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What causes elevated total bilirubin levels?

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Posted on Thu, 19 May 2016
Question: Dr. XXXXXXX Berger-Durnbaugh

Hi again! Question, so my enzymes came down amd the other tests came back normal. My Tbilirubin went from .56 to 1.0. That is quite a jump in a short time frame. I read that your other emzyme numbers could be normal and you can still have liver damage if this number is above 1.2. Jow does everything else go down and this go up?

Thanks as always!
-XXXXX
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Answered by Dr. Bonnie Berger-Durnbaugh (1 hour later)
Brief Answer:
Causes of increased total bilirubin

Detailed Answer:
Hello XXXXXXX

Total bilirubin can go up as an isolated elevated test due to non-hepatic things too. One common cause is hemolysis - where some of the red blood cells break apart because of lab technique. This is innocuous and when the test is repeated, it will be ok.

Another possibility is, in certain people, not eating enough/fasting conditions can increase total bilirubin. This may be the current situation because you hadn't been eating much for several days.

And T. biliruibin normal range is 0.3 to 1.9 (this can vary slightly between labs), so you are still solidly in the normal range.

To see how total bilirubin relates to alcoholic hepatitis the Maddrey discriminant function (MDF), a disease-specific prognostic score which indicates the severity of liver injury, has been developed. For this you would need to also have a prothrombin time drawn (PT). I do not think this is necessary to pursue currently because you are not jaundiced or showing other signs of hepatitis, and your total bilirubin is in a normal range.

Better to focus on how to not provoke your liver in the future. I don't think you need to worry about the last drinking spell's effects other than what to do to prevent it from happening again, as repeated episodes over time are what can get you in liver trouble.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh (4 hours later)
So os that possible then? To have all of your enzyme levels at a normal level and bilirubin be high? Indicating the possibilty of liver damage? I know we hadentioned that jaundice usually surfaces in the latter stages. Ive also read that usually (some docs say always) all enzymes levels are impacted by liver damage. Do you have an opinion on that one way or the other?

I will move on and concentrate on what i need to im just curious to know your thoughts .
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Answered by Dr. Bonnie Berger-Durnbaugh (2 hours later)
Brief Answer:
Thoughts:

Detailed Answer:
Well, my thinking is that given that you liver enzymes weren't that high (such as in the hundreds) in February, and your ultrasound only showed some fatty changes rather than any severe problem, and that your liver enzymes are even better this time, that you don't have a significant liver problem at this time. And that the bilirubin is not elevated - it is in a very healthy range - and may only have increased from a previous test due to your having been in a semi-fasting state for a few days prior. So, while you do have definite liver signs that indicate you need to be careful (the fatty liver changes), right now I don't think you are in a dangerous situation.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 3134 Questions

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What causes elevated total bilirubin levels?

Brief Answer: Causes of increased total bilirubin Detailed Answer: Hello XXXXXXX Total bilirubin can go up as an isolated elevated test due to non-hepatic things too. One common cause is hemolysis - where some of the red blood cells break apart because of lab technique. This is innocuous and when the test is repeated, it will be ok. Another possibility is, in certain people, not eating enough/fasting conditions can increase total bilirubin. This may be the current situation because you hadn't been eating much for several days. And T. biliruibin normal range is 0.3 to 1.9 (this can vary slightly between labs), so you are still solidly in the normal range. To see how total bilirubin relates to alcoholic hepatitis the Maddrey discriminant function (MDF), a disease-specific prognostic score which indicates the severity of liver injury, has been developed. For this you would need to also have a prothrombin time drawn (PT). I do not think this is necessary to pursue currently because you are not jaundiced or showing other signs of hepatitis, and your total bilirubin is in a normal range. Better to focus on how to not provoke your liver in the future. I don't think you need to worry about the last drinking spell's effects other than what to do to prevent it from happening again, as repeated episodes over time are what can get you in liver trouble.