From the Guidelines
Elevated bilirubin levels are primarily caused by conditions that either increase bilirubin production or impair its elimination from the body, with the most common causes including liver diseases, bile duct obstructions, genetic conditions, hemolytic anemias, and certain medications, as noted in a recent study 1.
Causes of Elevated Bilirubin
The causes of elevated bilirubin can be broadly categorized into:
- Conditions that increase bilirubin production, such as hemolytic anemias
- Conditions that impair bilirubin elimination, such as liver diseases and bile duct obstructions
- Genetic conditions that affect bilirubin metabolism, such as Gilbert's syndrome and Crigler-Najjar syndrome
- Certain medications that can cause liver injury or compete with bilirubin for processing pathways
Clinical Presentation
Symptoms of elevated bilirubin include:
- Yellowing of the skin and eyes (jaundice)
- Dark urine
- Light-colored stools
- In severe cases, itching
Diagnosis and Treatment
Diagnosis of elevated bilirubin involves measuring bilirubin levels in the blood, and treatment depends on addressing the underlying cause, whether that's treating liver disease, removing obstructions, or managing genetic conditions, as recommended in a recent technical report 1.
Key Considerations
It's essential to note that the most common causes of elevated bilirubin can vary depending on the population and geographical location, as highlighted in a study from the United States 1, and that treatment should be individualized based on the underlying cause and severity of the condition.
From the Research
Causes of Elevated Bilirubin
- Liver dysfunction or disease, as bilirubin is a byproduct of the liver's metabolism and excretion processes 2
- Hepatic failure, which can lead to anemia and elevated bilirubin levels 3
- Increased oxidative stress, although mildly elevated bilirubin levels may have protective effects against certain diseases 4
- Bile duct ligation or obstruction, which can cause bilirubin to build up in the blood 3
- Certain medical conditions, such as infection or alcohol intoxication, which can damage the liver and lead to elevated bilirubin levels 3
Underlying Disease States
- Elevated bilirubin levels almost always indicate the presence of an underlying disease state 2
- Conditions such as chronic liver disease, liver failure, or bile duct obstruction can cause elevated bilirubin levels 2, 3
- Anemia, which can result from accelerated clearance of circulating erythrocytes or suicidal erythrocyte death triggered by bilirubin 3
Diagnostic Evaluation
- A careful history and physical examination, followed by imaging assessment of the biliary tree and liver, is the best approach to evaluating a patient with jaundice or elevated bilirubin levels 2
- Algorithm models that incorporate bilirubin levels can be used to predict outcomes in patients with chronic liver disease 2