From the Guidelines
High protein and high bilirubin levels in blood tests often indicate liver dysfunction, and it is crucial to consult a healthcare provider immediately for proper evaluation. The combination of high protein and high bilirubin suggests possible liver disease, as the liver normally processes bilirubin (a breakdown product of red blood cells) and regulates protein levels 1. Common causes include hepatitis, alcoholic liver disease, medication toxicity, or biliary obstruction.
Key Considerations
- The liver's synthetic function can be assessed through serum albumin concentration, which is often considered a marker of liver function 1.
- Prothrombin time (PT) and INR are assessments of blood clotting, which are used to measure liver function, as the underlying protein clotting factors are made in the liver 1.
- A reduction in platelets, termed thrombocytopenia, is the most common haematological abnormality found in patients with chronic liver disease and is an indicator of advanced disease 1.
Diagnostic Approach
- The evaluation of patients with elevated serum liver chemistry tests should be interpreted in the context of all clinical information, and a decision about the need for further diagnostic evaluation can best be made based on the specific clinical scenario of the individual patient 1.
- Initial evaluations should determine whether the hyperbilirubinemia is conjugated (direct) or unconjugated (indirect), and further testing should be guided by the clinical scenario 1.
- A complete and expeditious evaluation is essential in patients with significant symptoms, evidence of chronic or decompensated liver disease, or severe liver chemistry abnormalities.
Management
- While waiting for medical attention, it is essential to avoid alcohol, acetaminophen, and other potentially liver-toxic substances, and to stay hydrated and follow a gentle diet.
- Treatment depends entirely on the underlying cause and might involve medication adjustments, lifestyle changes, or specific therapies for liver conditions.
- The liver has remarkable regenerative capacity, so early intervention often leads to improvement in both protein and bilirubin levels once the underlying issue is addressed.
From the Research
High Protein and High Bilirubin
- High bilirubin levels can be an indication of an underlying disease state, such as liver disease or hemolysis 2, 3, 4.
- Elevated plasma bilirubin levels can be secondary to alterations in any stage of its metabolism, including excess bilirubin production, impaired liver uptake, impaired conjugation, and bile clearance defect 3.
- The evaluation of patients with high bilirubin levels typically starts with a careful history and physical examination, followed by directed imaging of the biliary tree and liver, and laboratory tests such as assays for bilirubin, complete blood cell count, and liver function tests 2, 4.
- Measuring fractionated bilirubin allows for determination of whether the hyperbilirubinemia is conjugated or unconjugated, which can help in diagnosing the underlying cause of high bilirubin levels 4.
- There is no direct evidence in the provided studies that links high protein levels to high bilirubin levels, but it is known that liver disease, which can cause high bilirubin levels, can also affect protein metabolism 3, 4.
- Hemolysis, which can cause high bilirubin levels, can be diagnosed using laboratory tests such as serum erythrocyte adenylate kinase, serum bilirubin, LDH, and reticulocyte count 5, 6.