D/T Bilirubin Ratio
D/T Bilirubin Ratio ranges
- < 0.2 - Pre-hepatic
- 0.2 - 0.5 - Hepatocellular
- > 0.5 - Cholestatic
The D/T ratio is used to differentiate between different types of jaundice and liver injury patterns.
D/T Bilirubin Ratio interpretation
For Pre-hepatic
Pre-hepatic pattern - mostly unconjugated bilirubin. The liver is conjugating normally; excess comes from over-production.
Pre-hepatic pattern is most commonly seen in hemolytic processes (e.g., autoimmune hemolytic anemia, transfusion reactions) and benign unconjugated syndromes (Gilbert's syndrome).
For Hepatocellular
Hepatocellular injury pattern - both conjugation and canalicular export partly impaired.
Hepatocellular pattern is mostly seen in acute viral hepatitis or toxin/alcohol-related hepatocellular damage.
For Cholestatic
Cholestatic / obstructive pattern - predominantly conjugated bilirubin. Bilirubin is conjugated but can’t reach the gut.
Cholestatic pattern is most commonly seen in extra-hepatic biliary obstruction, like in choledocholithiasis; malignancy or less frequently intra-hepatic cholestasis.
Images:
Bilirubin Values in Normal and Various Pathological Conditions
Bilirubin Values Various Pathological Conditions
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