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Liver Function Tests (LFTS)

The document discusses liver function tests focusing on bilirubin measurements, where bilirubin is produced from the breakdown of hemoglobin and elevated levels can indicate disease; bilirubin exists in the blood as direct (conjugated) and indirect (unconjugated) forms; and jaundice results when bilirubin levels are too high, which can be pre-hepatic, hepatic, or post-hepatic in origin.

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150 views

Liver Function Tests (LFTS)

The document discusses liver function tests focusing on bilirubin measurements, where bilirubin is produced from the breakdown of hemoglobin and elevated levels can indicate disease; bilirubin exists in the blood as direct (conjugated) and indirect (unconjugated) forms; and jaundice results when bilirubin levels are too high, which can be pre-hepatic, hepatic, or post-hepatic in origin.

Uploaded by

farkad rawi
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Liver Function Tests (LFTs)

Measurement of Serum Bilirubin (Total, direct


&indirect)

T.A. Bahiya Osrah


Bilirubin
• Bilirubin is the product of heme degradation (80%
hemoglobin, 20% other hemo-protein as cytochrome,
myoglobin).

• Elevated levels of bilirubin in blood and urine indicate certain


diseases.
Bilirubin
• Bilirubin Structure:
Bilirubin consists of four
open chain pyrrols, Bilirubin

unlike heme which


consists of four rings
pyrrols called
(porphyrin).

Heme
Types of bilirubin in serum

• Indirect bilirubin: is unconjugated or water insoluble, it is


called indirect because it reacts slowly, so it indicates indirect
reaching to reagent.
• Direct bilirubin: is conjugated or water soluble it is called
direct because it reacts faster, so it indicates direct reaching to
reagent.
• Note: Total bilirubin = D+ ID
• Knowing the level of each type of bilirubin has diagnostic
important
Bilirubin Production
• After approximately 120 days in the circulation, red blood
cells are taken up and degraded by the reticuloendothelial
(RE) system, particularly in the liver, spleen and in the bone
marrow.
• hemoglobin destroyed to the heme + globin

amino acid
• Iron is removed from the heme molecule,
• porphyrin ring is opened to form bilirubin
Bilirubin Transportation
• Bilirubin is insoluble in water
and is carried in plasma bound
to albumin
• On reaching the liver, the
bilirubin is taken into the
hepatocyte by specific carrier
mechanism
Specific carrier
mechanism
Conjugation of bilirubin and
secretion into bile
In the liver:

Glucouronic acid + un-conjugated bilirubin


(water insoluble)

UDP-glucuronyltransferase

Bilirubin diglucuronides
(water soluble)

Bilirubin diglucuronides are water soluble and


readily transported into bile.
Further metabolism of bilirubin in
the gut
• In the intestine:
Bilirubin diglucuronides

Bacteria
Glucouronic acid + un-conjugated bilirubin
Further metabolism of bilirubin in the gut

Reabsorption
Into the blood
SUMMARY
Measurements of plasma bilirubin:
• Serum bilirubin concentration depends
on the rate of removal of bilirubin from
destruction of hemoglobin.
• A bilirubin test measures the amount of
bilirubin in a blood sample.
• Types of Bilirubin:
• Bilirubin is present in plasma as:
• Indirect Bilirubin (unconjugated
bilirubin)
• Direct Bilirubin (conjugated bilirubin)
• Total and direct bilirubin levels can be
measured from the blood, but indirect
bilirubin is calculated from the total and
direct bilirubin.
Jaundice
Jaundice:
• Is a term used in clinical medicine to describe a condition
in which the skin and sclera appear yellow caused by
increased amounts of bilirubin in the blood

Classification of the causes of Jaundice:


1. Prehepatic jaundice
2. Hepatic jaundice
3. Posthepatic jaundice
Pre-hepatic (before bile is made in the
liver)
Jaundice in these cases is caused by rapid increase in the
breakdown and destruction of the red blood cells (hemolysis),
overwhelming the liver's ability to adequately remove the
increased levels of bilirubin from the blood.
Examples of conditions with increased breakdown of red blood
cells include:
• Malaria,
sickle cell crisis,
thalassemia,
glucose-6-phosphate dehydrogenase deficiency (G6PD),
drugs or other toxins, and
autoimmune disorders
Hepatic (the problem arises within the liver)

Jaundice in these cases is caused by the liver's inability to


properly metabolize and excrete bilirubin.

Results from:
• Impaired cellular uptake.
• Defective conjugation.
• Abnormal secretion of bilirubin by the liver cell.
Post-hepatic (after bile has been made in the liver)

Jaundice in these cases, also termed obstructive jaundice, is caused by


conditions which interrupt the normal drainage of conjugated bilirubin in
the form of bile from the liver into the intestines.
This may due to:
gallstones in the bile ducts, tumor

•Rise in the serum conjugated bilirubin level and stool becomes clay-
colored. Why?
•Because of the normal drainage interruption of conjugated bilirubin in
the form of bile from the liver into the intestines urine urobilinogen
levels got decreased therefore the secretion of sterocobilin
resulted to a clay-colored stool
Physiologic jaundice of the newborn

• High bilirubin levels are common in newborns age (1-3 days old).
• It is happened because after birth the newborns breaking down the
excess RBCs they are born with and, because the newborn’s liver is not
fully mature, it is unable to process the extra bilirubin, leads to elevate its
level in blood and other body tissues.
• This situation usually resolves itself within a few days.
• Usually newborn is treated by phototherapy which breakdown bilirubin
(ID<<<<D) and convert it to the photo isomer form which is more soluble.
• Very high bilirubin is danger and toxic. It may cause brain damage and
affect on muscles, eyes and even death.
SUMMARY
The Lab practice
Calculations
The absorbance of bilirubin equivalent standard represents:
1. Direct bilirubin=2.5 mg/dl
2. Total bilirubin= 5 mg/dl
3. Direct bilirubin after 1min= (abs test- abs test blank/abs std )* 2.5
4. Total bilirubin after 5 min= (abs test- abs test blank/abs std )* 5
5. To convert mg/dl into µmol/l, multiply the final results by 17.1

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