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High bilirubin reading, no symptoms. Do I need to worry?

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General & Family Physician
Practicing since : 2008
Answered : 3631 Questions
Hi, My Bilirubin is read high for last 2 years. I have no symptoms of any thing and perfectly healthy. Please find below the reading taken for last two years and let me know if I need to worry on this bilirubin.

tested on 13/12/2010
Direct Bilirubin       0.25
Indirect Bilirubin      1.55 (out of range)
Total Bilirubin          1.80 (out of range)

tested on 24/12/2010
Direct Bilirubin      0.27
Indirect Bilirubin      1.53 (out of range)
Total Bilirubin          1.80 (out of range)
Total protein          7.0
Albumin               4.1
Globulin          2.9
Albumin/Globulin ratio     1.4
Aspartate Aminotransferase(SGOT) 21
Alanine Aminotransferase(SGPT) 50
Alkaline Phosphatase           59
G-Glutamyl Transferase           23
Lactate Dehydrogenase           124

tested on 4/4/2012
Direct Bilirubin      0.19
Indirect Bilirubin      1.22 (out of range)
Total Bilirubin          1.41 (out of range)
Total protein          6.8
Albumin               4.3
Globulin          2.5
Albumin/Globulin ratio     1.7
Aspartate Aminotransferase(SGOT) 21
Alanine Aminotransferase(SGPT) 39
Alkaline Phosphatase           65
G-Glutamyl Transferase           31
Lactate Dehydrogenase           151

tested on 16/05/2012
Direct Bilirubin       : Not known
Indirect Bilirubin : Not Known
Total Bilirubin          2.59 (out of range)
Posted Sat, 9 Jun 2012 in Liver and Gall Bladder
Answered by Dr. Raju A.T 51 minutes later

Thanks for your query.

There is mild derangement in the indirect bilirubin values.This is not serious but needs some more investigations to ascertain the safety.

Indirect bilirubin is the bilirubin which is unconjugated that means unprocessed bilirubin by the liver .

Normally red blood cells generated in the bone marrow are disposed of in the spleen when they get old or damaged. This releases hemoglobin, which is broken down to heme as the globin parts are turned into amino acids. The heme is then turned into unconjugated bilirubin in the spleen. This unconjugated bilirubin is not soluble in water. It is then bound to albumin and sent to the liver.In the liver it is conjugated with glucuronic acid , making it soluble in water (Direct bilirubin). Much of it goes into the bile and thus out into the small intestine.

There are two chances where indirect bilirubin increases in circulation

1)Excess production of Indirect bilirubin due to excess death of RBCs
2)Liver abnormality resulting in failure of conjugation

Since, The other liver parameters of the liver like SGOT and SGPT are fine I would not consider the liver having any problem here.

It could be the excess production of the Indirect bilirubin by increase death of RBCs.This can be confirmed by other blood tests like

CBC (complete blood count)
Peripheral smear test

Both the tests will give a detailed clue into why there is excess production of indirect bilirubin.

Do get back with the above test reports , we shall have a discussion on the treatment id anything is deranged.

Wish you good luck.
Above answer was peer-reviewed by
Follow-up: High bilirubin reading, no symptoms. Do I need to worry? 42 minutes later
Thanks Doctor for the clarification. Please find additional data on blood count

Red blood cell count      5.34
Hemoblobin          16.0     
hematocrit          46.4
mean corpuscular vol     86.9
mean corpuscular HGB     30.0
mean corpuscular Hemoglobin Concentration     34.6 H (normal range 31.5 - 34.5)
red cell distribution width     12.8
platelet count               278
mean platelet volume          8.0
white blood cell count          5.9

segmented neutrophils          50
eosinophils               07 H ( normal range 1 - 6)
lymphocytes               35
monocytes               08
basophils               00

Please Let me know what should I do?
Answered by Dr. Raju A.T 4 hours later

Thanks for the report.

The above readings appear absolutely normal this rules out major illness which cause death of RBCs and also rules out infections and blood related cancers.

Next would be to get the Peripheral smear done . This test shows evidence of early death of RBCs if any and can help in ruling out any major illnesses.Do go for it and get back with the report we shall have a detailed discussion then.

Wish you good health.
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