Bilirubin Levels
Monitor, assess, and manage bilirubin levels effectively through Bilirubin Levels Charts. Discover more about this life-saving tool.
Fact Checked by Ericka Pingol.
What are Bilirubin Levels?
Bilirubin levels in the blood offer a crucial insight into a person's liver function, overall health, and potential issues with the breakdown or excretion of red blood cells. Essentially, bilirubin is a yellowish substance the body creates when red blood cells break down. The liver is vital in processing this compound, making its levels a valuable diagnostic indicator.
Bilirubin production happens when red blood cells reach the end of their lifecycle, around 120 days. They are broken down, releasing hemoglobin, which is then converted into bilirubin.
Interpreting bilirubin levels in the context of a patient's medical history, physical examination, and other laboratory and diagnostic tests is essential to determining the underlying cause and guiding appropriate treatment.
What is the difference between conjugated and unconjugated bilirubin?
There are two main forms of bilirubin:
- Unconjugated (indirect) bilirubin: This form is insoluble and cannot be excreted in bile or urine. It is transported to the liver, where it undergoes conjugation (binding to a sugar molecule) to become soluble.
- Conjugated (direct) bilirubin: This form is soluble and can be excreted through bile and urine. It is produced in the liver when unconjugated bilirubin is conjugated. Elevated levels can impact bilirubin excretion and can be associated with diseases such as Rotor syndromes and other types of liver disease.
Elevated bilirubin levels can indicate conditions like hemolytic anemia or liver diseases impairing conjugation or uptake. Elevated levels of conjugated bilirubin may suggest biliary tract obstruction or liver disease that impairs bile excretion (Wehbi, 2020).
Why is measuring Bilirubin Levels necessary?
Measuring bilirubin levels is essential for several reasons in healthcare practice. It provides valuable insights into various medical conditions and helps guide appropriate diagnosis and management.
Assessing liver function
Bilirubin concentrations are a crucial indicator of liver health. Elevated levels of conjugated (direct) bilirubin can signify liver diseases that impair bile excretion, such as hepatitis, cirrhosis, or biliary obstruction.
Identifying hemolytic disorders
When bilirubin levels remain high for a significant period, this can indicate liver diseases that affect bile excretion, such as hepatitis, cirrhosis, or biliary obstruction. It can also indicate conditions affecting the liver's ability for bilirubin metabolism.
Monitoring neonatal jaundice
In newborns, measuring bilirubin levels is essential for detecting and managing neonatal jaundice, a common condition caused by the breakdown of excess red blood cells. Timely intervention can prevent potential complications, such as kernicterus (brain damage) (Bhutani & Wong, 2013).
Tracking treatment response
Bilirubin levels can be used to monitor the effectiveness of treatments for conditions like hemolytic anemia, liver diseases, or biliary tract obstruction. A decrease in bilirubin levels can indicate a positive response to treatment.
How do you measure Bilirubin Levels?
A bilirubin blood test is usually done to measure bilirubin levels. There are two types of tests (Wehbi, 2020):
- Total bilirubin (TBil): This measures both unconjugated and conjugated (direct) bilirubin. Normal ranges typically fall between 0.2 to 1.2 mg/dL.
- Direct bilirubin (Dbil): Specifically measuring conjugated bilirubin, normal levels are usually under 0.3 mg/dL.
These total and direct bilirubin levels can then be interpreted as the following:
- Normal levels: As mentioned, fall within the ranges of 0.2 to 1.2 mg/dL for total bilirubin and up to 0.3 mg/dL for direct bilirubin.
- High bilirubin levels: Elevation can indicate several conditions. An increase in unconjugated bilirubin may suggest hemolytic anemias or Gilbert's syndrome, while elevated conjugated bilirubin could indicate liver diseases such as hepatitis, cirrhosis, or bile duct obstruction.
How are Bilirubin Levels measured in newborns?
Measuring bilirubin levels in newborns is crucial for identifying and managing neonatal jaundice, a common condition that can potentially lead to serious complications if left untreated. Several methods are used to measure newborns' bilirubin levels, each with advantages and limitations.
- Transcutaneous bilirubinometry (TcB): This noninvasive method uses a handheld device to estimate bilirubin levels by measuring the yellowish discoloration of the skin and subcutaneous tissues. The device is placed on the newborn's forehead or sternum, emitting light waves absorbed by the bilirubin in the skin. The device then calculates the bilirubin level based on light absorption (Kuzniewicz et al., 2009).
- Total serum bilirubin (TSB) blood test: This directly measures the total bilirubin concentration in the newborn's serum or plasma. It is considered the gold standard for bilirubin measurement and provides accurate results. The blood sample is collected through heel prick or venipuncture and analyzed in a laboratory (Bhutani & Wong, 2013). While measuring total serum bilirubin levels is the most accurate method, it is invasive and can cause discomfort to the newborn.
