From the Guidelines
Hyperbilirubinemia can be dangerous and requires prompt evaluation and management to prevent serious complications, particularly in newborns and individuals with underlying liver disease or other risk factors. The clinical context is crucial in determining the severity and potential risks associated with hyperbilirubinemia. According to the American Academy of Pediatrics, if appropriate follow-up cannot be ensured in the presence of elevated risk for developing severe hyperbilirubinemia, it may be necessary to delay discharge either until appropriate follow-up can be ensured or the period of greatest risk has passed (72-96 hours) 1.
Clinical Context and Evaluation
In adults, normal total bilirubin (TBIL) levels typically range from 0.1 to 1.2 mg/dL. An elevation in TBIL levels indicates that the liver may not be processing bilirubin properly, which could result from various conditions including liver disease, bile duct obstruction, or certain blood disorders. The evaluation of patients with hyperbilirubinemia should be interpreted in the context of all clinical information, and a decision about the need for further diagnostic evaluation and/or the appropriate evaluation can best be made based on the specific clinical scenario of the individual patient 1.
Key Considerations
- The underlying cause of hyperbilirubinemia determines its seriousness, with some causes requiring immediate medical attention while others might be managed more conservatively.
- Symptoms to watch for include yellowing of the skin or eyes (jaundice), dark urine, light-colored stools, abdominal pain, or fatigue.
- Bilirubin elevations occur when there's increased red blood cell breakdown, reduced liver uptake of bilirubin, impaired bilirubin conjugation, or blockage preventing bilirubin excretion through bile.
- In patients with elevated serum aminotransferases, common hepatic diseases should be excluded with noninvasive serologic tests, and if these tests are unremarkable, a decision regarding additional serologic testing versus observation should be based on the clinical scenario 1.
Management and Prevention
Prompt consultation with a healthcare provider is essential for evaluation and management of hyperbilirubinemia. The healthcare provider will need to determine the cause through additional tests such as direct and indirect bilirubin measurements, liver function tests, and possibly imaging studies. In newborns, particularly those with elevated risk for developing severe hyperbilirubinemia, ensuring appropriate follow-up or delaying discharge until the period of greatest risk has passed may be necessary to prevent serious complications 1.
From the Research
Hyperbilirubinemia Overview
- Hyperbilirubinemia, indicated by jaundice, can be a sign of underlying disease states, including liver or biliary tract disorders 2, 3, 4, 5.
- The condition is typically apparent when serum bilirubin levels exceed 3 mg/dL 3.
Causes and Evaluation
- Hyperbilirubinemia can be caused by prehepatic, intrahepatic, or posthepatic disorders, including hemolysis, hepatocellular damage, and cholestatic disorders 4, 5.
- Evaluation of jaundice should start with a careful history and physical examination, followed by laboratory tests, including fractionated bilirubin, complete blood count, and liver function tests 2, 3, 5.
- Imaging studies, such as ultrasonography, computed tomography, or magnetic resonance cholangiopancreatography, may be necessary to differentiate between extrahepatic obstructive and intrahepatic parenchymal disorders 3, 5.
Potential Risks
- Hyperbilirubinemia can indicate serious underlying conditions, such as liver disease, biliary tract infection, or malignancies 2, 3, 4, 5.
- In trauma patients, jaundice may reflect serious underlying pathology, including bilirubin overload, hepatic dysfunction, or bile duct injury 6.
- Delayed or inadequate evaluation and treatment of hyperbilirubinemia can lead to poor outcomes, including liver failure or increased mortality 2.