High Bilirubin: What Elevated Bilirubin Means

Medically Reviewed By Avi Varma, MD, MPH, AAHIVS, FAAFP
Was this helpful?
222

Elevated bilirubin or hyperbilirubinemia is when the levels of bilirubin in the blood are higher than usual. Bilirubin is a metabolic waste product present in the blood. It forms when red blood cells break down. High levels of bilirubin can cause dark urine, pale stool, and jaundice, which is yellowing of the skin and whites of the eyes.

Elevated bilirubin could mean there is liver damage or another disorder that makes it hard for the body to break down bilirubin.

Doctors usually use blood tests to measure the amount of bilirubin in the body. Blood tests can also help find the cause of high bilirubin levels.

Read on to learn more about elevated bilirubin, including how doctors diagnose and treat it.

What is elevated bilirubin?

When hemoglobin, the oxygen-carrying part of red blood cells, grows old, it breaks down naturally and releases its byproducts into the bloodstream. Bilirubin is one such byproduct and at high levels, it can be potentially toxic. 

Blood carries most bilirubin to the liver, where it combines with bile, a digestive fluid that the liver makes. From the liver, bilirubin enters the digestive system, where it is eventually eliminated through urine and stool.

Conditions such as liver dysfunction, gallbladder problems, and hepatitis can disrupt the excretion of bilirubin. This leads to elevated bilirubin levels in the blood. The body tries to secrete the excess bilirubin by depositing it in the skin, causing jaundice.

A healthy adult usually has a total bilirubin level of about 1.2 milligrams per deciliter (mg/dl) of blood. Anything above that may be considered elevated.

Elevated bilirubin can also occur in infants. This is because the liver of an infant is usually not mature enough to break down bilirubin. However, the liver normally adapts within a few weeks after birth.

Mother holding baby
Gaia Moments/Getty Images

What symptoms may occur with elevated bilirubin?

Symptoms of elevated bilirubin vary depending on the underlying condition. However, some symptoms appear to be universal. They include symptoms of jaundice, including:

  • yellow in the whites of the eyes
  • yellowish tint on the skin
  • light or clay-colored stools

If elevated bilirubin is due to an infection, symptoms may include:

If elevated bilirubin is due to gallbladder conditions, such as gallstones, symptoms may include:

If elevated bilirubin is due to liver disease or liver failure, symptoms may include:

  • swelling in the abdomen, legs, or ankle
  • itchy skin 
  • easy bruising 
  • prolonged bleeding 

Symptoms that may indicate a life threatening or serious condition

Occasionally, symptoms may indicate a life threatening or serious condition. If you experience any of these symptoms along with jaundice, seek immediate medical care (call 911):

  • sudden onset of symptoms without warning
  • dark, tarry stools
  • confusion and disorientation
  • fever higher than 101°F (38°C)

What causes elevated bilirubin?

Elevated bilirubin may occur due to liver diseases and gallbladder problems. Here is a breakdown:

  • Gallstones: Gallstones can lodge in the bile duct, which can slow or keep the bile from emptying into the small intestines. Bilirubin needs to combine with bile to be excreted with stool. If bile cannot freely leave the gallbladder, bilirubin may build up.
  • Gallbladder disease: Infections, tumors, or congenital irregularities can affect how well the gallbladder works. If the gallbladder does not function properly, elevated bilirubin may occur.
  • Liver disease: Liver diseases may reduce the liver’s ability to process bilirubin. Duct blockages can also cause excess bilirubin to stay in the body.
  • Pancreatitis or pancreatic cancer: Problems with the pancreas may also lead to elevated bilirubin levels. 

Other causes of elevated bilirubin

Women can also experience elevated bilirubin levels during pregnancy. Pregnancy hormones affect how the gallbladder and liver excrete bile. This can cause bilirubin to clump together, causing jaundice and itchy skin. These symptoms usually go away within a few days of giving birth.

Newborns can also have elevated bilirubin levels. In fact, 6 in 10 full-term newborns develop jaundice. This occurs due to the fact that the liver of a newborn is not mature enough to aid in bilirubin excretion.

How are bilirubin levels measured?

A simple blood test for bilirubin can measure bilirubin levels. Bilirubin testing can also check for liver disease, jaundice, gallstones, or some other bilirubin-related conditions.

The test measures the amounts of direct bilirubin and total bilirubin in the blood. Direct or conjugated bilirubin is water soluble and easy to excrete. However, indirect or unconjugated bilirubin is hard to break down and is toxic. Total bilirubin is the sum of direct bilirubin and indirect bilirubin.

Your doctor will know you have elevated bilirubin if your total bilirubin count is too high.

How do doctors diagnose the cause of high bilirubin?

