Jaundice profile


Approximate Price of test


in egypt





Total .bilirubin  ;  15 pound


Direct .Bilirubin :

15 pound

Serum . Bilirubin (total ; ind ;direct) :  30 pound


Introduction :




    :  Yellow discoloration of 

    skin and eyes due to increase of bile pigment in the blood




    it is byproduct of heme 

    catabolism from aged RBCs


It is useful

in diagnosis and monitoring of liver disease and hemolytic disease and

assessment of severity of jaundice .


  • Serum

    bilirubin  :  contain two different form of bilirubin


1-      indirect bilirubin


2-      Direct bilirubin  ( conjugated)


Heme degradation & Bilirubin metabolism:


  • The protoporphyrin ring of the

    heme is opened to the biliverdin form and iron is released

  • Biliverdin is reduced to produce

    the yellow-pigmented molecule unconjuagted bilirubin ( insoluble or has low

    solubility in water or plasma)

  • the liver enzyme uridyl

    diphosphate glucuronyltransferase (UDPG-transferase) transfers moleculesof

    glucuronate, a sugar, to the bilirubin molecule. About 85% of bilirubin is

    conjugated  two molecules of glucuronate

    to form diglucuronate-bilirubin. Most of the rest of bilirubin is conjugated

    with one sugar molecule to form monoglucuronate-bilirubin.

  • Conjugated

    bilirubin passes into the intestine through the bile duct, where intestinal

    bacteria reduce bilirubin to urobilinogen

  • Some

    urobilinogen may be reabsorbed through the intestinal mucosa and returned to

    the portal circulation and the liver.

  • The

    remaining urobilinogen is excreted into urine or oxidized to form urobilin and

    excreted in the feces





Practical part :


  • Sampling precautions: 




protect serum from

light ? why




     Due to photo

degradation of bilirubin by light exposure




Avoid hemolysis  ? why



    Due to hemolysis

interfere with result cause decrease bilirubin value





Note : 


For bilirubin determination in

newborns, pipette 50 μL of sample. Multiply the result by



Principle of Reaction  :

Direct bilirubin


Sulfanilic acid + NaNo2                                 diazide

sulfanilic acid


Bilirubin  + diazide sulfanilic acid                            Azobilirubin


In Total Bilirubin :  






Caffine: used as activator to release unconjugted bilirubin from

albumin which attach to it

Titrate: used to stop reaction 



Na oH : convert

pH of reaction so colure convert to yellow then green




• Assist in the differential diagnosis of

obstructive jaundice


• Assist in the evaluation of liver and biliary


• Monitor the effects of drug reactions  on liver function

• Monitor jaundice in newborn patients

• Monitor the effects of phototherapy on  jaundiced newborns


Interpretation of results :


Prehepatic ( increased indirect bilirubin):

  •  All forms of hemolytic anemia
  • Hemolytic disease of newborn 




                Impaired hepatic uptake (increased

indirect )


  •  Gilbert syndrome
  • Hepatits
  • Cirrhosis 


           Impaired conjugation (increased both

direct& indirect)


  • Viral Hepatits
  • Cirrhosis
  • Premature infants
  • Crigler-Najjer syndrome
  • Novobiocin intake

       Impaired Secretion ( increase Direct)

  • Dubin Jonson syndrome
  • Rotor syndrome
  • Generalized liver



Posthepatic (Increase direct)

  • Gall stone
  • Cancer of head of pancreas


Gilbert syndrome


Mild deficiency of UDPG Transferase enzyme


Increased after  fasting or



Crigler_Najjer Syndrome

Marked Reductionof UDPG transferase enzyme

In neonate; may lead to kernicterus and then death


Dubin_Jonson syndrome

Defect in transfer of conjugated bilirubin


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