From the Guidelines
Elevated bilirubin levels require prompt medical evaluation to determine the underlying cause and appropriate treatment, as they can indicate liver dysfunction, bile duct obstruction, or increased red blood cell destruction. Bilirubin is a yellow-orange pigment produced during the breakdown of red blood cells, and elevated levels can be caused by various factors, including hepatitis, cirrhosis, gallstones, certain medications, and genetic conditions like Gilbert's syndrome 1. The most common cause of an isolated elevated bilirubin concentration is Gilbert’s syndrome, which is an inherited disorder of metabolism and leads to impaired conjugation via reduced activity of the enzyme glucuronyltransferase 1.
According to the most recent guidelines, hyperbilirubinemia is defined by a serum bilirubin >2.5 to 3 mg/dL, and metabolism of bilirubin can be divided into the prehepatic, intrahepatic, and posthepatic phases 1. The prehepatic phase can lead to a predominance of unconjugated hyperbilirubinemia, which can be seen in hemolysis or absorption of a large hematoma and related to increased heme production in hemolytic anemias.
Key Considerations
- Elevated bilirubin levels can range from harmless conditions requiring no treatment to serious disorders needing immediate intervention
- Common causes of elevated bilirubin include hepatitis, cirrhosis, gallstones, certain medications, and genetic conditions like Gilbert's syndrome
- Treatment depends entirely on the diagnosis, and may include antibiotics for infection, discontinuation of hepatotoxic medications, surgery for gallstones, or simply monitoring for benign conditions like Gilbert's syndrome
- While waiting for medical attention, it is essential to avoid alcohol and medications that can stress the liver, stay hydrated, and maintain a healthy diet
Next Steps
- Consult a healthcare provider promptly, especially if you notice yellowing of the skin or eyes (jaundice)
- Undergo additional tests, such as liver function tests, complete blood count, and possibly imaging studies to determine the underlying cause of elevated bilirubin levels
- Follow the recommended treatment plan to manage the underlying condition and prevent further complications.
From the Research
Elevated Bilirubin: Causes and Treatment
Elevated bilirubin levels can be an indication of hyperbilirubinemia, which is typically apparent when serum bilirubin levels exceed 3 mg/dL 2. This condition can be caused by various factors, including:
- Alcoholic liver disease
- Biliary strictures
- Choledocholithiasis
- Drug-induced liver injury
- Hemolysis
- Hepatitis
Diagnosis and Evaluation
To diagnose and evaluate elevated bilirubin levels, a comprehensive medical history, review of systems, and physical examination are essential 2. Initial laboratory evaluation should include:
- Bilirubin (total and fractionated)
- Complete blood cell count
- Aspartate transaminase
- Alanine transaminase
- Gamma-glutamyltransferase
- Alkaline phosphatase
- Albumin
- Prothrombin time
- International normalized ratio
Treatment Options
For neonatal hyperbilirubinemia, phototherapy is the most common treatment modality 3, 4, 5, 6. However, studies have shown that administering ursodeoxycholic acid (UDCA) in addition to phototherapy can:
- Decrease total bilirubin levels faster 3, 4, 5, 6
- Shorten phototherapy duration 3, 4, 5, 6
- Reduce the length of hospital stay 4, 6
Ursodeoxycholic Acid (UDCA) as an Adjuvant Treatment
UDCA has been shown to have a reductive effect on bilirubin levels in neonates on phototherapy 6. The additive effect of UDCA with phototherapy can improve the management of neonatal hyperbilirubinemia, reducing the duration of treatment and in-patient care 3, 4, 5, 6.