- End-tidal carbon monoxide (ETCOc) measurement: This method indirectly measures bilirubin levels by quantihemolysis rate hemolysis (breakdown of red blood cells). It involves measuring the concentration of carbon monoxide in the newborn's exhaled breath, which is a byproduct of heme degradation (Christensen et al., 2016). ETCOc measurement is a noninvasive estimate of bilirubin levels, but it may be less accurate than direct bilirubin measurement methods.
When interpreting direct bilirubin levels in newborns, healthcare professionals consider factors such as gestational age and postnatal absence of risk factors for hyperbilirubinemia (elevated bilirubin levels). Timely identification and management of neonatal jaundice are crucial to prevent potential complications, such as acute bilirubin encephalopathy (kernicterus) (Bhutani & Wong, 2013).
Printable Bilirubin Levels Chart
Download this Bilirubin Levels Chart to evaluate the total amount of serum bilirubin in an individual's bloodstream.
What is a Bilirubin Levels Chart?
A Bilirubin Levels Chart, also known as a bilirubin nomogram, evaluates the total amount of serum bilirubin in an individual's bloodstream. This chart aids healthcare professionals in diagnosing jaundice, a common condition in infants, and other diagnoses in adults.
This tool can help healthcare professionals with the treatment that may be necessary to decrease bilirubin levels.
Printable Bilirubin Levels Chart
Download this Bilirubin Levels Chart to evaluate the total amount of serum bilirubin in an individual's bloodstream.
How to use our Bilirubin Levels Chart?
Using a bilirubin levels chart is a straightforward process that can provide valuable insights into the interpretation and management of neonatal hyperbilirubinemia. Here's a step-by-step guide on how to use a bilirubin levels chart effectively:
Step 1: Determine potential heightened bilirubin levels
A physical exam of the infant should be conducted. The practitioner will inspect the skin for the extent of jaundice, typically using gentle pressure to help reveal the presence of the condition.
Step 2: Take necessary medical steps
Bilirubin levels can be measured using typical medical practices. Once the initial blood test returns, the healthcare professional can plot the levels of bilirubin found in the bloodstream against the individual's age.
Step 3: Complete the bilirubin levels chart
Use Carepatron's printable Bilirubin Levels Chart to get a clear visual of how the bilirubin level is progressing within the individual. Repeat the process as many times as medically needed. The graph will begin to take shape, and practitioners will be able to see a progression line as the graph continues to be filled in.
Step 4: Plan for appropriate treatment
Utilize the data gathered on the bilirubin levels chart to make necessary treatment decisions based on the bilirubin levels.
Bilirubin Levels Chart example (sample)
We have created a digitally accessible and printable Bilirubin Levels Chart PDF template. Here, you can gain more insight into what it will look like when you fill this chart in. The progression line in this chart example is for reference only. Check out a preview of this template by clicking on the link below. You can also download this as a PDF for easier access.
Download this Bilirubin Levels Chart example here:
Why use Carepatron as your Bilirubin Levels app?
Carepatron is a practice management software designed for modern practitioners. It is a bilirubin-level app designed to meet the needs of healthcare professionals who perform bilirubin tests.
Carepatron's Bilirubin Levels app provides healthcare professionals with a specialized solution for continuous monitoring of bilirubin levels in an individual. It is a user-friendly system that helps with data entry, physical chart interpretations, and future treatment decisions. The bilirubin levels chart and our extensive library of resources and templates help practitioners with clinical documentation.
Ready to transform how you run your practice? Join thousands of practitioners who have already chosen Carepatron as their practice management partner! Sign up today for a free trial!
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References
Bhutani, V. K., & Wong, R. J. (2013). Bilirubin neurotoxicity in preterm infants: risk and prevention. Journal of clinical neonatology, 2(2), 61–69. https://doi.org/10.4103/2249-4847.116402
Christensen, R. D., Malleske, D. T., Lambert, D. K., Baer, V. L., Prchal, J. T., Denson, L. E., Gerday, E., Weaver, Lewis, K. A., & Shepherd, J. G. (2016). Measuring End-Tidal Carbon Monoxide of Jaundiced Neonates in the Birth Hospital to Identify Those with Hemolysis. Neonatology, 109(1), 1–5. https://doi.org/10.1159/000438482
Kuzniewicz, M.W., Escobar, G.J., & Newman, T.B. (2009). Impact of Universal Bilirubin Screening on Severe Hyperbilirubinemia and Phototherapy Use. Pediatrics, 124, 1031 - 1039.
Wehbi, M. (2020, March 4). Bilirubin: Reference range, interpretation, collection, and panels. Medscape. https://emedicine.medscape.com/article/2074068-overview
Commonly asked questions
Healthcare providers, such as pediatricians, neonatologists, and nurses who care for newborns, often request a Bilirubin Levels Chart to assess and manage infant jaundice.
Plasma bilirubin is measured in the blood and indicates how well the liver processes waste. Urine bilirubin results from the liver excreting bilirubin into the bile, which is removed from the body. Its presence in the urine usually indicates liver dysfunction.
Elevated bilirubin levels are primarily associated with jaundice and severe, severe cases, conditions such as hemolytic anemia, biliary obstruction, Gilbert's syndrome, and liver disorders, including hepatitis.
