High vs. Low Levels, Direct vs. Indirect

Written by WebMD Editorial Contributors

• Why Do You Get This Test?
• What Happens During the Test?
• Who Should Get It? Who Shouldn’t?
• What Do the Results Mean?

A bilirubin test measures the amount of bilirubin in your blood. It’s used to help find the cause of health conditions like jaundice, anemia, and liver disease.

Bilirubin is an orange-yellow pigment that occurs normally when part of your red blood cells break down. Your liver takes the bilirubin from your blood and changes its chemical make-up so that most of it is passed through your poop as bile.

If your bilirubin levels are higher than normal, it’s a sign that either your red blood cells are breaking down at an unusual rate or that your liver isn’t breaking down waste properly and clearing the bilirubin from your blood.

Another option is that there’s a problem somewhere along the pathway that gets the bilirubin out of your liver and into your stool.

In children and adults, doctors use it to diagnose and monitor liver and bile duct diseases. These include cirrhosis, hepatitis, and gallstones.

It’ll also help determine if you have sickle cell disease or other conditions that cause hemolytic anemia. That’s a disorder where red blood cells are destroyed faster than they’re made.

High levels of bilirubin can cause a yellowing of your skin and eyes, a condition doctors call jaundice.

High bilirubin levels are common in newborns. Doctors use the age of the newborn and the bilirubin type and levels to determine if treatment is necessary.

A nurse or lab technician will draw blood through a small needle inserted into a vein in your arm. The blood is collected in a tube.

With newborns, blood is usually drawn by using a needle to break the skin of the heel.

Your doctor will send the blood to a lab for analysis.

Before the test, tell your doctor about how active you’ve been and what food and medicines you’ve taken. Certain medications may alter your results.

After the test, you’ll be able to continue with your normal activities right away.

Your doctor may order a bilirubin test if you:

• Show signs of jaundice
• Have anemia, or low red blood cells
• Might be having a toxic reaction to drugs
• Have a history of heavy drinking
• Have been exposed to hepatitis viruses
• Have cirrhosis

You might also have your bilirubin tested if you have symptoms like:

• Dark urine
• Nausea and vomiting
• Abdominal pain or abdominal swelling
• Clay-colored stools
• Fatigue

A bilirubin test measures total bilirubin. It can also give levels of two different types of bilirubin: unconjugated and conjugated.

Unconjugated (“indirect”) bilirubin. This is the bilirubin created from red blood cell breakdown. It travels in the blood to the liver.

Conjugated (“direct”) bilirubin. This is the bilirubin once it reaches the liver and undergoes a chemical change. It moves to the intestines before being removed through your stool.

For adults over 18, normal total bilirubin can be up to 1.2 milligrams per deciliter (mg/dl) of blood. For those under 18, the normal level will be will be 1 mg/dl. Normal results for conjugated (direct) bilirubin should be less than 0.3 mg/dl.

Men tend to have slightly higher bilirubin levels than women. African-Americans tend to have lower bilirubin levels than people of other races.

High total bilirubin may be caused by:

• Anemia
• Cirrhosis
• A reaction to a blood transfusion
• Gilbert syndrome — a common, inherited condition in which there is a deficiency of an enzyme that helps to break down bilirubin.
• Viral hepatitis
• A reaction to drugs
• Alcoholic liver disease
• Gallstones

Very strenuous exercise, such as marathon running, can increase your bilirubin levels.

Caffeine, penicillin, barbiturates, and nonsteroidal anti-inflammatory drugs (NSAIDs) called salicylates all lower your bilirubin levels.

Lower-than-normal levels of bilirubin aren’t a problem.

In newborns, high bilirubin levels that don’t level out in a few days to 2 weeks may be a sign of:

• Blood type incompatibility between mother and child
• Lack of oxygen
• An inherited infection
• A disease affecting the liver

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Alanine-aminotransferase (ALT, SGPT) – Lab Results explained

Optimal Result:

0 – 32 U/L,

or
0. 00 – 32.00 IU/L.

