The clinical importance of a protein-bound fraction of serum bilirubin in patients with hyperbilirubinemia

N Engl J Med. 1983 Jul 21;309(3):147-50. doi: 10.1056/NEJM198307213090305.


A directly reacting fraction of bilirubin that is probably covalently bound to albumin (albumin-bound bilirubin) has recently been described. To determine its clinical importance we used a new high-performance liquid-chromatography technique to measure it in the serum of 200 patients with hyperbilirubinemia from various causes. Albumin-bound bilirubin was an important fraction (8 to 90 per cent) of total bilirubin in patients with hepatocellular and cholestatic jaundice as well as in patients with the Dubin-Johnson syndrome. It was not detected in normal volunteers, neonates with physiologic jaundice, or patients with Gilbert's disease or hemolysis. Thus, albumin-bound bilirubin appears in serum when hepatic excretion of conjugated bilirubin is impaired. It becomes a larger component of serum bilirubin as jaundice subsides, delaying resolution of this disorder and causing bilirubin to persist in plasma after it has disappeared from the urine.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Bilirubin / blood*
  • Chromatography, High Pressure Liquid
  • Gilbert Disease / blood
  • Humans
  • Hyperbilirubinemia / blood*
  • Infant, Newborn
  • Jaundice / blood
  • Jaundice, Chronic Idiopathic / blood
  • Protein Binding
  • Serum Albumin / analysis*


  • Serum Albumin
  • Bilirubin