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What causes unconjugated bilirubin?

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Posted on Sat, 29 Nov 2014
Question: Causes of unconjugated hyperbilirubinemia
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Answered by Dr. Ronald Schubert (27 minutes later)
Brief Answer:
Unconjugated bilirubin from anemia or Gilberts

Detailed Answer:
Thanks for contacting HCM

You are wondering where a person gets high bilirubin that are not conjugated. Conjugated bilirubin are the by products of metabolism of hemoglobin. Each red blood cell lives for about 90 days. When that cell dies it releases is hemoglobin into the blood stream and starts to break down. The breakdown is converted into bilirubin. The liver then takes up the bilirubin and conjugates it to be excreted in the stool. When the body is breaking down red blood cells faster than the liver can conjugate it then there is a higher level of unconjugated bilirubin. So in some forms of anemia there will be increased bilirubin. It appears that you may have had an episode of increased anemia or red blood cell turnover as evidenced by your blood smear showing increased target cells and stomatocytes. Since the anemia has now resolved your bilirubin counts should also return to normal.

You also mention in your history that you have Gilbert's disease. This is also a very common congenital condition where when the body is stressed like from a cold, infection or from dehydration that the bilirubin will increase. This is a completely benign condition and has no long term health effects.

Overall I think you should continue to monitor your health. Have regular lab checks for anemia and bilirubin. I also recommend that you be sure to eat healthy avoid taking supplements. Some food supplements can cause undue stress to the body for example high amounts of creatinine for body building can be harmful to the kidneys. Avoid using medications that are not prescribed by your doctor. Exercise regularly but not to excess.

Hope this answers your question. Please contact us again with your health care concerns and questions
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Ronald Schubert (44 minutes later)
I have had this since 2009. My bilirubin has fluctuated during this time and has been as low as 34 but as high as 94umol. It has been up and down but is now back to 64umol. It has never been in the normal ranges. I have been referred back to a specialist due to the recent increase. Have also had some mild pain over liver but it's still working normally and not enlarged. Is cholestasis a possibility? Or is this Gilberts? I have not been officially diagnosed with anything yet, the only way they could is via biopsy but they cannot justify the risk as the abnormality is too mild. Thanks
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Answered by Dr. Ronald Schubert (6 minutes later)
Brief Answer:
Gilbert's syndome

Detailed Answer:
Thanks for requesting more information.

I also appreciate that you have been having this problem, elevated bilirubin, for years. During this time your liver functions have been normal. Because your liver functions are normal cholestasis is not likely. In cholestasis there is a abnormal gene and this will increase bilirubin but will also cause liver damage as evidenced by elevated ALT AST.

The more likely diagnosis is Gilbert's syndrome. I actually have it too. This is completely benign and has no long term effects. I agree with your doctors that having a liver biopsy is too high risk. I see you have a lot of anxiety over this problem. You need not worry because you will live a normal life with Gilbert's. Accept that you have elevated bilirubin.

Hope this answers your question. Please contact us again with your health care concerns and questions
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Answered by
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Dr. Ronald Schubert

General & Family Physician

Practicing since :1984

Answered : 2407 Questions

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What causes unconjugated bilirubin?

Brief Answer: Unconjugated bilirubin from anemia or Gilberts Detailed Answer: Thanks for contacting HCM You are wondering where a person gets high bilirubin that are not conjugated. Conjugated bilirubin are the by products of metabolism of hemoglobin. Each red blood cell lives for about 90 days. When that cell dies it releases is hemoglobin into the blood stream and starts to break down. The breakdown is converted into bilirubin. The liver then takes up the bilirubin and conjugates it to be excreted in the stool. When the body is breaking down red blood cells faster than the liver can conjugate it then there is a higher level of unconjugated bilirubin. So in some forms of anemia there will be increased bilirubin. It appears that you may have had an episode of increased anemia or red blood cell turnover as evidenced by your blood smear showing increased target cells and stomatocytes. Since the anemia has now resolved your bilirubin counts should also return to normal. You also mention in your history that you have Gilbert's disease. This is also a very common congenital condition where when the body is stressed like from a cold, infection or from dehydration that the bilirubin will increase. This is a completely benign condition and has no long term health effects. Overall I think you should continue to monitor your health. Have regular lab checks for anemia and bilirubin. I also recommend that you be sure to eat healthy avoid taking supplements. Some food supplements can cause undue stress to the body for example high amounts of creatinine for body building can be harmful to the kidneys. Avoid using medications that are not prescribed by your doctor. Exercise regularly but not to excess. Hope this answers your question. Please contact us again with your health care concerns and questions