Your Direct Bilirubin Level

What Causes Elevated Direct Bilirubin Levels?

Elevated direct bilirubin levels can have various causes, ranging in severity from 'worrying' to 'generally fatal'.  Finding the true cause means ruling out or confirming each possibility – in other words, diagnosis.

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Diagnosis is usually a complex process due to the sheer number of possible causes and related symptoms.  In order to diagnose elevated direct bilirubin levels, we could:

  • Research the topic
  • Find a doctor with the time
  • Use a diagnostic computer system.
The process is the same, whichever method is used.

Step 1: List all Possible Causes

We begin by identifying the disease conditions which have "elevated direct bilirubin levels" as a symptom.  Here are eight of many possibilities (more below):
  • Cirrhosis Of The Liver
  • Gilbert's Syndrome
  • Liver Cancer
  • Chemotherapy Side-Effects
  • Hepatitis
  • Hemochromatosis
  • Drug Side-Effects
  • Gallbladder Disease

Step 2: Build a Symptom Checklist

We then identify all possible symptoms and risk factors of each possible cause, and check the ones that apply:
well controlled hepatitis B or C
significant periumbilical pain
severe fatigue after slight exertion
pale fingernails
diarrhea for 1-3 months
unexplained fevers that hit hard
having non-problematic gallstones
very great unexplained weight loss
sugar/sweet craving
significant right hypochondriac pain
low TIBC
elevated eosinophil count
... and more than 80 others

Step 3: Rule Out or Confirm each Possible Cause

A differential diagnosis of your symptoms and risk factors finds the likely cause of elevated direct bilirubin levels:
Cause Probability Status
Drug Side-Effects 95% Confirm
Hemochromatosis 13% Unlikely
Liver Cancer 13% Unlikely
Cirrhosis Of The Liver 5% Ruled out
Gallbladder Disease 2% Ruled out
Hepatitis 1% Ruled out
Gilbert's Syndrome 0% Ruled out
Chemotherapy Side-Effects 0% Ruled out
* This is a simple example to illustrate the process

Arriving at a Correct Diagnosis

The Analyst™ is our online diagnosis tool that learns all about you through a straightforward process of multi-level questioning, providing diagnosis at the end.

If you indicate having had recent lab tests, The Analyst™ will ask further questions including this one:
Bilirubin, direct. Unit: mg/dL [umol/L]
Possible responses:
→ Don't know
→ 0.0 to 0.3 [0-5] (normal)
→ Recently elevated
→ Chronically elevated
Based on your response to this question, which may indicate either normal direct bilirubin level or high direct bilirubin level, The Analyst™ will consider possibilities such as:
(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.

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.

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.

Hemolytic Anemia

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

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.

Pancreatic Cancer

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

Sickle Cell Trait / Disease

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

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