- 14d – 16y less than 21
- Adult less than 21
1. Hyperbilirubinaemia with raised enzymes see Liver enzymes
2. Hyperbiliruinaemia with normal enzymes
Disorders of hepatic excretion
Gilbert’s syndrome, a common incidental finding, is an unconjugated hyperbilirubinaemia
Dubin Johnson and Rotor syndromes, much less common but also found incidentally, are conjugated hyperbilirubinaemias
Crigler-Najjar syndrome is a rare severe unconjugated hyperbilirubinaemia.
- uncommon but important. Check blood count, film, reticulocytes
- thyroid disease, iron overload, drug reaction, resolving hepatitis
Clinical. How should I investigate an isolated case of slightly raised bilirubin in an asymptomatic adult?
Answer: We recommend:
- Values up to 20% above ULN are likely to be statistical rather than clinically abnormal.
- If the subject is unwell, repeat when fully recovered.
- Values <1.5 times ULN: interval retest in 1-3 months unless clinical suspicion of disease.
- Values > 1.5 ULN: confirm proportion of indirect (unconjugated) bilirubin.
- If > 70% unconjugated, probable Gilbert syndrome: no further testing needed if non-progressive on interval retesting, unless haemolysis is clinically suspected. If rising on retesting, consider haemolysis and test haptogloblin, lactate dehydrogenase and blood film with reticulocyte count.
- Values >3 times ULN: clinical disease probable, further investigation required.
Can be added on to an existing request up to 1 days following sample receipt
Specimen Labelling Procedure