Laboratory Elevations in Gallstone Disease
Yes, bilirubin can be elevated in patients with gallstones, but red blood cell count and albumin are not typically elevated by gallstones themselves.
Bilirubin Elevation in Gallstone Disease
Bilirubin elevation occurs commonly in gallstone disease through two distinct mechanisms:
15-50% of patients with acute calculous cholecystitis (ACC) show elevated bilirubin without any common bile duct stones (CBDS), due to acute inflammatory processes affecting the gallbladder and biliary tree rather than direct obstruction 1
25% of patients with acute calculous cholecystitis have serum bilirubin levels between 2.0-5.0 mg/dL with completely normal common bile ducts, demonstrating that gallbladder inflammation alone can produce jaundice 2
When common bile duct stones are present (occurring in 5-15% of gallstone cases), bilirubin elevation is even more pronounced, with 60% of ACC patients with CBDS showing abnormal bilirubin levels 1
Critical Clinical Caveat
The World Society of Emergency Surgery strongly recommends against using elevated bilirubin as the only method to identify common bile duct stones, as elevated bilirubin alone has only a 15% positive predictive value for CBDS despite a compelling clinical picture 1, 3. This means that while bilirubin can be elevated with gallstones, it poorly discriminates between simple cholecystitis and stones in the bile duct.
Red Blood Cell Count
Red blood cell count is NOT typically elevated in gallstone disease. The evidence discusses red blood cell distribution width (RDW-CV) as a potential diagnostic marker being studied 4, but there is no established relationship between gallstones and elevated RBC count itself. Any elevation in RBC count would need alternative explanation unrelated to the gallstones.
Albumin Levels
Albumin is NOT elevated in gallstone disease. In fact, albumin is a negative acute phase reactant that typically decreases during inflammatory conditions. Gallstone disease, particularly acute cholecystitis, represents an inflammatory state where albumin would be expected to decrease or remain normal, not increase. The provided evidence does not mention albumin elevation in any context related to gallstones 1, 3.
Additional Laboratory Patterns in Gallstone Disease
For clinical context, the laboratories that ARE commonly elevated include:
Alkaline phosphatase (ALP) is elevated in 77% of patients with CBDS, with sensitivity of 92% at cut-off >125 IU/L 3
ALT is elevated in approximately 90% of patients with choledocholithiasis, and 50% of ACC patients without CBDS show elevated ALT 1, 3
AST elevation occurs in 41-51% of ACC patients without CBDS 1
Gamma-glutamyl transpeptidase (GGT) shows 80.6% sensitivity and 75.3% specificity for CBDS at cut-off of 224 IU/L 1