Difference between conjugated and unconjugated hyperbilirubinemia

Following are the difference between conjugated and unconjugated hyperbilirubinemia

                                               Unconjugated                                  conjugated                 

Water solubility                      0                                                        +

Affinity for lipids                      +                                                       0               

Renal excretion                         0                                                       +

Van den Bergh reaction     Indirect                                              Direct

Fractions of normal bilirubin

Normal serum bilirubin level is 0.3-1.0 mg/dl.

Conjugated fraction is 0.1-0.3 mg/dl and

Unconjugated fraction is 0.2-0.7 mg/dl.

What are the conditions which produce predominantly conjugated and unconjugated hyperbilirubinemia?

Conjugated hyperbilirubinaemia is said to occur with > 50% conjugated fraction of bilirubin is conjugated

Causes of conjugated hyperbilirubinemia

• Viral or drug-induced hepatitis.
• Drug-induced cholestasis.
• Cholestatic jaundice of pregnancy.
• Cirrhosis of liver.
• Dubin-Johnson syndrome.
• Rotor syndrome.
• Secondary carcinoma of liver.

Causes of unconjugated hyperbilirubinemia

Unconjugated hyperbitirubinaemia is said to occur when the unconjugated fraction is > 80%

Causes of conjugated hyperbilirubinemia

• Haemolysis.
• Ineffective erythropoiesis.
• Prolonged fasting (<300 cal/day).
• Gilbert's syndrome and rarely Crigler-NaJ|ar syndrome
• Neonatal jaundice.