Bilirubin is one of two bile pigments involved in the reabsorption and excretion of erythrocyte components. The breakdown of erythrocytes and their components are carried-out by reticuloendothelial cells of the bone marrow, spleen, liver, and other tissues. Although the mechanisms of erythrocyte demise and removal from circulation are unclear, the reutilization of various erythrocyte components has been well-studied: The iron of heme, the amino acids of globin, and the lipids of the cell membrane are all reutilized by the body, while the porphyrin ring of hemoglobin is catabolized and excreted via bile in the urine and feces. During the catabolism of hemoglobin, the porphyrin ring of heme is cleaved to form the other bile pigment, biliverdin. The subsequent oxidation of biliverdin converts it to bilirubin, which is then transported via albumin from the reticuloendothelial cells to the liver, where it is conjugated with β-glucuronic acid, preparing it for excretion.
Several clinical conditions result in elevated serum levels of conjugated and unconjugated bilirubin, such as pernicious anemia, infective hepatitis, Gilbert's disease, and many types of jaundice: hemolytic, obstructive, and hepatocellular.
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