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Bilirubinatotala
PostedBySynevoOnaugust13,2009@2:37pmInBiochimiegeneraldinsngeiurin,Testedebiochimie|NoComments

Informatiigenerale
Bilirubinaesteprodusainmacrofageprincatabolismulenzimaticalfractiuniihemdindiversehemoproteine.Aproximativ80%dinbilirubina
circulantaderivadineritrociteleimbatranite.Canderitrocitelecirculanteatingsfarsitulvietiilornormaledeaproximativ120zile,elesunt
distrusedecelulelereticuloendoteliale.Oxidareahemuluigenereazabiliverdina,careestemetabolizatalarandulsauinbilirubina.Restulde
1520%dinbilirubinacirculantaprovinedinaltesurse(distrugereaeritrocitelormaturedinmaduvaosoasahematogenasaumetabolismul
altorproteinececontinhemcitocromiihepatici,mioglobinamusculara,enzime)56.
Bilirubinaastfelformatacirculainsange,fiindtransportatalaficatsubformaunuicomplexsolubilbilirubinaalbumina.Desibilirubinaeste
legatadestuldeputernicdealbumina,eapoatefiextrasacuusurintadinsangedecatreficat.Lanivelhepaticarelocconjugareabilirubinei
cuacidulglucuronic,subactiuneaUDPglucuroniltransferazelor.Bilirubinaconjugataincludebilirubinmonoglucuronid,carepredominain
ficat,sibilirubindiglucuronid,carepredominainlichidulbiliar.Bilirubinaconjugataestetransportataincanaliculelebiliare,deundeeste
deversataimpreunacubilaincailebiliaresiapoiinintestin,undesuferaoseriedereducerisuccesivecuformaredeurobilinogensi
stercobilinogen.Stercobilinogenulsiomicapartedinurobilinogensunteliminateprinfecaleceamaimareparteaurobilinogenuluieste
reabsorbitaintestinal,ajungeprincirculatiaportalalaficat(circuitulenterohepatic),fiindreexcretataprinbila10.
Nivelurilebilirubineisericecrescatuncicandproductiadepasestemetabolismulsiexcretiaacesteia.Clinichiperbilirubinemiaaparecaicter
pigmentareagalbenaategumentuluisisclerelor,careseinstaleazalavalorialebilirubineide22.5mg/dL.
Tulburarilemetabolismuluibilirubineipotfiimpartiteinpatrucategoriimajore:
productiecrescutadepigment
preluarehepaticascazuta
conjugarehepaticainadecvata
excretieredusadepigmentconjugatdinficatsibila12.

Inlaboratorsemasoaradouafractiunialepigmentuluifractiuneahidrosolubilaconjugata,caredareactiadirectacureactivuldiazosicare
reprezintabilirubinaconjugata(subformademonosidiglucuronid)sifractiunealiposolubilacarereprezintabilirubinaneconjugata9.
Primeletreitulburarialemetabolismuluibilirubineisuntasociatecubilirubinemiepredominantneconjugata,iarapatracategorieeste
asociatacubilirubinemiepredominantconjugatasibilirubinurie.
Bilirubinasericatotalaprezintavaloricrescuteinurmatoarelecazuri:
hemolizanecomplicata
icterhepatocelular
obstructiebiliaraextrahepatica
hepatitavirala
hepatitaalcoolica.
Bilirubinaindirecta[1](BI)
Bilirubinaneconjugatasaubilirubinaindirectaseobtineprindiferentadintrevaloareabilirubineitotalesiaceleidirecte.Concentratia
plasmaticaabilirubineineconjugateestedeterminatade:
ratacucarebilirubinanousintetizataintrainplasma(turnoverulbilirubinei)
rataeliminariibilirubineidecatreficat(clearanceulhepaticalbilirubinei)8.
Cresterilevalorilorbilirubineineconjugateinserpotaveaurmatoarelecauze:
turnoverulcrescutcaracterizatprindistrugereacrescutaaeritrocitelorcirculanteapareinafectiuniasociatecuhemoliza:
*anemiilehemoliticeinmajoritateacazurilordehemolizanecomplicatanivelulmediualbilirubineisericeestede34mg/dL
*icteruldatoratproductieicrescutedepigmentcaurmareainfarctelortisulare(infarctepulmonare,colectiisanguineintesuturi,dupa
cateterisme,rupturideanevrismeaortice)

preluarehepaticaalterataprodusadeunelemedicamente(acidflavaspidic,novobiocina)
conjugarealterataabilirubineidatorataactivitatiiscazuteabilirubinglucuroniltransferazei
*icterulneonatalaproapetotinounascutiimanifestaungraddehiperbilirubinemieneconjugatatranzitorieintreadouasiacinceazi
deviatacaefectalfaptuluicainaceststadiuenzimahepaticaglucuroniltransferazaesteincaimatura.Valoareabilirubineiindirectenu
depaseste5mg/dL.Lanounascutiicuunproceshemoliticsupraadaugat,incarcaturadepigmentducelaunictermaipronuntatsi
nivelulbilirubineipoatedepasi20mg/dL.
*deficitulereditardeglucuroniltransferaza:
sindromGilbert(hiperbilirubinemieusoarasipersistentacuvalorimediide1.23mg/dL,rareoridepasind5mg/dL)
sindromCriglerNajjar(tipulIcuabsentaglucuroniltransferazeisivalorialeBIde2045mg/dLsitipulIIcudeficitpartialde
glucuroniltransferazasivalorialeBIcuprinseintre620mg/dL)
*deficitdobanditdeglucuroniltransferaza
*inhibitiemedicamentoasa
*icterullapteluidesan(inhibitiereversibilaaglucuroniltransferazei)356.
Bilirubinadirecta[2](BD)
Bilirubinaconjugata,hidrosolubilasicureactivitatecrescuta,daoreactiedeculoarecureactivuldiazo,fiindcunoscutasubnumelede
bilirubinadirecta.Crestereavalorilorbilirubineidirecteinseresteasociatacuexcretiaredusadepigmentconjugatdinficatsibilasiaparein
icterelecolestaticesauincelehepatocelulare.Crestereapatologicaabilirubineidirecteducelaaparitiaacestuipigmentinurina.Intrucat
bilirubinaindirectanuseeliminaprinurina,prezentabilirubineiinurinadenotacrestereainserabilirubineiconjugate.
Valoricrescutealebilirubineidirecteaparin:
obstructieintrahepatica:
*datorataunordefectefamilialealefunctieiexcretoriihepatice:

sindromulDubinJohnson(ictercronicidiopaticcuvalorialebilirubineitotaleintre315mg/dLcupreponderentabilirubinei
conjugate
sindromulRotor
*datorataunordefectedobanditealefunctieiexcretoriihepatice:
colestazaindusademedicamente
icterpostoperator
hepatitasicirozainbolilehepatocelulareexistadeobiceiointerferentaintreceletreietapealemetabolismuluibilirubinei:
preluare,conjugaresiexcretie.Excretiaestetotusietapaceamaiafectatasicaurmareinserpredominabilirubinaconjugata.
obstructieextrahepaticaobstructiamecanicaaductelorbiliaresedatoreazacelmaiadeseacalculilor,tumorilorsaustricturilor.Nivelul
bilirubineisericedepasesterareori35mg/dL356.
NOTA:
Bilirubinatotala=Bilirubinaneconjugata(indirecta)+Bilirubinadirecta
Bilirubinatotalasidirectasuntdeterminatedeanalizorbilirubinaindirectarezultaprincalcul8.
Pregatirepacientjeun(penemancate)78.
Specimenrecoltatsangevenos78.
Recipientderecoltarevacutainerfaraanticoagulantcu/faragelseparator7.
Prelucrarenecesaraduparecoltareseseparaserulimediatsiselucreazainmax.4oreinperioadadeasteptare,serulesteprotejatde
lumina(expunerealaluminaproducescaderisemnificativedupa23ore).Dacanusepoatelucrain4ore,serulseparatsestocheazala4C
sau20C7.
Volumprobaminim0.5mLser7.

Cauzederespingereaprobeispecimenhemolizat,specimenneprotejatdelumina78.
Stabilitateaprobeiserulseparatestestabil4orelatemperaturacamerei48orela28C6lunila20C7.
Metodaspectrofotometrica(colorimetrica)7.
Valoridereferinta7
Bilirubinatotala
Varsta

Valori(mg/dL)

Copii>1lun
Nusuntdisponibilevalori
dereferinpentruprima

<1

lundevia.
Adulti

<1.2

Bilirubinadirecta

<0.3mg/dL

Bilirubinaindirecta

<1mg/dL

Factordeconversie:mg/dLx17.1=mol/L.
Limitadedetectie0.1mg/dL(1.71mol/L)4.
Valoricritice>15mg/dL(bilirubinatotala)4.
Limitesiinterferente
Medicamente

Cresteri:acebutolol,acetaminofen,acetazolamida,acyclovir,albendazol,alopurinol,alprazolam,amilorid,amiodarona,amitriptilina,
amoxapin,amfotericina,agentiantifungici,antimalarice,antipiretice,acidascorbic,asparaginaza,atorvastatin,azatioprin,azitromicina,
barbiturice,benazepril,bleomicina,busulfan,captopril,carbamazepin,cefalosporine,cetirizin,cimetidina,clindamicina,clofibrat,
clonidina,clopidogrel,clozapina,colchicina,ciclofosfamida,ciclosporina,ciproheptadina,citarabina,dapsona,diazepam,diclofenac,
dietilstilbestrol,diltiazem,disopiramida,doxepin,doxorubicin,doxiciclina,enalapril,enoxaparina,eritromicina,etambutol,etopozid,
famotidina,fluconazol,flutamida,furosemid,ganciclovir,gentamicina,hidralazina,ibuprofen,idarubicina,imipramina,indometacin,
interferon,isotretinoin,kanamicina,ketoconazol,ketoprofen,labetalol,lamivudina,levamisol,levodopa,lincomicina,lisinopril,
medroxiprogesteron,meprobamat,metotrexat,metildopa,metoclopramid,morfina,netilmicina,nitrofurantoin,ofloxacin,papaverina,
penicilina,penicilamina,pentoxifilina,piroxicam,progesteron,propafenona,propiltiouracil,ramipril,ranitidina,rifampicina,
streptomicina,sulfamethoxazol,tacrolimus,tamoxifen,tiazide,ticarcilina,ticlopidina,tobramicina,tolbutamid,trimetoprim,vaccinuri
pentruhepatitaA,BsivaccinulBCG,verapamil,zidovudina3.
Scaderi:amikacina,anticonvulsivante,prednison,teofilina,tioridazina,ursodiol3.
Interferenteanalitice
Hemolizasilipemiainteferacutestele7.

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273274.
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7.LaboratorSynevo.Referintespecificetehnologieidelucruutilizate.2010.RefType:Catalog.
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Type:InternetCommunication.
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[2]Bilirubinadirecta:https://www.synevo.ro/bilirubinadirecta/
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