Alanine-aminotransferase (ALT), formerly called serum glutamic pyruvic transaminase, is an enzyme produced by the liver and found in blood. Its primary function is to serve as a catalyst for chemical reactions.  A healthy human body will naturally display low levels of ALT; however, when the liver is damaged or diseased it will release ALT into the bloodstream causing ALT levels to rise. As such, an ALT test is typically done to identify liver diseases, especially cirrhosis and hepatitis.  ALT tests can also be used to keep track of medications that can damage the liver. If a person has jaundice (yellowing of the skin or eyes) an ALT test can determine whether a blood disorder or liver disease is the cause. However, ALT is a liver-specific enzyme and elevated levels typically indicate a problem with liver cell integrity. Further, ALT tests may be done in tandem with an alkaline phosphatase test to distinguish liver damage from a bile duct problem. 

Normal Ranges in U/L:

Male: 5-63  U/L

Female: 5-54  U/L

What does it mean if your Alanine-aminotransferase (ALT, SGPT) result is too low?

– Decreased ALT levels are associated with a B6 deficiency.

– A low level of ALT in the blood is typical and healthy for an adult.

What does it mean if your Alanine-aminotransferase (ALT, SGPT) result is too high?

Slightly high ALT levels may be caused by:

– Alcohol abuse

– Cirrhosis (long-term damage and scarring of the liver)

– Mononucleosis

– Drugs such as statins, aspirin, and some sleep aids

Moderately high ALT levels may be because of:

– Chronic (ongoing) liver disease

– Alcohol abuse

– Cirrhosis

– Blockage of the bile ducts

– Heart attack or heart failure (when your heart can’t pump enough blood to your body)

– Kidney damage

– Muscle injury

– Damage to red blood cells

– Heat stroke

– Too much vitamin A

Very high ALT levels can be caused by:

– Acute viral hepatitis

– An overdose of drugs such as acetaminophen (Tylenol)

– Liver cancer

– Sepsis

An ALT test whose value is twenty or fifty fold the normal range indicates damage to the liver. Liver diseases like hepatitis and cirrhosis may be the cause of the damage.

Symptoms of liver disease include:

– Jaundice, or yellow skin

– Fatigue

– Unexpected weight loss

– Swelling around the eyes, stomach, or legs

There are also many medications that have the potential to damage the liver, including: antibiotics, chemotherapy, aspirin, narcotics, and barbiturates. It is worth noting that levels of ALT fluctuate throughout the day and can also increase significantly in response to strenuous physical exercise. 

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Biochemical blood test: decoding, what shows | “Omicron

A biochemical blood test (BAC) is a study that is carried out in a laboratory and is used only for medical purposes. Such an analysis indicates the functional state of the body, its organs. According to him, the doctor finds a failure, determines the place of its deployment, helps the patient to cope with it faster. The correct interpretation of this analysis in adults helps the doctor to examine the internal organs.

In general, such an analysis helps to understand what indicators responsible for metabolic processes, mineral, carbohydrate, lipid, protein metabolism need to be studied.

Deciphering the LHC is the comparison of the results obtained by the patient with normal values. All indicators determined by the laboratory, their reference values ​​are entered into the form. It is laboratory specialists who are wondering how to correctly read such an analysis .;

To whom this examination is carried out, and to whom it is not

Doctors do not conduct such an examination just like that. As a rule, the appointment is given by the therapist.

It is given to patients with:

• Diseases located in the genitourinary, circulatory system.
• Leukemia.
• Renal, liver failure.
• Hereditary pathologies.
• Heart attack, stroke, arthritis, arthrosis, osteoporosis, diabetes.
• Disorders in the work of the stomach, intestines, pancreas.

Remember: if one or two indicators obtained after passing a biochemical analysis deviate from the norm, the doctor can immediately make a diagnosis, but usually the patient is prescribed additional examinations, other tests.

How to properly prepare for the examination

It is imperative to prepare for this examination.

That is why the patient should refuse:

1. Heavy, fried, fatty foods, spicy foods. It must be done 1 day before the procedure. You will also have to switch to a balanced diet.
2. Coffee, strong tea, psychostimulants. It is necessary to refuse 12 hours before the examination from coffee, alcoholic beverages.
3. Situations that negatively affect the emotional state, stress, physical activity.

Remember: on the day of the biomaterial donation, you will have to stop eating.

After passing all the tests, the specialist will compare the result obtained in the laboratory with the standard, identify a possible illness, and tell the patient more about what such an examination includes.

