as suspected bilirubin

[Mary4now]

I talked to my monitor and he said the bilirubin is stage 3 so I have to go in for weekly blood draws.  He said the best thing to work with the elevated bilirubin is water and rest, So, I'm laying in bed drinking water.  I think I have been a little lax drinking water at work, and oh so tired.  I also feel a little guilty for wanting to go to bed all the time, when I should be washing the floor etc.

[Mary4now]

yes I posted another comment with my numbers,
it seems they categorize by stages depending on the numbers, 3 is when they take some action.
so my bilirubin was 3.3 total, but the low hgb is time to reduce the ribivarin.
because its a study they cant introduce the procrit.  it works, but its not FDA approved for hep c.  someting like that.  I dont totally get their reasoning, could be because I'm tired.
I will know week 16 which arm I'm in and if I'm randomized to stop.
So I feel better that I know why I'm tired and brain dead.  I really do picture my warm bed during the day and look forward to it, like a best friend.

[nygirl7]

Did you ever find out what the doctor meant by stage 3 bilirubin?

[Gee704]

Thanks Mike!

My total is higher than the direct or indirect.
So hypothetically 0.2 (total) - less than 0.1 (direct) = less than 0.2 (indirect)
                     or 0.2 - 0.09 = 0.11

[mikesimon]

I never saw results expressed with a < - maybe I am remembering wrong but I have never had a bilirubin that low. I didn't see the < sign when I posted so I guess it could be right - it could be 0 or maybe even < 0. I'm kidding.

Mike

[mikesimon]

Yes it's odd to have a total bilirubin lower than the direct + the indirect.
I think your test result is wrong.
Your total bilirubin has to = .3 if the other results are accurate.
But, your bilirubin looks great.

[Gee704]

"Indirect bilirubin is calculated by subtracting the direct bilirubin from the total bilirubin."

My 12 week post cbc came back today.
Total Bili = 0.2
Dir Bili = < 0.1
Ind Bili = < 0.2

That makes the above statement true but why wouldn't they just report it as "0" ?

Has anyone heard of these values being reported like this? Seems odd!

[mikesimon]

Increased indirect or total bilirubin may be a sign of:

    * Crigler-Najjar syndrome
    * Erythroblastosis fetalis
    * Gilbert's disease
    * Healing of a large hematoma (bruise or bleeding under the skin)
    * Hemolytic anemia
    * Hemolytic disease of the newborn
    * Hepatitis
    * Physiological jaundice (normal in newborns)

Increased direct bilirubin may indicate:

    * Bile duct obstruction
    * Cirrhosis
    * Dubin-Johnson syndrome (very rare)
    * Hepatitis
    * Intrahepatic cholestasis (buildup of bile in the liver) due to any cause

See:  http://www.nlm.nih.gov/medlineplus/ency/article/003479.htm

Normally, 90% or more of measured serum bilirubin is unconjugated (indirect-reacting). When the total bilirubin level is elevated and fractionation shows that the major portion (≥90%) is unconjugated, liver disease is never the explanation. Instead, the clinical suspicion should turn to one of two explanations. If the patient is young and healthy, an inherited decrease in the inability to conjugate bilirubin is likely; it is referred to as Gilbert's syndrome. It causes no symptoms and is associated with no liver disease. Interestingly, fasting and intercurrent illnesses such as influenza often make the level of unconjugated bilirubin even higher in those with Gilbert's syndrome. This syndrome is easily diagnosed when all the standard liver test results are normal, and 90% or more of the total bilirubin is unconjugated. There is no need for an imaging study or liver biopsy in cases of suspected Gilbert's syndrome.

Elevations of the unconjugated bilirubin level, when the conjugated bilirubin level remains normal, may also indicate an increased load of bilirubin caused by hemolysis. Anemia and an elevated reticulocyte count are usually present in such cases (Table 4).
    * Sickle cell anemia
    * Transfusion reaction
    * Pernicious anemia

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hepatology/guide-to-common-liver-tests/

With cirrhosis it is a whole different situation and yes, both direct and indirect may be elevated - because the liver can no longer function to conjugate.
But, with cirrhosis you'd see a lot more than just an elevation of bilirubin.
As a general rule elevated direct bilirubin is hepatobiliary related.

Mike

[nygirl7]

In describing total and direct (conjugated) bilirubin it states "with hepatitis and decompensated cirrhosis, both direct and indirect bilirubin may be elevated."



I think her biopsy results showed stage 1 liver damage so I dont think this is the case here or face it we'd all be f'd.

[Isobella]

I may be reading my text incorrectly but when describing indirect (unconjugated) bilirubin, it states that "with certain clinical problems, congestive heart failure and severe liver damage, both indirect and direct bilirubin levels will increase.  Indirect bilirubin frequently increases because the damaged liver cells cannot conjugate normal amounts, which leads to increased unconjugated bilirubin."

In describing total and direct (conjugated) bilirubin it states "with hepatitis and decompensated cirrhosis, both direct and indirect bilirubin may be elevated."

Personally, I'm just hoping she had a big plate of carrots and yams with butter the night before the test and her future levels will be normal and not cause her any trouble in the trial.

[mikesimon]

Direct or conjugated bilirubin is associated with liver disease - indirect/unconjugated bilirubin.
is not associated with liver disease.
Hemolytic anemia raises the indirect bilirubin because of the increased destruction of red blood cells.

Mike

[Isobella]

I may never be able to eat carrots and yams again.............

[FlGuy]

When our kids were young we stopped feeding them carrots and yams.  But, it wasnn't because of the billirubin !   It had more to do with the Jackson Pollock diaper artwork.

[Isobella]

The range for indirect serum Bilirubin is 0.1-1mg/dl
The range for total serum Bilirubin is 0.1-1.2mg/dl
and for direct serum Bilirubin is 0.1-0.3mg/dl

Indirect bilirubin is calculated by subtracting the direct bilirubin from the total bilirubin.

Liver damage can cause both of these levels to be elevated.  Maybe check to see what they were before you started treatment. Hemolytic anemia can also cause an increase.  What's your Hgb looking like?  Maybe that's a factor.

Eating a high-fat dinner the evening prior to the test may alter bilirubin levels.  Carrots and yams may also increase the serum bilirubin level.  Maybe it was something you ate?

I didn't find anything about rest and water, I know that in newborns the level may get to as high as 12mg/dl and panic mode is 15mg/dl...how that translates for adults, I don't know.  When the bilirubin level is >3mg/dl there will usually be jaundice.

That's all I know about bilirubin.

Good luck to you,

Isobella

[Mary4now]

Yikes, I dont know, maybe its a stage they have for the study, showing that it needs to be monitored, Last week the NP said the bilirubin was a little high and we would watch it then I go this call to come in after the last labs.  
I'll find out what the number is either today or I have an appointment with the doc on Wed.
I know nothing about this bilirubin process so I'll do some searching today
I have a call into the monitor to see if I can get the actual number,  
thx

[willbb]

Mary then  normal ref. range for bili  is .2   -1.2 mg/dl   what is St 3 bili.??

[mikesimon]

I cannot recall hearing bilirubin levels expressed in "stages".
Neither have I heard that drinking water will lower bilirubin levels although maybe it's possible that large amounts of water might possibly dilute the level. What rest has to do with it is beyond me.

That bilirubin information just sounds strange to me.

[nygirl7]

My bilirubin goes from .2 to .5 to .7 back to .2 all of the time it varies greatly - I'm not sure what he is talking about stage 3 bilirubin?  Maybe I'm missing something but even my .7s are still considered in normal range. What is your bili number?