Elevated Bilirubin Levels

Elevated Bilirubin Levels: Overview

Bilirubin is produced when the liver breaks down old red blood cells.  The levels of bilirubin in the body are normally low, so elevated levels may indicate certain diseases such as those that impair liver function, bock bile ducts, or cause increased destruction of red blood cells.

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Bilirubin is a yellow-brown substance found in bile.  It is a waste product that leaves the body through urine and stool, giving stool its normal brown color and urine its yellow color.  It also gives bruises their yellow color.

Causes and Development

The bilirubin level found in the body reflects the balance between production and excretion.  Increased bilirubin levels may be due to liver disease (such as hepatitis), blood disorders (such as hemolytic anemia), or blockage of the bile ducts through which bile flows from the liver to the small intestine.  An allergic reaction to the blood received during a transfusion can also cause the levels of bilirubin to rise in adults.

Signs and Symptoms

The most common symptom of high bilirubin levels is jaundice, which is a yellowing of the skin and whites of the eyes.

Diagnosis and Tests

A bilirubin test measures the amount of bilirubin found in a small sample of blood.  Because bilirubin exists in the blood in two forms, two measurements are taken:

(1) Indirect (or unconjugated) bilirubin: This form is not water-soluble; it ends up in the liver, where it is changed into a soluble form (direct or conjugated).

(2) Direct (or conjugated) bilirubin: This form is water-soluble and is made by the liver from indirect bilirubin.

Three values are normally provided: Total bilirubin, direct bilirubin, and indirect bilirubin.  The first two are measured directly in the blood sample; the indirect bilirubin level is calculated from the first two.  Results are usually available in 1 to 2 hours.

Signs, symptoms & indicators of Elevated Bilirubin Levels:

Lab Values - Chemistries

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Risk factors for Elevated Bilirubin Levels:

Circulation

Sickle Cell Trait / Disease

Sickle cell disease causes rapid destruction of red blood cells in the blood, leading to increased bilirubin levels.

Hemolytic Anemia

Certain conditions, such as hemolytic anemia, can cause increased destruction of red blood cells and therefore increased bilirubin production.

Drug Side-Effect

(Prescription) Drug Side-Effects

Certain medicines can damage the liver.  Examples include many antibiotics, some types of birth control pill (sex hormones), antipsychotic drugs, and many others.

Metabolic

Gilbert's Syndrome

One common – and harmless – cause of elevated bilirubin is Gilbert's syndrome, a deficiency in an enzyme that helps break down bilirubin.

Organ Health

Cirrhosis of the Liver

Diseases that cause liver damage can lead to increased bilirubin levels.  Cirrhosis may cause normal, moderately high or high levels of bilirubin, depending on the type of cirrhosis.

Gallbladder Disease

Certain health conditions, such as gallstones or an infected gallbladder, can block the bile ducts and lead to an accumulation of bile in the body.

Hepatitis

Diseases that cause liver damage can lead to increased bilirubin levels.  To further investigate the cause of jaundice or increased bilirubin levels, liver function tests or other evidence of infective hepatitis (hepatitis A, B, C, delta, E, etc.) are commonly used.

Tumors, Malignant

Pancreatic Cancer

Certain diseases, such as pancreatic cancer, can block the bile ducts and lead to an accumulation of bile in the body.

Elevated Bilirubin Levels suggests the following may be present:

Circulation

Hemolytic Anemia

Certain conditions, such as hemolytic anemia, can cause increased destruction of red blood cells and therefore increased bilirubin production.

Sickle Cell Trait / Disease

Sickle cell disease causes rapid destruction of red blood cells in the blood, leading to increased bilirubin levels.

Drug Side-Effect

Metabolic

Tumors, Malignant

Pancreatic Cancer

Certain diseases, such as pancreatic cancer, can block the bile ducts and lead to an accumulation of bile in the body.

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