Clinical aspects of serum bilirubin determination
- Lawrence S Friedman, MD
Lawrence S Friedman, MD
- Section Editor — General Gastroenterology
- Professor of Medicine
- Harvard Medical School
- Tufts University School of Medicine
- Section Editor
- Sanjiv Chopra, MD, MACP
Sanjiv Chopra, MD, MACP
- Editor-in-Chief — Gastroenterology and Hepatology
- Section Editor — General Hepatology; Gallbladder and Biliary Tract Disease
- Professor of Medicine
- Harvard Medical School
- Senior Consultant in Hepatology
- James Tullis Firm Chief
- Beth Israel Deaconess Medical Center
A number of blood tests are available that reflect the condition of the liver. The most common tests used in clinical practice include the serum aminotransferases, bilirubin, alkaline phosphatase, albumin, and prothrombin time. These tests are often referred to as "liver function tests," although this term is somewhat misleading since most do not accurately reflect how well the liver is functioning, and abnormal values can be caused by diseases unrelated to the liver. In addition, these tests may be normal in patients who have advanced liver disease.
Several specialized tests have also been developed (such as indocyanine green clearance), which, although uncommonly used in clinical practice, can measure specific aspects of hepatic function.
Despite their limitations, liver biochemical and function tests have many applications in clinical medicine:
●They provide a noninvasive method to screen for the presence of liver disease. The serum alanine aminotransferase, for example, used to be part of panel of tests used to screen all blood donors in the United States for the presence of transmissible viruses.
●They can be used to measure the efficacy of treatments for liver disease (such as immunosuppressant agents for autoimmune hepatitis). (See "Autoimmune hepatitis: Treatment".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Sticova E, Jirsa M. New insights in bilirubin metabolism and their clinical implications. World J Gastroenterol 2013; 19:6398.
- Stender S, Frikke-Schmidt R, Nordestgaard BG, Tybjærg-Hansen A. Extreme bilirubin levels as a causal risk factor for symptomatic gallstone disease. JAMA Intern Med 2013; 173:1222.
- Horsfall LJ, Rait G, Walters K, et al. Serum bilirubin and risk of respiratory disease and death. JAMA 2011; 305:691.
- ZIEVE L, HILL E, HANSON M, et al. Normal and abnormal variations and clinical significance of the one-minute and total serum bilirubin determinations. J Lab Clin Med 1951; 38:446.
- Werner M, Tolls RE, Hultin JV, Mellecker J. Influence of sex and age on the normal range of eleven serum constituents. Z Klin Chem Klin Biochem 1970; 8:105.
- TISDALE WA, KLATSKIN G, KINSELLA ED. The significance of the direct-reacting fraction of serum bilirubin in hemolytic jaundice. Am J Med 1959; 26:214.
- Blanckaert N. Analysis of bilirubin and bilirubin mono- and di-conjugates. Determination of their relative amounts in biological samples. Biochem J 1980; 185:115.
- Blanckaert N, Kabra PM, Farina FA, et al. Measurement of bilirubin and its monoconjugates and diconjugates in human serum by alkaline methanolysis and high-performance liquid chromatography. J Lab Clin Med 1980; 96:198.
- Blanckaert N, Servaes R, Leroy P. Measurement of bilirubin-protein conjugates in serum and application to human and rat sera. J Lab Clin Med 1986; 108:77.
- Weiss JS, Gautam A, Lauff JJ, et al. The clinical importance of a protein-bound fraction of serum bilirubin in patients with hyperbilirubinemia. N Engl J Med 1983; 309:147.
- Muraca M, Blanckaert N. Liquid-chromatographic assay and identification of mono- and diester conjugates of bilirubin in normal serum. Clin Chem 1983; 29:1767.
- Defreese JD, Wang TS. Properties and determination of serum and bilirubin. Crit Rev Clin Lab Sci 1984; 19:267.
- Lauff JJ, Kasper ME, Ambrose RT. Quantitative liquid-chromatographic estimation of bilirubin species in pathological serum. Clin Chem 1983; 29:800.
- Martelanc M, Žiberna L, Passamonti S, Franko M. Direct determination of free bilirubin in serum at sub-nanomolar levels. Anal Chim Acta 2014; 809:174.
- Bloomer JR, Berk PD, Howe RB, Berlin NI. Interpretation of plasma bilirubin levels based on studies with radioactive bilirubin. JAMA 1971; 218:216.
- Thompson HE, Wyatt BL. Experimentally induced jaundice (hyperbilirubinemia): Report of animal experimentation and of physiologic effect of jaundice in patients with atrophic arthritis. Arch Intern Med 1938; 61:481.
- Raymond GD, Galambos JT. Hepatic storage and excretion of bilirubin in man. Am J Gastroenterol 1971; 55:135.
- Schmid R, Diamond I, Hammaker L, Gundersen CB. Interaction of bilirubin with albumin. Nature 1965; 206:1041.
- Diamond I, Schmid R. Experimental bilirubin encephalopathy. The mode of entry of bilirubin-14C into the central nervous system. J Clin Invest 1966; 45:678.
- HOFFBAUER FW, RAMES ED, MEINERT JK. Limitations and merits of a single serum sample analysis in the differential diagnosis of jaundice. J Lab Clin Med 1949; 34:1259.
- KLATSKIN G. Bile pigment metabolism. Annu Rev Med 1961; 12:211.
- SHERLOCK SP. Biochemical investigations in liver disease; some correlations with hepatic histology. J Pathol Bacteriol 1946; 58:523.
- Hardison WG, Lee FI. Prognosis in acute liver disease of the alcoholic patient. N Engl J Med 1966; 275:61.
- Harinasuta U, Chomet B, Ishak K, Zimmerman HJ. Steatonecrosis--Mallory body type. Medicine (Baltimore) 1967; 46:141.
- Kim WR, Wiesner RH, Therneau TM, et al. Optimal timing of liver transplantation for primary biliary cirrhosis. Hepatology 1998; 28:33.
- KLATSKIN G, BUNGARDS L. An improved test for bilirubin in urine. N Engl J Med 1953; 248:712.
- Measurement of serum bilirubin
- - van den Bergh method
- - Alkaline methanolysis
- - Dry reagent chemistry
- Delta bilirubin
- CLINICAL SIGNIFICANCE OF SERUM BILIRUBIN
- Indication of the severity of hepatic dysfunction
- Correlation of bilirubin concentration with jaundice
- Significance of the serum bilirubin concentration
- Value of fractionating the bilirubin
- Urine bilirubin
- SUMMARY AND RECOMMENDATIONS