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Bilirubin is produced in the reticuloendothelial cell during the degradation of erythrocytes that have aged. The hemoglobin heme component and other heme proteins are removed, transformed into the Bilirubin and then transported in complex serum albumin into the liver.
Within the liver, Bilirubin can be coupled with glucuronic acid to allow it to be dissolved and then transported through the bile passageway and elimination through digestion. The conditions or diseases that are hemolytic and thus produce Bilirubin more quickly than the liver can metabolize it cause amounts of non-conjugated (indirect) the Bilirubin to rise within the circulatory system.
Liver insufficiency and other conditions in which the enzyme that conjugates bilirubin is damaged can cause similar elevations in the unconjugated Bilirubin in circulation. A blockage in the bile duct or injury to the hepatocellular structure results in increases in the concentrations of conjugated (direct) and unconjugated (indirect) Bilirubin within the circulation.
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