The physical and psychological preparation you can provide for this or any test or procedure depends on your child's age, interests, previous experience, and level of trust. When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing . Bilirubin metabolism begins with the breakdown of red blood cells by phagocytic cells. Hemoglobin is broken down to heme and globin.
Heme is converted to bilirubin, which is then carried by albumin in the blood to the liver.
Total serum bilirubin equals direct bilirubin plus indirect bilirubin. Conjugated bilirubin is excreted into the bile by the liver and stored in the gall bladder or transferred directly to the small intestines. Bilirubin is further metabolized by bacteria in the intestines to urobilins, which contribute to the color of the feces. A small percentage of these compounds are reabsorbed and eventually appear in the urine, where they are referred to as urobilinogen. If the bile ducts are obstructed, direct bilirubin will build up, causing some of it to escape from the liver and end up in the blood.