From the Guidelines
Elevated bilirubin is a condition that occurs when there is an excess of bilirubin in the bloodstream, which can be caused by various factors including liver disease, bile duct blockages, genetic conditions, or excessive red blood cell breakdown. The most common causes of elevated bilirubin include hepatitis, alcoholic liver disease, blockage of the common bile duct by a gallstone or tumor, and toxic reaction to a drug or medicinal herb 1.
Causes of Elevated Bilirubin
- Liver disease (such as hepatitis or cirrhosis)
- Bile duct blockages
- Certain genetic conditions like Gilbert's syndrome
- Excessive red blood cell breakdown (hemolysis)
- Sepsis or low perfusion states
- Tumor- or malignancy-related causes of biliary obstruction Normal bilirubin levels are typically below 1.2 mg/dL for adults, and when levels rise above this threshold, it may indicate an underlying problem requiring medical attention 1.
Diagnosis and Treatment
Diagnosis involves blood tests to measure both direct (conjugated) and indirect (unconjugated) bilirubin, which helps determine the cause.
- Treatment depends on the underlying cause, such as addressing liver disease, removing bile duct obstructions, or treating hemolytic conditions.
- For mild elevations due to Gilbert's syndrome, no treatment is usually needed.
- Persistent elevated bilirubin requires medical evaluation as it may signal serious conditions requiring prompt intervention. It is essential to note that the most common etiology of jaundice internationally varies by geography, type of hospital, and demographics, and that the majority of measurable bilirubin should be conjugated, even in individuals with significant liver disease 1.
From the Research
Elevated Bilirubin: Causes and Treatment
Elevated bilirubin, 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, bile duct obstruction, and hemolysis 2.
Symptoms and Diagnosis
The symptoms of elevated bilirubin include jaundice, which is a yellowing of the skin and eyes. Diagnosis is typically made through a physical examination, laboratory tests, and imaging studies 2.
Treatment Options
Treatment for elevated bilirubin depends on the underlying cause. For neonates with hyperbilirubinemia, phototherapy is often used to reduce bilirubin levels. However, studies have shown that adding ursodeoxycholic acid (UDCA) to phototherapy can accelerate the reduction of bilirubin levels and shorten the duration of hospitalization 3, 4, 5, 6.
Key Findings
- UDCA plus phototherapy reduced total serum bilirubin (TSB) and length of hospital stay with proper safety and efficacy in neonates with hyperbilirubinemia 3.
- The mean decrease in TSB during the first 24 hours was greater in the UDCA treatment group compared to the control group 4.
- The addition of UDCA to phototherapy accelerated the reduction of TSB in neonates with glucose-6-phosphate dehydrogenase deficiency and hyperbilirubinemia 5.
- UDCA accentuated the reductive effect of phototherapy on TSB in neonates, reducing the duration of treatment and in-patient care 6.
Important Considerations
- Elevated bilirubin can be a sign of an underlying disease state, and a careful history and physical examination, followed by directed imaging of the biliary tree and liver, are essential for diagnosis 2.
- The use of UDCA as an adjuvant to phototherapy in neonatal hyperbilirubinemia may be beneficial, but further studies are needed to confirm its efficacy and safety 4.