How to correctly decipher the result

Normal values ​​of a biochemical blood test should be as follows:

Normal values ​​
Indicator name	Men	Women
Total protein	64-84 g/l
Hemoglobin	130-160 g/l	120-150 g/l
Haptoglobin	150-2000 mg/l
Glucose	3. 30-5.50 mmol/l
Urea	2.5-8.3 mmol/L
Creatinine	62-115 µmol/L	53-97 µmol/l
Cholesterol	3.5-6.5 mmol/L
Bilirubin	5-20 µmol/l
ALT(ALT)	Up to 45 U/L	Up to 31 U/L
ASAT(AST)	Up to 45 U/L	Up to 31 U/L
Lipase	0-190 u/l
Alpha-amylase	28-100 u/l
Pancreatic amylase	0-50 u/l

When deciphering the analysis given by men or women, experts pay attention to:

1. Total protein, showing the amount of proteins in the blood. Such components are involved in all biochemical reactions. They carry various substances, accelerate the reaction, and are responsible for immunity. Normally, they should be 64-84 g / l. If there are more proteins in the body, then this indicates an infection. In addition, the amount of proteins in the blood increases arthritis, rheumatism, oncology. If there are few proteins in the body, then this indicates liver disease, problems with the intestines, kidneys, and cancer.
2. Albumin. It is produced by the liver. This is the basis of blood plasma. Specialists distinguish such components into a separate protein group, called the protein fraction. If there are a lot of these components, then this indicates dehydration, dehydration, an extensive burn. A sharp decrease in the level of these components occurs in smokers, as well as in women who are carrying a child, breastfeeding. Also, a sharp decrease in the level of these components indicates an ailment localized in the liver, intestinal infectious inflammation, heart failure, oncology, burns, fever, trauma, overdose of serious medications.
3. Glucose. She is responsible for carbohydrate metabolism. A sharp increase in blood glucose levels provokes emotional arousal, stress, sharp pain, food intake. Normally, blood glucose should be 3.5-5.5 mmol / l. Also, a sharp increase in blood glucose levels indicates diabetes, endocrine disorders, pancreatitis, a tumor localized in the pancreas, cerebral hemorrhage, chronic damage to the liver, kidneys, myocardial infarction, cystic fibrosis. A sharp decrease in glucose levels indicates damage to the liver, pancreas, hypothyroidism, cancer of the stomach, adrenal glands, arsenic poisoning, heavy drugs, and alcohol intoxication.
4. Uric acid. It is the main component of the breakdown of nucleic acids, purine bases. This acid is no longer involved in the metabolic process, so it is excreted by the kidneys in its original form. Normally, it should be in the body 0.16-0.44 mmol / l. If there is a lot of acid in the body, then this indicates kidney failure, leukemia, lymphoma, prolonged fasting, frequent use of alcoholic beverages, an overdose of salicylates, diuretics. If there is little acid, then this indicates the patient’s use of piperazine drugs, allopurinols, prebenecides, ACTH, as well as hepatitis, anemia.
5. Urea responsible for the breakdown of proteins. The amount of these components in a person changes with age. With an ailment localized in the kidneys, there are a lot of these components in the blood. A sharp decrease in their number is caused by physiological, pathological causes.
6. Creatinine, which is responsible for protein metabolism. It is excreted by the kidneys. In general, creatinine is a metabolic product that occurs in skeletal muscle. It is rarely produced by the brain. That is why the amount of these components directly depends on the work of the kidneys and muscles. A sharp increase in x number indicates kidney failure, severe trauma, muscle damage, increased thyroid function, and long-term use of serious anti-inflammatory antibacterial drugs. Their moderate amount was found in people actively involved in sports.
7. ALT, Alat. According to this indicator, ailments localized in the liver are detected. The component is synthesized inside the cells. Normally, only a small part of them penetrates into the blood. Severe liver damage, cytolysis increase the level of this hormone. It also increases with myocardial infarction, another serious illness. If the ALT indicator is much higher than the AST indicator, then this indicates an ailment localized in the myocardial cells.
8. AST, ASAT. It is a hormone involved in amino acid metabolism. It is abundant in heart tissues, liver, kidneys, nervous tissue, skeletal muscles, and other organs.

