Indirect Vs. Direct Bilirubin! Learn the BASICS of jaundice!!!

[@kyleFed]

Excellent explanation! Thanks Dr. Tala!

[@TalaTalksNICU]

Thank you so much again Kyle! We really appreciate your support!

[@marykas7630]

I’m 11 and really wanting to be a neonatologist when I grow up so I am getting a head start on it now. Let me just say that usually when I’m studying jaundice or anemia or ect. I get very confused. I am sooo grateful for this video and how it explains things. This was great. Tysm 😅 It really helped with my studies! ❤

[@TalaTalksNICU]

Mary! That is amazing!! 11! Definitely our youngest viewer (apart from when we've forced our kids to watch! ha!) We are SO impressed you are watching any medical videos let alone about jaundice!!! We think it is the BEST field in the world-so I think you're making a great decision. The babies will be so lucky to have you take care of them! We wish you luck and perseverance :)

[@marykas7630]

@@TalaTalksNICU thank you so much!!

[@tobyrichards9181]

That's impressive that you already have an idea of what your journey in life.

[@Spicytots5]

Thank you SO MUCH for clarifying in 15 minutes what my professor couldn't convey in an entire semester. Wish I would have found your channel earlier!!

[@TalaTalksNICU]

Oh wow! That could be one of our favorite comments ever!! Thanks so much- so happy you're here!

[@JamesonMJr]

I tell everyone about your channel. I'm a new NNP student and your videos are helping me tremendously. THANK YOU.

[@TalaTalksNICU]

That's so kind of you- thank you for advertising for us!!! ha! We're SO happy that these are helpful to you. It also all takes a lot more time than we had initially thought these videos would (ha!) and so I can't even tell you how motivating comments like yours are. They really keep us going! Thanks again for watching :)

[@oreskoul]

well and simply explained. thank you

[@TalaTalksNICU]

Glad it was helpful!

[@shahmirkhan5411]

Have my finals in a month. These videos made this topic so easy to understand. Thanks !

[@TalaTalksNICU]

Oh we're SO glad they helped! Thanks for commenting and GOOD LUCK in your finals :)

[@RY-zs6jx]

Thanks u so much Doctor Tala. This video helped me understand 100 percent the difference between direct and indirect bilirubin. I love your videos and I love the way you teach.

[@TalaTalksNICU]

Oh Yay! That makes us so happy! Thanks so much for watching and for taking the time to comment :)

[@mazeraj5]

Thank you so Much Tala , can you make them Out of 10. 😍😍😍🔥🔥🔥...With Love from Tanzania, 🇹🇿

[@TalaTalksNICU]

Hello Mazera! Thanks so much for being here! We're so happy you're watching all the way from Tanzania :)

[@Jo-mp3qo]

Yes!! I have been too excited for this topic 🤗 Thank you

[@TalaTalksNICU]

Thank you so much Jo for subscribing and for continuing to watch!

[@osamaalagamawy3891]

محاضرة ممتازة ...حضرتك رائعة فى الشرح والتبسيط...بارك اللة فيكى

[@TalaTalksNICU]

I asked my father to translate -(myArabic is pretty shaky!) thank you so much Osama - we are so thankful you think that )

[@thejoyrandolphshow]

As a mum, I found this really really helpful

[@TalaTalksNICU]

Congratulations on being a mum- and thanks for letting us know :)

[@samp3257]

Wow excellent explanation. Starting from the basics really helped me understand a 100x better.

[@TalaTalksNICU]

Thank you so much for letting us know, Sam. To explain everything from the basics is really why we started this channel- so your comment was very validating! Thank you!

[@TS-kl8zg]

Fun. Passionate. And greatly helpful! THANK YOU so much Dr. Tala for these amazing Videos. Would you please give a talk on fluid, nutrition, and growth? Thank you:)

[@TalaTalksNICU]

Thank you so much for your lovely words! Talk on fluid and nutrition is coming soon- after the NEC lectures :) Thanks!!

[@hraqhraq]

4:25 RBCs when it breaks down it will not release Bilirubin as you said; it will release Hemoglobin which then Macrophages line cells will pick up and start breaking it down to Heme and Globins. Heme is then further broken down to Iron and Bilivirdin; Bilivirdin then will be converted to Bilirubin by these cells, and the story does not end there

[@TalaTalksNICU]

Hello! Again- you're absolutely right. We missed out many, many steps in the bilirubin metabolism, and even more with what happens in the gut with bilirubin. So even though those steps are important for exams, research, future meds etc- clinically they're not as relevant. And here we're really trying to emphasize what needs to be known for better bedside care!

[@mragehemedi5328]

This so amazing,,Very nice presentation 👏 today i have gone beyond understanding 🔥

[@TalaTalksNICU]

Oh yay! That's our goal- so happy that this helps :)

[@wparsa]

I really enjoy learning from your great doctor. Thank you so much.

[@TalaTalksNICU]

Thank you so much Dr. Mazhary for your lovely compliment!! Thanks for watching too :)

[@thembiq6598]

Thanks Tala. That was one of my requests, thank you so so much 💕

[@TalaTalksNICU]

Absolutely Themby! We're happy you're still here. More jaundice episodes to come too...

