions Associated with Elevated Bile Pigments:
- Hemolytic anemias (sickle cell disease, hereditary spherocytosis, autoimmune hemolytic anemia, G6PD deficiency)
- Acute and chronic hepatitis (viral, autoimmune, alcoholic, drug-induced)
- Cirrhosis and advanced liver disease from any etiology
- Choledocholithiasis (bile duct gallstones) and biliary obstruction
- Pancreatic cancer and cholangiocarcinoma (biliary tract cancer)
- Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC)
- Pregnancy-related cholestasis and HELLP syndrome
- Sepsis and systemic infections affecting hepatic function
- Genetic conditions (Gilbert syndrome, Dubin-Johnson syndrome, Rotor syndrome)
- Neonatal jaundice from physiologic hyperbilirubinemia or Rh/ABO incompatibility
- Potential Complications: Severe unconjugated hyperbilirubinemia in neonates may cause bilirubin encephalopathy (kernicterus) with permanent neurologic damage; chronic liver disease leads to portal hypertension, ascites, variceal bleeding, and hepatic encephalopathy
Follow-up Tests
- Recommended When Elevated Bile Pigments Detected:
- Complete liver function panel: alkaline phosphatase, gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, total protein
- Abdominal ultrasound to visualize biliary tree for stones, obstruction, or hepatic cirrhosis
- Complete blood count (CBC) with reticulocyte count to assess for hemolytic anemia
- Peripheral blood smear if hemolysis suspected to identify abnormal red blood cells
- Haptoglobin and lactate dehydrogenase (LDH) levels for hemolysis assessment
- Direct antiglobulin test (Coombs test) if autoimmune hemolytic anemia suspected
- Viral hepatitis serology (hepatitis A, B, C antibodies and antigens) if hepatitis suspected
- Autoimmune markers (ANA, anti-smooth muscle antibodies) for autoimmune hepatitis
- CT scan or MRI/MRCP for detailed imaging of biliary tree and pancreas if obstruction suspected
- Prothrombin time (PT/INR) to assess hepatic synthetic function if liver disease suspected
- Endoscopic retrograde cholangiopancreatography (ERCP) if therapeutic intervention needed for biliary obstruction
- Monitoring Frequency:
- Acute hepatitis: repeat testing every 3-7 days until normalization
- Chronic liver disease: repeat testing every 3-6 months or as directed by hepatologist
- Neonatal jaundice: may require repeated testing every 24 hours in first week of life
- Gilbert syndrome: no specific monitoring required; levels fluctuate normally with illness or stress
Fasting Required?
- Fasting Status: No fasting required for bile pigment testing; test can be performed on non-fasting or fasting samples
- Important Note: If other liver function tests or metabolic panel tests are being performed simultaneously, fasting (typically 8-12 hours) may be recommended to ensure optimal accuracy of those components
- Special Instructions:
- Avoid strenuous physical activity 24 hours before testing if possible, as exercise may temporarily elevate bilirubin levels
- Avoid excessive alcohol consumption in 24 hours prior to test for accurate assessment of liver function
- Inform healthcare provider of all current medications, especially those affecting liver function (acetaminophen, statins, NSAIDs, antibiotics, anticonvulsants)
- Blood collection preferred in morning when diurnal variation is at baseline; avoid collection immediately after meals if possible
- Protect specimen from light exposure as bilirubin degrades with phototherapy, affecting accuracy
- For 24-hour urine collection (if urobilinogen assessment needed): collect all urine in 24-hour period in container without preservative unless specified by laboratory
- Neonatal screening does not require fasting; collected via heel stick from newborn screening card

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