A sharp increase in its amount indicates:

• myocardial infarction;
• viral, toxic, alcoholic hepatitis;
• angina pectoris;
• acute pancreatitis;
• liver cancer;
• acute rheumatic heart disease;
• heavy physical exertion;
• heart failure.

This hormone also increases with skeletal muscle injury, burns, heat stroke, after heart surgery.

1. Alkaline phosphatase. An increase in this hormone indicates intrahepatic stagnation of bile in the small bile duct, mechanical, parenchymal jaundice, progressive osteoporosis, and destruction of bone tissue.
2. Cholesterol. It is a hormone responsible for fat metabolism. It enters cell membranes, participates in the synthesis of sex hormones, vitamin D. Doctors divide cholesterol into total, low-density lipoprotein, high-density lipoprotein.

In this case, there are several stages of increasing the level of cholesterol in humans.

For example, if he has it within:

• From 5.2 to 6.5 mmol / l, then this indicates a mild degree of its increase, a high development of atherosclerosis.
• From 6.5 to 8.0 mmol / l, this indicates a moderate increase. This condition is corrected by the transition to proper nutrition.
• From 8.0 and above, this indicates a high level of its content in the blood. The patient will have to take medication.

Remember: a sharp increase in this hormone indicates atherosclerosis, hyperthyroidism, chronic hepatitis, decompensated diabetes mellitus, obstructive jaundice.

A sharp decrease in the blood level of this hormone indicates a tumor localized in the liver, cirrhosis, rheumatoid arthritis, increased work of the thyroid, parathyroid glands, prolonged starvation, impaired absorption of useful substances by the body, chronic obstructive ailment localized in the lungs.

Bilirubin

This is a yellow-red component resulting from the breakdown of hemoglobin in the spleen, liver, and bone marrow. Normally, it should be 3.4-20.5 µmol / l.

An increase in its level indicates:

• cholelithiasis;
• tumor localized in the pancreas;
• inflammation of the biliary tract.

A sharp decrease in this hormone indicates:

• acute viral hepatitis;
• bacterial liver disease;
• toxic hepatitis;
• taking serious medications;
• tumor localized in the liver;
• primary biliary cirrhosis;
• hemolytic anemia.

After disintegration, this hormone enters the bloodstream and binds to Albumin. Then it enters the liver, combines with glucuronic acid. Specialists call this hormone direct bilirubin.

Amylase

Amylase, which helps to take carbohydrates from food, speeds up the process of digestion of the latter. There are many such substances in the salivary glands, the pancreas. Often in the body you can find alpha-amylase, pancreatic amylase. Normally, alpha-amylase should be 28-100 units / l, and pancreatic amylase 0-50 units / l.

An increase in amylase indicates:

• Peritonitis.
• Pancreatitis.
• Diabetes mellitus.
• Cyst localized in the pancreas.
• Stones.
• Cholecystitis.
• Renal failure.

A sharp decrease in this hormone indicates:

• Thyrotoxicosis.
• Myocardial infarction.
• Complete necrosis of tissues located in the pancreas.
• Toxicosis inherent in women bearing a child.

Potassium

It is an important intracellular electrolyte. In the body it should be 3.5-5.5 mmol / l.

A sharp decrease in its amount indicates:

• An excess of adrenal hormones.
• Chronic starvation.
• Vomiting, diarrhea.
• Kidney dysfunction.
• Cystic fibrosis.

A sharp increase in its amount indicates:

• Dehydration.
• Acute renal, adrenal insufficiency.
• Severe cell damage.

In specialists, a sharp increase in this hormone indicates hyperkalemia, and a sharp decrease in their number indicates hypokalemia.

Sodium

Sodium, which is not involved in metabolism, but it is abundant in the extracellular fluid. It maintains osmotic pressure, Ph. It is excreted in the urine, its production by the adrenal glands, aldosterone, is regulated.

A sharp decrease in this hormone indicates:

• Decrease in concentration, increase in fluid volume, diabetes mellitus, chronic heart failure, liver cirrhosis, nephrotic syndrome, severe edema.
• Loss of an element, frequent use of diuretic drugs by the patient, ailments localized in the kidneys, adrenal insufficiency.

