Bilirubin is created by the breakdown of red blood cells present in the body. Excretion of bilirubin is possible with the help of the liver. Elevated levels of bilirubin can cause a health complication known as jaundice, which can be characterized by the yellowing of the eyes and skin.
High levels of bilirubin can occur in adults; however, the disorder is most prevalent in newborns. It affects newborns more because it takes some time after babies are born for them to metabolize bilirubin and pass it out in their stool effectively.
The approximated range of bilirubin present in blood serum should be:
- 1 mg/dL for children below the age of 18
- 1.2 mg/dL for adults
The skin typically turns yellow once bilirubin levels get between 2 and 3 mg/dL. A person experiencing yellowness on their skin or eyes should immediately consult with their doctor. This may be a clear sign of severe health complications.
Elevated bilirubin levels
A high concentration of bilirubin in the blood is termed as hyperbilirubinemia. These elevated levels of bilirubin can lead to jaundice. Due to the yellow and brown bilirubin present in the blood, jaundice can make the whites of the eyes and the skin appear yellow.
Several factors could cause a rise in the levels of bilirubin outside the newborn period. This can happen before, during, or after the formation of bilirubin.
What is bilirubin?
The breaking down of red blood cells in the body forms bilirubin. It then travels to the liver where it is stored in the bile duct, which then ultimately leaves the body when we stool.
Bilirubin is yellow and brown in color, and it is this pigment that gives feces its brown color. The red blood cells have a lifespan of about 120 days, and it is continually renewed. The presence of hemoglobin in red blood cells helps to transport oxygen in the body, which is then broken down into bilirubin and other bodily matters.
The bilirubin is transported to the liver by a simple protein known as albumin. It then becomes conjugated as soon as it reaches the liver. This means it becomes soluble and ready to be excreted.
Bilirubin that doesn’t conjugate can be very toxic, while the conjugated ones are not, especially since it passes from the body quickly.
Before bilirubin reaches the liver
Several conditions can elevate the levels of bilirubin before it reaches the liver. This is referred to as the pre-hepatic or “pre-liver” phase, and it could be as a result of hemolytic anemia or the reabsorption of internal blood by the body.
Hemolytic anemia manifests when too much red blood cells break down right before the end of their natural life cycle.
The liver
The liver may not be able to make bilirubin water-soluble if the liver is unhealthy and isn’t working well. This may lead to too much bilirubin build-up in the liver.
Causes include:
- Alcoholic liver disease
- Viruses like hepatitis A
- Autoimmunity. This is common when a disorder of the immune system attacks red blood cells.
- Overdose of some medications, such as acetaminophen
After bilirubin leaves the liver
Once the liver is free of bilirubin, it’s levels may peak since the bilirubin hasn’t been able to exit the body.
A blockage may cause this in other organs that make excretion possible, such as gallstones present in the gallbladder. This is termed as the post-hepatic phase.
Other causes include any of the following;
- Pancreatitis
- Cancer or inflammation of the gallbladder, which forms bile
Testing for bilirubin
Blood tests can be done to measure the levels of bilirubin. Although less accurate, urine tests can also be done to test for bilirubin.
If bilirubin is detected in a routine urine test, a medical doctor may have to confirm the result by running a blood serum test to identify any possible damages to the liver.
Other tests include:
- Tests to ascertain liver function and to also check for possible traces of hepatitis
- Physical examination around the abdominal region to determine if the liver is tender or enlarged
- An endoscopy can sometimes be done to check the ducts where bile is moved to the gut
- The liver can be visualized by using imaging tests. This might include computerized X-ray, ultrasound, or high-powered imaging using an MRI scan.
- Although very uncommon, a liver biopsy may also be needed. This is done by evaluating a sample of liver tissue.
Treatment
Treatment of high bilirubin may sometimes depend on the underlying cause. As soon as the cause is determined, bilirubin can be eliminated through treatment or lifestyle choices, part of which include avoiding alcohol.
What is Gilbert’s syndrome?
Gilbert’s syndrome is referred to as a mild form of high bilirubin. Because the process of bilirubin removal in the body is slowed down, the levels can increase and decrease. This fluctuation isn’t near enough to trigger yellowing skin, but some people may notice sickening symptoms like fatigue or stomach pain.
Gilbert’s syndrome is mostly noticed when a blood test is done for other purposes. A family’s pattern of heredity can be seen in the gene connected to Gilbert’s syndrome.
Increased bilirubin in newborns
Newborns with an increased level of bilirubin have a condition that doctors refer to as jaundice in neonates or neonatal hyperbilirubinemia. According to the Merck Manual, almost half of all newborns show signs of jaundice in the first week after birth.
In adults, bacteria present in the gut can break down conjugated bilirubin to form urobilin, which is then passed through excretion. It takes many days for the liver in neonates to adequately process bilirubin.
The severity and medical significance of increased bilirubin depend on what caused it. Other factors to put into consideration include the age of the infant, and if they were born prematurely.
Bilirubin levels in a healthy baby, born at full term, tend to raise worries when they exceed around 18 mg/dL. For babies born prematurely, the sooner the delivery happens in the gestation period, the lower the threshold at which medical experts consider levels of bilirubin to be too much.
Increased bilirubin levels can be very toxic to the nerves, and it can cause significant damage to the brain. Most jaundice in newborns is not severe, and the symptoms naturally resolve. Prolonged jaundice is typical in breast-feeding infants. This type of jaundice is generally not harmful, but it still needs to be monitored.
Neonatal doctors might advise mothers to see a lactation consultant, among other treatments if jaundice was diagnosed. Some newborns are treated with phototherapy, where an expert exposes the baby to a certain kind of blue-green light.
This is an essential treatment, where the light transforms the bilirubin into a different form that the kidney and liver can remove.
Have you or anyone you know had to treat jaundice before? Ever been diagnosed with elevated levels of bilirubin? What method of treatments did you use? Kindly share it with us in the comments.
