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Bilirubin Metabolism - Pathophysiology
 • Conjugated Bilirubin
 • Unconjugated Bilirubin

By Dr. Khushboo Gala @LouLectures

#Bilirubin #Metabolism #Pathophysiology
Bilirubin Metabolism ... Pathophysiology • Conjugated ... BilirubinUnconjugated ... Bilirubin By ... LouLectures #Bilirubin
Biochemistry and Metabolism of Bilirubin
Hemolysis → Hemoglobin → Heme → Biliverdin → Unconjugated Bilirubin (a.k.a. "indirect
→ Biliverdin → Unconjugated ... Bilirubin (a.k.a ... Conjugation → Conjugated ... common bile duct Unconjugated ... , and conjugated
Liver Function Tests (LFTs)
 - Aspartate aminotransferase (AST) 
 - Alanine aminotransferase (ALT) 
 - Alkaline
transpeptidase (GGT) - Bilirubin ... - Unconjugated ... Indirect) - Conjugated
Inherited Non-hemolytic Disorders of Hyperbilirubinemia 

== Disorders of Conjugation ==
Gilbert Syndrome:
 • 5-10% of the population
, intermittent unconjugated ... UGT1A1 activity • Unconjugated ... bilirubin in the ... and unconjugated ... bilirubin • Defect
Classification of Jaundice
Unconjugated hyperbilirubinemia (predominantly indirect bilirubin)
 • Increased bilirubin production (eg, hemolytic anemias, hemolytic reactions,
Classification of Jaundice Unconjugated ... predominantly indirect bilirubin ... • Increased bilirubin ... ) • Impaired bilirubin ... #unconjugated #
Inherited forms of Hyperbilirubinemia
Major pathways involved in bilirubin production, conjugation, and excretion. Notes: Both the UB
pathways involved in bilirubin ... for transporting unconjugated ... bilirubin into ... Decreased UGT1A1 - Unconjugated ... absent UGT1A1 - Unconjugated
Laboratory Testing in Hemolytic Anemia

Intravascular vs Extravascular Hemolysis
Reticulocytes
Unconjugated bilirubin
LDH
Peripheral smear
Haptoglobin
Urine hemosiderin
Urine hemoglobin
Carboxyhemoglobin

#Hemolytic #Anemia #Laboratory #Testing #workup
Reticulocytes Unconjugated ... bilirubin LDH
Liver Chemistry Tests - AST, ALT, Alkaline Phosphatase and Bilirubin Metabolism
AST and ALT:
 • AST: liver
Phosphatase and Bilirubin ... initial insult Bilirubin ... cytochromes) • Unconjugated ... MRP2 transports conjugated ... bilirubin into
Liver Function Tests (LFTs) - Normal Values and Interpretation

Alanine aminotransferase (ALT/SGPT) - Liver, cardiac & skeletal
in bone Total bilirubin ... TBili) Direct bilirubin ... (Conjugated/DBili ... Indirect bilirubin ... (Unconjugated)
Hemolytic Anemias - Differential Diagnosis Algorithm

Signs of anemia and hemolysis:
 • ↓ Haptoglobin
 • ↑ LDH
• ↑ Indirect / unconjugated ... bilirubin • ↑