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Haptoglobin, bilirubin, and liver function tests. When red blood cells break down, they release hemoglobin into the bloodstream. The hemoglobin combines with a chemical called haptoglobin. A low level of haptoglobin in the bloodstream is a sign of hemolytic anemia.
The breakdown product of red blood cells is converted to bilirubin within macrophages and taken to the liver. If there is a process that causes too many red cells to be lysed (e.g. hemolytic anemia) then there may be too much bilirubin presented to the liver.The bilirubin presented to the liver in this case is free or unconjugated bilirubin, attached to albumin. Bilirubin becomes conjugated (to glucoronic acid) in the liver.If for some reason the bilirubin cannot leave the liver (e.g. blocked bile ducts), then the conjugated bilirubin backs up in the canaliculi and ultimately into the blood.ilirubin becomes conjugated (to glucoronic acid) in the liver. If for some reason the bilirubin cannot leave the liver (e.g. blocked bile ducts), then the conjugated bilirubin backs up in the canaliculi and ultimately into the blood.