What is elevated bilirubin?
Bilirubin is a metabolic waste product that is present in the blood, the result of red blood cells breaking down. Bilirubin is synthesized primarily in the spleen. Most circulating bilirubin passes through the liver, which processes it and where it is either absorbed back into the body or removed through urine and stool. Higher-than-normal levels of bilirubin in the blood is hyperbilirubinemia.
Bilirubin is measured in the blood as total bilirubin and direct bilirubin. A healthy adult usually has a total bilirubin of about 1.2 milligrams per deciliter (mg/dL) of blood and 0.3 mg/dL for direct bilirubin. The numbers can vary a bit in either direction, depending on several factors, including diet, exercise, and medications.
High levels of bilirubin could mean there is liver damage or a disorder that makes it hard for the body to break down bilirubin. In newborns, however, a high bilirubin level does not necessarily mean liver damage is present. It is not uncommon for an infant’s liver to be too immature to fully break down bilirubin. Usually, the liver adapts within a few weeks after birth.
Having a high bilirubin level alone is not a medical emergency, but it could be the sign of a serious, life-threatening illness. People who show symptoms, such as yellowing of the whites of their eyes or a yellowish tint to the skin (jaundice), should see their doctor as soon as possible for an urgent evaluation. If a doctor is not available, people with signs of jaundice should go to an urgent care clinic.
What other symptoms might occur with elevated bilirubin?
The most obvious elevated bilirubin symptoms are:
Yellowish tint on the skin
Yellow in the whites of the eyes
- Light or clay-colored stools
If elevated bilirubin levels are caused by an infection, other symptoms could include:
- Abdominal pain
Other symptoms that may occur along with elevated bilirubin
Other symptoms may occur in addition to jaundice, depending on the cause of elevated bilirubin.
Symptoms of elevated bilirubin due to gallbladder conditions, such as gallstones, include:
Intense pain in the upper right or center part of the abdomen
Pain behind the shoulder blades or your right shoulder
Symptoms of elevated bilirubin due to liver disease or live failure include:
Swelling in the abdomen, legs, or ankle
- Easy bruising or prolonged bleeding
Symptoms that might indicate a life-threatening or serious condition
Occasionally, symptoms could indicate a life-threatening or serious condition. If you experience any of these symptoms along with jaundice, seek immediate medical care (call 911):
What causes elevated bilirubin?
Elevated bilirubin results from an excess of bile production or a weakened ability for the body to process or excrete it. There can be several reasons for these changes.
Digestive system causes of elevated bilirubin
The most common cause of elevated bilirubin is a problem with either the liver or the gallbladder, both parts of the digestive system.
Gallstones: Gallstones can block or slow down passage of a liquid called bile. Bile carries bilirubin to your intestines to be eliminated with stool. If bile cannot freely leave the gallbladder, the bilirubin builds up.
Gallbladder disease: Infection, tumors or congenital defects can affect how well the gallbladder works. If it does not function properly, it can result in elevated bilirubin levels.
Liver disease: Liver diseases cause inflammation in the liver, which reduces its ability to process bilirubin. Blockages or congenital defects can also cause excess bilirubin to stay in the body.
- Pancreatitis or pancreatic cancer: The pancreas, also part of the digestive system, can cause elevated bilirubin levels, most often because of a blockage in bile excretion.
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 result in bilirubin backing up, causing itchy skin and jaundice. These symptoms usually go away within days of childbirth.
Newborns can also have elevated bilirubin levels. Up to 60% of newborns born at full-term can have some jaundice. Most have elevated bilirubin because their liver is not yet fully mature.
How is the cause of elevated bilirubin diagnosed?
Your doctor will perform a physical exam and ask you questions about your symptoms, such as:
When did you notice the symptoms?
Are they getting worse or staying about the same?
What medications (including over-the-counter, supplements and natural products) do you take?
What type of diet do you eat?
- How much alcohol do you consume?
After a physical exam, you may be sent for some of the following tests:
Blood tests, to measure bilirubin, liver function and more
Urine tests, to look for bilirubin
Imaging tests, such as ultrasound or computer tomography (CT) scans, to check the size and shape of the liver, pancreas and/or gallbladder
- Liver biopsy, to take samples of the liver tissue for testing
It is not always possible to diagnose an underlying cause or condition. If the problem persists and your provider is unable to determine a cause, seeking a second opinion may give you more information and answers.
What are the treatments for elevated bilirubin?
Treatment for elevated bilirubin levels depends on the cause.
In cases of most newborn jaundice, treatment may include:
Phototherapy, also called light therapy. The infant, dressed only in a diaper and an eye shield, is exposed to a special ultraviolet lamp that helps the body breakdown the bilirubin
Immunoglobulin transfusion, if the elevated bilirubin is caused by a mother/baby blood incompatibility. Immunoglobulin is a blood protein.
- Blood transfusion is rarely done but can be necessary in extreme situations.
Treatments for elevated bilirubin not caused by an immature liver could include:
What are the potential complications of elevated bilirubin?
While most cases of newborn jaundice go away shortly after birth, a few infants do experience encephalopathy, swelling of the brain.
For adults, failure to seek treatment for elevated bilirubin levels could result in serious complications, such as:
Increased bleeding and slower clotting time
Infection, which could lead to sepsis
- Liver failure
All of these complications could lead to death, so it is vital to seek medical help if you show any signs of elevated bilirubin. Once the underlying cause is diagnosed, it is important to follow the treatment plan to reduce the risk of potential complications.