1.

BILIRUBIN METABOLISM
1.1 CREATING BILIVERDIN IN
THE ENDOTHELIAL SYSTEM

Separating Fe2+ and globin: removing carbon methylene α ,

releasing biliverdin by the enzyme heme oxygenase
1.2 CREATING UNCONJUGATED
BILIRUBIN (INDIRECT BILIRUBIN)

 Yellow
 Insoluble in water
 Toxic to nerve system
1.3 CREATING CONJUGATED
BILIRUBIN ( DIRECT BILIRUBIN)

85% bilirubin
diglucuronate
15% bilirubin
monoglucuronate
Soluble in water
Nontoxic to the
nervous system
1.4 CHANGE OF BILIRUBIN
IN LIVER AND INTESTINE
Hemolytic jaundice

Hepatocellualar
jaundice

Obstructive jaundice
NORMAL VALUE OF BILIRUBIN
 CASE 1
Patient A have bilirubin tests.
Lab test Results Unit
Direct bilirubin is
Total bilirubin 3,7 mg/dL normal, indirect
Direct bilirubin 0.9 mg/dL bilirubin is
Indirect bilirubin 2,5 mg/dL increase.
Conclusion: He or she maybe has hemolytic jaundice
 CASE 2
Patient B have bilirubin tests. The result are:
Lab tests Results Unit
direct bilirubin
Total bilirubin 4,6 mg/dL
and indirect
Direct bilirubin 1,8 mg/dL bilirubin are
increase.
Indirect bilirubin 2,8 mg/dL

Conclusion: He or she maybe has hepatocellualar jaundice

 CASE 3
Ex3: Patient C have bilirubin tests. The result are:
Lab test Results Unit Direct bilirubin is
Total bilirubin 3,2 mg/dL increase and indirect
Direct bilirubin 0,2 mg/dL bilirubin is normal.
Indirect bilirubin 3 mg/dL

Conclusion: He or she maybe has hepatocellualar jaundice