[@lalohernandez5582]

Does increased bilirubin negatively impact oxygenation by breakdown of the RBCs?

[@TalaTalksNICU]

When RBCs breakdown, bilirubin is released. (So a very elevated indirect bilirubin could imply that many RBCs have broken down and the patient is anemic. If the patient is anemic this could affect the body's oxygenation). Hope this helps??

[@123zuhhra6]

thanks. new nicu doctor here.

[@TalaTalksNICU]

Congratulations! Enjoy your role!!!

[@reneswartz8916]

Wow awesom refresher and well explained. Listening in all the way from South Africa

[@TalaTalksNICU]

Hi Rene! That's so great you're watching! SA is a bucket-list country for us :) Thanks for your comments!

[@elizabethmaejalbuna-arias4802]

Great Explanation Dr. Tala!!

[@TalaTalksNICU]

Thank you! Thanks for taking the time to comment too :)

[@hossamyasser8651]

Thanks, Dr. Tala.

[@TalaTalksNICU]

Thank you for watching :)

[@teneshamoody8133]

Thank you! You really made a complicated topic simple!

[@TalaTalksNICU]

Oh that makes us so happy Tenesha- literally our goal! Thanks so much for watching and commenting :)

[@UnisaAKanu]

Thank you Dr Tala, this is really educative

[@TalaTalksNICU]

You are very welcome, thanks for being here!

[@chineduokafor6763]

Crystal clear concepts 😔 where were this videos when I was in med school?!

[@TalaTalksNICU]

So glad they're helpful now at allDr. Okafor! Thanks for writing :)

[@RoXon007]

Thanks you for clear simple explanation, you. Deserve my susbcribe😊 Watching this for my tomorrow peads ospe

[@TalaTalksNICU]

Good luck! And thank you for your lovely comment and for subscribing :)

[@stillbreathing100]

Your videos are awesome! Teaches me as to how to teach!

[@TalaTalksNICU]

That's SO great!! We love your comments. I think teaching, like everything else, is mostly a skill. The more we do, the better we are. But I agree, I've definitely had a few teachers that I'm like- I want to present the information more like her or him!

[@sagalahmed8374]

Thank you! Very clear and informative!

[@TalaTalksNICU]

So glad you think so- thank you!!!

[@docammar8156]

Thanks Dr tala.. cleared concept

[@TalaTalksNICU]

Thank you so much Doc! Appreciate you watching and commenting :)

[@shinysamson8575]

lots of love from India ❤

[@TalaTalksNICU]

THANK YOU! Thanks for subscribing and for taking the time to comment!

[@naseembaloch1359]

Awsme lecture

[@TalaTalksNICU]

Thank you so much Naseem :)

[@sagarbadarkhe5506]

Thank you Dr. Tala ❤

[@TalaTalksNICU]

Thank you for being here :)

[@ReemaAman-qh9wj]

Outstanding mam

[@TalaTalksNICU]

Wow! That’s a lovely comment! Thank you!

[@kebedealemu8859]

Excellent neonatologist.

[@TalaTalksNICU]

Thank you so much for the lovely compliment!

[@ZULFIQARALI-fe7zk]

The best lecture

[@TalaTalksNICU]

Thank you! And thank you for taking time to write!

[@patohchicha5273]

Wow,was a good one,,thank you so much Doc

[@TalaTalksNICU]

Thank you so much for watching and for taking the time to comment

[@ochiengjoseph8225]

Thanks so much doctor Tala

[@TalaTalksNICU]

Thank you for being here!

[@sonyamelzer]

Very helpful!

[@TalaTalksNICU]

So happy!! Thank you!!

[@drazam325]

Great feeling to hear

[@TalaTalksNICU]

Thanks so much Azam! We love seeing your comments :)

[@ElizabethMumba-p8z]

Genius ❤!!!

[@TalaTalksNICU]

I wish! Whoever figured it all out in the first place is the genius!!!! Ha! Thanks for being here :)

[@bwalyatubi6814]

May you please discuss electrolyte imbalance too? And approach to dehydration in neonates....hypoglycemia and hyperglycemia

[@TalaTalksNICU]

Hello again! Yes! That is definitely high up on our list. Electrolytes/ fluids/ TPN is such a massive topic that we have been a little hesitant to start! We promise we'll get there!

[@drliaqatalishah]

Handsome lecture by beautiful icon

[@TalaTalksNICU]

Ha! I took a screen shot of your lovely comment and sent it to Arianna saying 'we can quit now'! Ha! Thank you :)

[@toady1up]

FANTASTIC TEACHING!!!!

[@TalaTalksNICU]

Thank you so much for watching and for taking time to comment Robin :)

[@toady1up]

@@TalaTalksNICU As a new NICU nurse (coming from adult ED and oncology), your vids are critical to my personal learning! I cannot thank you enough for your depth and enthusiastic presentation!

[@TalaTalksNICU]

Thank you so much Robin! We really appreciate you taking the time to comment! And congratulations on your new role- you're going to LOVE it here!

