The American Journal of Digestive Diseases

, Volume 2, Issue 6, pp 330–334 | Cite as

Present concepts of the nature of direct and indirect bilirubin

  • Philip Kramer
Progress In Gastroenterology


Present evidence would indicate that two or possibly more types of bilirubin, known historically as direct and indirect bilirubin, exist. The differences reside in the chemical nature of each bilirubin and not in the nature of the protein linkage. Direct bilirubin is a water-soluble compound probably in the form of a conjugated bilirubin-glucuronide11; because of its solubility, direct bilirubin is excreted in the urine. Both types of bilirubin are associated with serum albumin which probably acts simply as a vehicle for carrying the pigment. The van den Bergh test measures two types of bilirubin; at the pH at which the reaction is conducted each type is dissociated from its protein molecule. The role of alcohol in the van den Bergh is unknown and is not that of separating bilirubin from protein.


Public Health Alcohol Albumin Serum Albumin Bilirubin 
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Copyright information

© Paul B. Hoeber, Inc. 1957

Authors and Affiliations

  • Philip Kramer
    • 1
  1. 1.From Evans Memorial Hospital, Massachusetts Memorial Hospitals, and the Department of MedicineBoston University School of MedicineBoston

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