If a bilirubin blood test indicates elevated bilirubin, your doctor may order additional tests to determine what is causing the high bilirubin. These tests may include:

  • Blood tests: Other blood tests can check for hepatitis infection, liver disease, liver damage, copper deficiencies, Wilson’s disease, and general screen with a full blood count.
  • Urine tests: These tests can measure the volume of bilirubin in your urine. A healthy person’s urine contains insignificant amounts of bilirubin. So, a high amount of bilirubin in urine is a sign of an anomaly.
  • Imaging tests: An ultrasound, a CT scan, or MRI can check the size and shape of your liver, pancreas, and gallbladder. These scans can also detect disorders, such as liver dysfunction and gallstones.
  • Liver biopsy: This test analyzes samples of your liver tissue to look for unusual cells related to liver disease or damage.

To diagnose the cause of elevated bilirubin, your doctor may ask you several questions:

  • When did symptoms first appear?
  • Have your symptoms gotten worse?
  • What medications do you take?
  • What type of diet do you eat?
  • How much alcohol do you consume?

How is high bilirubin treated?

Treatment for elevated bilirubin levels depends on the cause.

For a newborn infant, until the liver matures, treatment may include:

  • increased feeding
  • phototherapy, also called light therapy
  • immunoglobulin transfusion
  • blood transfusion 

Treatments for elevated bilirubin in adults involves treating the cause and complications, such as:

  • antibiotics to treat infection
  • corticosteroids to reduce liver inflammation
  • changing medications if they caused the elevated levels
  • surgery to remove gallstones or the gallbladder
  • surgery to clear obstructions in the ducts of the liver or pancreas
  • liver transplant if the liver is severely damaged

Is high bilirubin life threatening?

Left untreated, elevated bilirubin may lead to complications. These complications include:

If you have any symptoms that occur with high bilirubin, seek medical care. Early diagnosis and treatment can reduce your risk for complications.

Summary

Elevated bilirubin is when there are higher-than-normal levels of bilirubin in the blood. The liver is responsible for filtering bilirubin from the blood, combining it with bile, and moving it into the digestive system to excrete it in stool and urine.

High bilirubin levels may be a sign of liver disease and gallbladder problems. Symptoms of elevated bilirubin include jaundice, possibly with fever, chills, and abdominal pain.

Bilirubin testing measures bilirubin levels in your blood. Elevated bilirubin could mean there is liver damage or another disorder that makes it hard for the body to break down bilirubin. Treatment depends on the underlying condition that is making it hard for the body to break down bilirubin.

Elevated bilirubin can also occur in infants when the liver has not fully matured. Treatment is available while the liver becomes fully functioning, usually within a week.

Was this helpful?
222
Medical Reviewer: Avi Varma, MD, MPH, AAHIVS, FAAFP
Last Review Date: 2022 Mar 29
View All Symptoms and Conditions Articles
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Bilirubin in urine. (2020). https://medlineplus.gov/lab-tests/bilirubin-in-urine/
  2. Bilirubin blood test. (2020). https://medlineplus.gov/lab-tests/bilirubin-blood-test/
  3. Duraiswamy, S., et al. (2016). Updated etiology and significance of elevated bilirubin during pregnancy: Changes parallel shift in demographics and vaccination status. https://link.springer.com/article/10.1007/s10620-016-4282-3
  4. Dysark, K. C. (2021). Neonatal hyperbilirubinemia.  https://www.merckmanuals.com/professional/pediatrics/metabolic,-electrolyte,-and-toxic-disorders-in-neonates/neonatal-hyperbilirubinemia
  5. Gallstones. (2020). https://familydoctor.org/condition/gallstones/
  6. Joseph, A., et al. (2021). Jaundice. https://www.ncbi.nlm.nih.gov/books/NBK544252/
  7. Kalakonda, A., et al. (2021). Physiology, bilirubin. https://www.ncbi.nlm.nih.gov/books/NBK470290/
  8. Nonalcoholic fatty liver disease. (2020). https://familydoctor.org/condition/nonalcoholic-fatty-liver-disease/
  9. Singh, A., et al. (2021). Unconjugated hyperbilirubinemia. https://www.ncbi.nlm.nih.gov/books/NBK549796/
  10. Tholey, D. (2021). Jaundice. https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/approach-to-the-patient-with-liver-disease/jaundice
  11. Tsai, M., et al. (2019). Beyond a measure of liver function—bilirubin acts as a potential cardiovascular protector in chronic kidney disease patients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6337523/
  12. Tripathi, N., et al. (2021). Conjugated hyperbilirubinemia. https://www.ncbi.nlm.nih.gov/books/NBK562172/
  13. What are jaundice and kernicterus? (2020). https://www.cdc.gov/ncbddd/jaundice/facts.html