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Opinion on unconjugated hyperbilirubinemia - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Excellent Posted in: Liver and Gall Bladder
Answered by

General & Family Physician
Practicing since : 2004
Answered : 40 Questions
User :   Hi i am a 20yr old male suffering from unconjugated hyperbilirubinaemia. My tests show that my liver is still working normally, but my doctor stated that there was stomatocytes, atypical lymphs and target cells on a blood count, she has some minor concerns that I may be suffering from chronic liver disease and would like me to be reviewed annually. What is your opinion on this?
Doctor :   Hi,
Doctor :   Dr xxxx here
Doctor :   please give me a minute to read your post
User :   ok
Doctor :   What liver tests have you gone through ?
Doctor :   which say liver is normal
User :   MRI scan, ultrasound, 24 hour urine copper, liver function tests
User :   but blood smear was abnormal
Doctor :   All the tests you mentioned do not miss chronic liver disease,
Doctor :   i consider the Hyperbilirubinemia in you id due to the abnormal RBCs
Doctor :   is*
User :   rbc?
Doctor :   not much relayed to the liver itself
Doctor :   RED BLOOD CELLS ( rbc )
Doctor :   major component cells in the blood carry the oxygen to tissues
User :   ok, what could be the cause of the abnormal cells
User :   also my bilirubin level is 41umol
User :   which i think is 2.4mg?
Doctor :   ok the bili levels is not too high to get bothered ,and the causes for abnormal rbc may be hereditary ,enzyme defects in rbc, drug induced or iron deficiency
User :   ok are any of these serious
User :   i dont drink and have never taken any drugs
Doctor :   ok, the above causes may be serious based on there severity
Doctor :   the severity determined based on the count of atypical cells
Doctor :   can read me the report in detail , the report on stomatocyte and target cells
User :   i dont have that report, i am in the uk and doctors do not give us the reports unless we request them
User :   all i know is that i have stomatocytes, atypical lymphs and target cells, and that I am to have annual LFT's
Doctor :   the count of the cells is very important in identifying the cause
Doctor :   and also they can be normal if the count is low
User :   i think it is low
User :   because on all my previous lft's they werent present
Doctor :   number ?
User :   sorry i dont have a number
User :   what is the possibility of me having chronic liver disease?
User :   or is it possibly something else causing these cells
Doctor :   i do not see any possibilities of liver disease
Doctor :   the causes i mentioned above are known to produce those cells in more number though less of them is normal
User :   ok why do you think that my doctor has some minor concerns that liver disease may be present?
Doctor :   and because of these abnoraml rbcs have short life span and die soon causing rise in bilirubin levels
Doctor :   i dis agree with him , but his thoughts may be triggred by some more information he might have gathered during physical examination
User :   i will show you the letter he sent to my gp
Doctor :   yes,
User :   24 hour copper excretion was within normal limits at 8 ug/24 hours. In view of the fact that at one point he had stomatocytes and target cells and atypical lymphs on a blood count, I have some minor concerns that there might be chronic liver disease and this is not just simple unconjugated hyperbilirubinaemia. I will review him on an annual basis.
User :   It may well be Gilberts syndrome but there were changes in your blood count that can be seen with liver disease. If it is a liver disease it must be very mild as your liver blood tests show your liver is still working normally - and it is likely to be a disease that you were born with - from the other tests I have done it hasnt shown anything I have to treat. Some liver diseases dont need treating and don neceassarily get worse or affect life expectancy. However I dont feel I can 100% say this is Gilberts -the only way I could would be with Liver Biopsy but the abnormality is so mild I cannot justify the risk to you. I feel your liver blood tests should be checked say 6 monthy and if any more concerning abnormality became apparent - I would review the situtaion about furtjher investigation to see if you needed any treatment.
Doctor :   i still need the count of the atypical rbcs
User :   ok i can request them, do you have an email address that i could forward them to?
Doctor :   yes, that will be very informative to me so that i can help you on your query
Doctor :   mail it to YYYY@YYYY
User :   how do i ensure that you receive it
User :   ?
Doctor :   you will get a reply mail by our CRM
Doctor :   and we would have informed beforeahand
User :   ok may i ask what is your speciality
Doctor :   I am a general practitioner
User :   ok
User :   so in your opinion do i have anything to worry about at the moment
User :   would anything serious already have been picked up?
Doctor :   no, i do not think there is any liver related faults, and i could not comment on the health of blood till i get the atypical blood counts
Doctor :   if it was serious the any amongst the tests you mentioned would have picked
User :   could it be haemolytic anaemia?
User :   is this a possibility
Doctor :   yes blood dying due to any cause is called hemolytic anaemia, and i doubt the hemolytic anaemia in you might be due to abnormal shaped rbcs
User :   ok thankyou
User :   i will forward my rbc count
Doctor :   but have to confirm it only after i get the reports
User :   ok i will get that sorted next week
User :   what do you advise about drinking alcohol and my diet
Doctor :   thats fine'
Doctor :   well , as you know drinking alcohol is hazardous to liver, you may increase the risk if you go for alcohol
Doctor :   diet wise i suggest you to have less fat food
Doctor :   and also to improve iron and multivitamin content in the food
User :   ok i am fit and healthy and exercise regularly, should i stay away from alcohol 100%
User :   ?
Doctor :   thats it i advise
Doctor :   no to alcohol
User :   ok
Doctor :   is there anything i can help you with ?
User :   is an lft every 6 months sufficient
User :   or should i be seeking further investigation
Doctor :   its better to get it done if you really have abnormal rbc count in large
Doctor :   i can brief you this way. the blood after life span entering into the liver get damaged by thr liver cells and the haemoglobin present in the rbc is released as bilirubin
Doctor :   if in case of more abn rbc more rbc will die early leaving behind more bilirubin
Doctor :   the bilirubin is digested by the liver and thrown out through feces giving it yellow to orange color
Doctor :   if the bili is produced more which exceeds the liver normal capacity to digest
Doctor :   the bili starts appearing in the blood and distributed to all the normal tissues in the body imparting them yellow color
Doctor :   and thats jaundice
User :   and the higher the level of bili the more serious?
Doctor :   higher means above 4mg/dl
User :   so is mine ok
Doctor :   till 2 mg/dl it can be normal sometimes, may be only physiological
Doctor :   3 mg/dl should be taken care with more investigation
Doctor :   above 4 is considered seroius
User :   ok do i have anything to worry about with the results i have
Doctor :   serious*
User :   i am only 20!
Doctor :   NO, not at al
Doctor :   need not worry
Doctor :   just mail me the blood report , so that i can confirm your well being
User :   ok thank you so much
User :   must go now my time is running out
User :   i will try to get these results to you by the end of the week
Doctor :   ok,
Doctor :   thanks for consulting me
Doctor :   kindly provide your feedback
Doctor :   bye for now
User :   i will thanks
Doctor :   take care
User :   goodbye
User :   you too
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