[@marionparsons2292]

Thanks for the video! I have a question about interpreting lab values - we send them blood and they send us back three numbers, the total, indirect, and direct bilirubin. Does the indirect bilirubin value include only unbound bilirubin molecules, or is it a sum of the unbound and albumin-bound? For example, if the albumin is low, does that mean that a given high indirect bili is more alarming (i.e., more unbound and able to cross into brain) than the same number would be if the albumin was normal?

[@TalaTalksNICU]

Hello Marion! This is SUCH a great question and I wish I'd covered it better in the video! The indirect value includes both the bound and unbound values. So you're right- when the albumin is low we should be a lot more worried. (Especially since albumin is often low in setting of 'leaky' capillaries scenarios like in sepsis- which in itself would mean the blood brain barrier isn't as strong so same level of indirect bilirubin more likely to get into brain). There has been ongoing research to try to find a commercially available lab value that will only measure the unbound fraction.... Hope this helps! Thanks again for being here :)

[@enesyldrm1431]

Thank you for doing this!

[@TalaTalksNICU]

Thank you for watching and subscribing Enes! We appreciate this community so much!

[@AshishPriyadarshi-jj4ib]

Can you please cover congenital hypothyroidism?

[@TalaTalksNICU]

Yes! This is a great video idea- straight forward too- we really need to cover this soon!!

[@christoph7817]

Do I „freeze“ the gestational age at birth or do I let it mature postnatally when calculating fototherapy threshol? I mean: if a baby is born at 34+6 days and is now 9 days old and has jaundice, do I use the fototherapy theeshold for 34 gestational age or the one for 36 weeks, since the baby has technically reached that age outside the womb?

[@TalaTalksNICU]

Great question- we still use gestational age at birth (otherwise counting the '9' days old twice). I thin we should do an updated hyperbili video with the guidelines that came out since we made the initial series of videos. Thanks so much for being here Christoph!

[@elizabethbenway5725]

Does the lab value for indirect bilirubin include the bound indirect bilirubin? Bound bilirubin is not conjugated, correct? So is there a way to account for how much bound indirect bilirubin there is? Or does that not matter because it is bound and so not a threat?

[@TalaTalksNICU]

This is such a great question Elizabeth. Nearly every lab counts the total bilirubin (includes conjugated=direct, as well as unconjugated=indirect- everything that is bound and free). We don't have easy consistent ways to measure the free, unconjugated (indirect) bilirubin. As you said, this is what we really care about. So we have to make conclusions and guesses based on other values. So if the direct bilirubin is high- we are more concerned. (Not because it crosses the BBB, but because it will displace unconjugated bilirubin from albumin and increase how much free bilirubin there is). If the albumin is low, we are also more worried about how much free bilirubin there will be. Honestly though- even if we knew the exact number for 'free indirect bilirubin'- it still wouldn't give the full story. Each infant's BBB (blood brain barrier) would be different from others. If an infant is premature or has sepsis, they would have a weaker BBB, and so it would be more likely free bilirubin would get through. Does this all make sense??

[@lisarochester2978]

thank you, very helpful

[@TalaTalksNICU]

So glad you found it helpful! Thanks for letting us know!

[@tobyrichards9181]

Tala can I use your video for teaching some nurses about Jaundice

[@TalaTalksNICU]

YES! Hi Toby! Literally what they're made for :)

[@FarahFarah02]

How does the conjugated bilirubin bind to albumin ? it is water soluble!

[@TalaTalksNICU]

Albumin is apparently a genius molecule! I'm reading up on this but apparently it has different binding areas it can bind water soluble and fat soluble molecules. (Thanks for the question- I wasn't sure!)

[@monjidibrahim1168]

Big like 👍

[@TalaTalksNICU]

Thanks so much Monjid!

[@MaryNyathi-g6h]

Great

[@TalaTalksNICU]

Thanks for taking the time to comment!

[@tamateyophelia9399]

Thanks

[@TalaTalksNICU]

Thank you so much for watching!

[@UnisaAKanu]

Good

[@TalaTalksNICU]

Thanks!

[@Sewsweet08Australia]

Thankyou

[@TalaTalksNICU]

Thank you for watching! And taking the time to comment :)

[@ngawanajerydel8571]

thank you

[@TalaTalksNICU]

Thank you for watching and for subscribing!

[@aishaahmedmaxamuud2926]

dr waxan ku su'aala maxa sababa biyaha raga soo daaha?

[@TalaTalksNICU]

I’m so sorry- not sure what language so don’t know how to translate?!

[@R999soup]

amazing mam.can u make a video on bronchopulmonary dysplasia?

[@TalaTalksNICU]

Yes Riya! That is on our list! We'll get to it- we promise! Thanks for watching and commenting :)

[@margaretgicheru-dh1ee]

Mum told me I had it

[@TalaTalksNICU]

Lots of babies do!! I’m sure all is great with you now :)

[@margaretgicheru-dh1ee]

@@TalaTalksNICU Yes,am now 36years.Glory to almighty God.