Delta-bilirubin is a bilirubin covalently bound with albumin, which is nontoxic and excreted neither in urine nor in bile.
It appears in the serum when hepatic excretion of conjugated bilirubin is impaired in patients with hepatobiliary disease.
The half-life of delta bilirubin is 2-3 weeks which is the same as albumin to which it is bound.
Increased delta bilirubin and GGT levels along with lower albumin levels are seen in chronic diseases of obstructive and hepatic jaundice.
The percentage of delta bilirubin is significantly higher in chronic obstruction and hepatic jaundice in comparison to haemolytic jaundice.
Total Bilirubin = Direct bilirubin + indirect bilirubin
Direct bilirubin = Conjugated + Delta bilirubin
Indirect bilirubin = Unconjugated bilirubin
Therefore
Delta bilirubin = Total bilirubin - (Unconjugated bilirubin + Conjugated bilirubin)
Delta bilirubin percent = Delta bilirubin / Total bilirubin *100
Bilirubin levels use to remain elevated in patients with intrahepatic or obstructive
Jaundice, long after the hepatitis had subsided or the obstruction
was relieved. The persistently high bilirubin concentration was later attributed to delta bilirubin due to its long half-life.
An increase in delta bilirubin percentage is seen in patients with good biliary drainage, usually above 60% in 7 to 28 days as delta bilirubin is excreted slower.
Long duration biliary atresia is associated with elevated delta bilirubin levels.
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