Bilirubin is a bile pigment. It is mainly derived from breakdown of hemoglobin in red blood cells (RBCs). Hemoglobin is the molecule in RBCs that carries oxygen.
Bilirubin normally circulates in the blood attached to a molecule of the protein albumin. There, it exists in two forms: conjugated (direct) and unconjugated (indirect). Bilirubin dicluguronide, the conjugated form, is water-soluble and is excreted in bile.
Bilirubin is significant diagnostically in two main disease processes: hemolytic anemia and bile obstruction.
In hemolytic anemia, where RBCs are being broken down in the bloodstream (for any of the possible reasons cited in this article), the resulting increase in bilirubin is unconjugated, because it has been released from the red blood cells, but the resulting hemoglobin has not yet traveled to the liver for conjugation. For that reason, if a patient (dog, cat, person, etc.) presents with pale gums, icterus (jaundice) and a blood test result of elevated bilirubin that is unconjugated, the diagnosis of intravascular hemolysis is determined and the cause for the hemolysis must be found in order for treatment to be effective.
On the other hand, patients are much more likely to become jaundiced because of biliary tract obstruction. In hemolytic anemia, RBC destruction is unlikely to exceed the ability of the liver to process and conjugate RBC breakdown products.
Bile obstruction, on the other hand, can be partial or complete. If no bile can leave the liver and be delivered to its ultimate destination in the small intestine, it backs up into the bloodstream, rapidly leading to icterus. This bile will still be conjugated by the liver until the patient is quite ill, though, so a test on the blood will show a high total level of bilirubin, with most of the bilirubin being conjugated.
Bile obstruction can occur inside the liver itself when a diseased liver swells and tiny passageways called canaliculi are no longer open enough to allow bile flow.
Bile obstruction can also happen where the canaliculi dump bile into larger tubes called bile ducts, which wind their way through the pancreas and into the duodenum, the first section of the small intestine. Near the pancreas the bile duct splits in two, and obstruction past that split can result in a reduction of flow without a full stoppage. In that case, jaundice and the resulting illness will usually be less and take a more chronic course than if total obstruction occurs.
See you tomorrow, Dr. Randolph.
My cat was diagnosed with pancreatitis and has been hospitalized now for 5 days. All of his blood work has now come back okay other than his bilirubin which is elevated. They have administered steroids in order to calm down the inflammation in the pancreas which has caused him to be a bit jaundice. They are currently treating it. How long would you say it takes to see progress on his bilirubin? Thanks
Only some very sophisticated scanning of the liver can answer that question, and, it’s unlikely that will be done AS LONG AS the laboratory results and clinical status are improving. Prayers for your baby. Thanks for reading, Dr. Randolph.
My dog is having her bilirubin level very high i.e 5
And she is on medication now
Can that be cured?
Because I’ve seen that bilirubin is danger when It crosses 2
But she has 5
What can I do?
Not even the vet is giving me hope but my dog is totally active now
You may want to ask your pet’s doctor to refer you to a board-certified internist for more aggressive diagnostics and possibly more aggressive treatment. Let us know what you find out, please. Thanks for reading, Dr. Randolph.
My boxer has been drinking excessively for the past 4-5 days. two days ago he dank about every 30-40 minutes but now just about normal. He did urinate normal and we did not noticed any excessive urination. We’ve changed his dog food but it was the same brand “Purina”. I’ve took him to the local Vet and had done some bloodwork.The following values were out of range: HGB=19.8; RBC=8.63; Total Protein=12.0; Albumin=6.0; Bilirubin=14.6; GGT=0. Can you tell me what kind of health issue does my dog suffering and what is your recommendation for his treatment. Thanks JW from Italy.
I’m sorry, but I don’t have enough information to make a diagnosis. Can’t the doctor you took him to help you with these questions? Thanks for reading, Dr. Randolph.
My cat would not eat the moist version, only a very small amount of the dry.
My cat has a high level of bilirubin (and ALP and ALT) and is on medication. Are there any dietary changes I can make to help her?
Hill’s Pet Nutrition makes a Feline version of l/d. However, you should check with your veterinarian and find out whether it is appropriate for your kitty. Thanks for reading, Dr. Randolph.