Can Bilirubin, Red Blood Cell Count, and Albumin Be Elevated with an Upper Respiratory Infection?
No, these specific laboratory parameters are not typically elevated with uncomplicated upper respiratory infections; in fact, albumin tends to decrease rather than increase during acute respiratory infections due to the inflammatory response. 1
Laboratory Changes Expected with Respiratory Infections
What Actually Happens During URIs and Lower Respiratory Infections
Albumin decreases, not increases, during acute respiratory infections as part of the acute phase inflammatory response. 1 This occurs because:
- Inflammation causes reprioritization of hepatic protein synthesis, actively lowering albumin production 1
- In COVID-19 pneumonia cases, decreased albumin (as low as 33.5-35.7 g/L) was consistently documented alongside respiratory symptoms 1
- Albumin functions as an inflammatory marker rather than a nutritional indicator during acute illness 1
Red blood cell counts typically decrease or remain normal during respiratory infections, not increase. 1 The evidence shows:
- In documented COVID-19 cases with respiratory symptoms, RBC counts were decreased (3.73-4.10 × 10¹²/L) 1
- Mild anemia with decreased hemoglobin and hematocrit accompanied respiratory infections 1
Bilirubin may show modest increases in severe respiratory infections, but this represents hepatic dysfunction from systemic illness rather than a direct effect of URI:
- Direct bilirubin can be elevated in severe COVID-19 pneumonia cases 1
- This occurs in the context of multi-organ involvement with severe systemic inflammation 1
Laboratory Markers That DO Increase with Respiratory Infections
The following are the actual laboratory abnormalities seen with respiratory tract infections 1:
- Inflammatory markers: ESR (25-67 mm/h), CRP (53-170 mg/L), IL-6 elevated 1
- White blood cell changes: Often normal or decreased total WBC, with marked lymphopenia (0.62-0.96 × 10⁹/L) 1
- Liver enzymes: ALT (46-79 U/L) and AST (72 U/L) may increase in severe cases 1
- Coagulation markers: D-dimer significantly elevated (400-3330 ng/ml) in severe cases 1
Critical Clinical Context
The combination you describe (elevated bilirubin, elevated RBC, elevated albumin) is inconsistent with respiratory infection pathophysiology. 1 This pattern should prompt investigation for alternative diagnoses:
- Elevated RBC with elevated bilirubin suggests hemolytic process or polycythemia with Gilbert's syndrome 2, 3
- Elevated albumin is extremely rare and suggests hemoconcentration from severe dehydration, not infection 1
- Elevated bilirubin with normal/elevated RBC may indicate Gilbert's syndrome, where higher red cell mass contributes to unconjugated hyperbilirubinemia 2
Important Caveats
Do not attribute these specific elevations to a simple URI without investigating other causes. 4 The pattern described warrants:
- Fractionated bilirubin to determine if conjugated or unconjugated 4
- Complete hepatic panel including liver enzymes and synthetic function tests 4
- Assessment for hemolysis, dehydration, or underlying hematologic conditions 4
CD4 cell counts and other laboratory values can show substantial variation during acute illness 1, but the specific triad of elevated bilirubin, RBC, and albumin does not represent typical URI-associated changes and requires alternative explanation.