From the Guidelines
Elevated bilirubin levels can indicate several diseases, with the most common being liver disorders such as hepatitis, cirrhosis, and Gilbert's syndrome, and the management of these conditions should prioritize reducing morbidity, mortality, and improving quality of life. Bilirubin is a yellowish pigment produced when old red blood cells break down, and it's normally processed by the liver before being excreted. When bilirubin levels rise above normal (typically >1.2 mg/dL for adults), it can cause jaundice, characterized by yellowing of the skin and eyes.
Causes of Elevated Bilirubin
The causes of elevated bilirubin can be categorized into unconjugated and conjugated hyperbilirubinemia. Unconjugated hyperbilirubinemia is usually due to haemolysis or impaired conjugation, whereas conjugated hyperbilirubinemia is typically due to parenchymal liver disease or obstruction of the biliary system 1. The most common cause of an isolated elevated bilirubin concentration is Gilbert’s syndrome, which is an inherited disorder of metabolism and leads to impaired conjugation via reduced activity of the enzyme glucuronyltransferase 1.
Diagnosis and Management
Diagnosis of the underlying cause of elevated bilirubin is crucial, and it typically involves a combination of laboratory tests, including liver function tests, complete blood count, and imaging studies such as ultrasound or CT scan 1. Management of elevated bilirubin depends on the underlying cause, and it may involve supportive care, medication, or surgery. For example, patients with viral hepatitis may require supportive care with rest, hydration, and avoiding alcohol, while those with Gilbert's syndrome may not require any treatment 1.
Prioritizing Morbidity, Mortality, and Quality of Life
In managing elevated bilirubin, it is essential to prioritize reducing morbidity, mortality, and improving quality of life. This may involve early recognition and treatment of underlying liver disease, prevention of complications, and management of symptoms such as jaundice and pruritus. The most recent and highest quality study recommends a comprehensive approach to managing elevated bilirubin, including laboratory tests, imaging studies, and treatment of underlying causes 1.
Key Considerations
Some key considerations in managing elevated bilirubin include:
- Early recognition and treatment of underlying liver disease
- Prevention of complications such as liver failure and hepatocellular carcinoma
- Management of symptoms such as jaundice and pruritus
- Use of laboratory tests and imaging studies to diagnose and monitor underlying causes
- Individualized treatment plans based on the underlying cause and severity of disease.
From the Research
Elevated Bilirubin Disease
Elevated bilirubin disease, also known as hyperbilirubinemia, is a condition characterized by high levels of bilirubin in the blood. This can be caused by various factors, including liver disease, biliary tract disease, and hemolysis.
Causes of Elevated Bilirubin
- Liver disease, such as alcoholic liver disease, hepatitis, and cirrhosis 2, 3
- Biliary tract disease, such as choledocholithiasis, biliary strictures, and neoplastic obstruction of the biliary tree 2, 3
- Hemolysis, such as autoimmune hemolytic anemia 4, 5
- Disorders of impaired bilirubin conjugation, such as Gilbert syndrome 3
Diagnosis and Evaluation
The diagnosis and evaluation of elevated bilirubin disease involve a comprehensive medical history, review of systems, and physical examination 2, 6, 3. Initial laboratory evaluation should include:
- Fractionated bilirubin
- Complete blood count
- Alanine transaminase
- Aspartate transaminase
- Alkaline phosphatase
- Gamma-glutamyltransferase
- Prothrombin time and/or international normalized ratio
- Albumin
- Protein Imaging studies, such as ultrasonography or computed tomography, may also be necessary to differentiate between extrahepatic obstructive and intrahepatic parenchymal disorders 2, 3.
Treatment and Outcome
Treatment of elevated bilirubin disease depends on the underlying cause. Immunosuppressive therapy may be effective in cases of autoimmune hemolytic anemia and giant cell hepatitis 4, 5. Liver transplantation may be necessary in severe cases of liver disease 5. The outcome of elevated bilirubin disease varies depending on the underlying cause and the effectiveness of treatment. In some cases, complete remission or cure may be possible, while in others, the disease may be chronic or fatal 4, 5.