A sharp increase in its amount indicates:

• Increased work of the adrenal glands.
• Frequent salt intake by the patient.
• Loss of intracellular fluid, profuse sweat, vomiting, diarrhea, increased urination that occurs with diabetes insipidus.
• Violation of water-salt metabolism, ailments localized in the hypothalamus, coma.

In physicians, a sharp increase in the level of this hormone in the blood indicates hypernatremia, and a sharp decrease in hyponatremia.

Now we know what a biochemical blood test is, what it shows. Like any other analysis, a biochemical blood test and its interpretation should be very important for the patient. That is why experts recommend taking a biochemical blood test only in a proven laboratory, where the decoding of this analysis in women and men will be carried out by specialists familiar with all existing standards.

19.03.2023

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Ostapenko Tatyana Veniaminovna

Ultrasound doctor, therapist, the highest category

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Cardiologist, therapist, 1st category

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Articles

Get a biochemical blood test in Moscow, affordable prices and fast results

Cost of the service

About the study

Indications

How to prepare

Biochemical blood test: explanation

Cost of the service

About the study

An adult’s blood chemistry test measures how the body works. Based on the indicators, it is possible to analyze the risk of developing cardiovascular diseases, detect pathologies of the liver and kidneys, and metabolic disorders.
Blood biochemistry is carried out to detect malfunctions in the internal organs, primarily the liver and kidneys. The analysis includes several indicators, the values ​​of which allow you to determine how the metabolic processes are going.
What does a biochemical blood test show? It sets the values ​​of the following indicators:

• glucose;
• total protein;
• ALT;
• AST;
• total bilirubin, cholesterol;
• urea;
• creatinine.

Readings

Doctors often refer to blood biochemistry, as it allows you to analyze the work of the body as a whole. The study is carried out:

• for preventive purposes;
• to check the effect of medications on the functioning of the liver and urinary system;
• to evaluate the results of treatment.

Biochemical research helps to find out the causes of diseases: female reproductive system, gastrointestinal tract, endocrine and cardiovascular systems, musculoskeletal system. The analysis allows you to determine the liver and kidney failure.
In most cases, blood biochemistry is performed in conjunction with other studies. This allows more accurate diagnosis of pathologies.

How to prepare

Biochemical research requires venous blood. The analysis is taken in the morning, always on an empty stomach. The last meal should be 8-14 hours before taking the biomaterial.

During the day for the procedure, it is necessary to exclude excessive physical activity, increased psycho-emotional stress, as well as refuse fatty foods, alcoholic beverages.

Biochemical blood test: transcript

Biochemical research requires venous blood. The analysis is taken in the morning, always on an empty stomach. The last meal should be 8-14 hours before taking the biomaterial.

During the day for the procedure, it is necessary to exclude excessive physical activity, increased psycho-emotional stress, as well as refuse fatty foods, alcoholic beverages.

Biochemical blood test: decoding

The study is carried out not only to identify metabolic disorders, but also to assess the likelihood of atherosclerosis, liver disease, urinary system, diabetes. Primary diagnosis allows you to analyze the state of health, determine further therapeutic tactics.

Norms of a biochemical blood test:

1. Glucose. The norm is 3.3-5.5 mmol / l. Determining the content of glucose in the blood is necessary for diagnosing diabetes mellitus, tracking its course, and detecting other metabolic disorders.

2. Total protein. The norm is from 64 to 84 g / l. The indicator allows you to evaluate protein metabolism. If the total protein is outside the normal range, then this may indicate metabolic disorders, diseases of the liver, kidneys, and oncological pathologies.

3. Total bilirubin. Indicators from 5 to 20 µmol / l are considered normal. If the total bilirubin is elevated, then this may indicate:

• cholelithiasis;
• violation of the outflow of bile;
• liver tumors;
• violation of the production of enzymes responsible for the formation of direct bilirubin;
• intrahepatic choleostasis;
• various hepatitis;
• the presence of parasites in the body;
• primary biliary cirrhosis.

An increase in total bilirubin may indicate an accelerated breakdown of red blood cells.

4. ALT and AST are enzymes involved in protein metabolism. These indicators allow you to identify and track the results of the treatment of liver diseases. Deviations occur with hepatitis, liver failure, the use of certain drugs, and for other reasons. In men, the norm of ALT and AST is up to 45 units / l, and in women – up to 31 units / l.

5. Total cholesterol.