when bilirubin is high?

The test results will show measurement values for the bilirubin in your bloodstream. There are actually two different types of bilirubin in your bloodstream: the bilirubin that goes to your liver for processing, and the bilirubin that comes out of your liver. Your test will show these values separately, as well as your total bilirubin. It’ll usually show them as milligrams of bilirubin per deciliter of blood, or mg/dL.

The bilirubin that goes to your liver for processing is “unconjugated,” which means it’s not water-soluble (dissolvable in water). It’s bound to a protein in your blood called albumin that helps carry it to your liver. When your liver processes the bilirubin, it unbinds it from the albumin and binds it to a sugar molecule, making it water-soluble. This allows it to mix with bile and pass through your intestines.

“Conjugated” bilirubin is the bilirubin your liver processed. Sometimes it’s called “direct” bilirubin on your test results. That’s because this type can be measured directly. Unconjugated bilirubin can’t be measured directly. It’s measured by subtracting the value of conjugated bilirubin from the value of total bilirubin in your blood. Unconjugated bilirubin may be called “indirect” bilirubin on your test results.

Different labs may have slightly different ranges for what they consider normal bilirubin levels. On average, total bilirubin levels between 0.2 and 1.3 mg/dL are considered normal for children and adults. If your levels are higher, your healthcare provider may want to investigate further to look for the cause. It may suggest a problem that needs attention. But high bilirubin itself won’t usually need treatment.

It’s a little different for newborns. Normal levels for newborns can range anywhere between 1.0 and 12.0 mg/dL. Most of the time, hyperbilirubinemia in newborns is predictable and self-limited. But healthcare providers continue to monitor these cases to make sure bilirubin levels don’t rise too far or too fast. This could indicate a more serious condition, and it could also be toxic to the newborn.

Healthcare providers recommend treatment for newborns when bilirubin levels rise above 15 mg/dL in the first 48 hours or 20 mg/dL after 72 hours. At these levels, unconjugated bilirubin exceeds the amount of available albumin to bind it. The unconjugated bilirubin can cross the blood-brain barrier in newborns and harm their developing brains. It can cause varying degrees of brain damage, called kernicterus.

This risk isn’t the same for children and adults. Adult brains aren’t as vulnerable, and adults aren’t as likely to have such high levels of unconjugated bilirubin. Newborns produce bilirubin faster than adults do, and they conjugate it much slower. There are many more causes of conjugated hyperbilirubinemia in adults. For adults, hyperbilirubinemia might signal a dangerous condition, but the bilirubin itself isn’t dangerous.

You might have higher levels of unconjugated (indirect) bilirubin if your body is breaking down red blood cells faster than your liver can keep up with. This might indicate:

Common causes of unconjugated bilirubinemia in newborns include:

You might have higher levels of conjugated bilirubin (direct) if your body is having trouble clearing it. This might indicate a biliary disease or gallstone disease, such as:

Conditions that affect your liver’s ability to process bilirubin will cause high levels of both types to build up in your blood.

You might have a higher total bilirubin count if something is temporarily stressing your liver, such as a new medicine or a high dose of alcohol. It could also indicate an acute or chronic liver disease. Some causes include:

A healthcare provider will review your symptoms and health history to try and identify likely causes. Different causes will have different treatment options. They may suggest further blood tests or imaging tests to help diagnose your condition. They may also test your bilirubin levels again to make sure they aren’t rising. If bilirubin rises too high in your newborn, they’ll recommend treatment to reduce it.

Phototherapy is the standard treatment to reduce bilirubin levels in newborns. A healthcare provider places your infant under a lamp that emits fluorescent white or blue-spectrum light. The light helps break down the bilirubin into a water-soluble form so that the body can excrete it without conjugating it in the liver. This prevents unconjugated bilirubin from depositing in your newborn’s brain tissue.

Higher levels of direct bilirubin in your blood may indicate your liver isn't clearing bilirubin properly. This may indicate liver damage or disease. Higher levels of indirect bilirubin may be a sign of other problems.

Bilirubin is a yellowish substance that is found in bile, a fluid your liver makes to help digest food. Bilirubin is made naturally, mainly when old red blood cells die and break down.

Bilirubin can be toxic, so your body has various ways of removing it from your body. Bilirubin gets eliminated in stool and, in smaller amounts, urine. It is also released through bile.

If the liver is damaged and cannot properly release bilirubin through bile, the bilirubin might leak into your blood. If too much bilirubin gets in your blood, there can be negative side effects, including a yellowing of the skin and eyes called jaundice.

A bilirubin blood test helps healthcare providers determine how much of the potentially toxic substance is in your blood and can help screen for an underlying disease causing the bilirubin to leak into your blood.

Typically, the normal level of bilirubin in the blood is less than 1 milligram per deciliter (mg/dL). A high amount of bilirubin in the blood is called hyperbilirubinemia and generally requires medical evaluation.

Hyperbilirubinemia can lead to jaundice, the yellowish coloration of the skin and eyes. Jaundice is one of the main signs of a high amount of bilirubin in the blood. At about 3mg/dL, the white part of your eyes gets yellow. As the bilirubin level in your blood further increases, the skin also starts to change color into a lemon yellow.

It is normal for a newborn's bilirubin level to be a little high. Before the baby is born, the pregnant person's liver will take care of keeping the baby’s bilirubin levels in check. After birth, the baby’s liver has to remove the excess amount of bilirubin on its own. In some babies, the liver is not mature enough to get rid of the excess amount of bilirubin. This causes the bilirubin to keep building in the baby’s body, leading to jaundice.

Jaundice occurs in about 60% of babies. You can usually see it by the time the baby is two to four days old. Typically, the jaundice goes away on its own in the first couple weeks and doesn’t cause any complications.

To determine what exactly is the underlying cause of your increased bilirubin, your doctor may administer more tests and ask about other signs and symptoms. The high amounts of bilirubin levels in the body can occur in a variety of liver-related health conditions.

To determine what exactly is the underlying cause of your increased bilirubin, your doctor may administer more tests and ask about other signs and symptoms. The high amounts of bilirubin levels in the body can occur in a variety of health conditions.

Hepatitis is an inflammation of the liver, usually due to a virus. Because it’s inflamed, the liver may not be able to properly get rid of the bilirubin. And so, bilirubin levels in the blood may go up and down if you have hepatitis.

Hepatitis usually doesn't cause symptoms. When symptoms do develop, besides jaundice from increased bilirubin, hepatitis can cause fever, fatigue, loss of appetite, nausea, vomiting, and abdominal pain.

Cirrhosis is the scarring of the liver tissue. Cirrhosis occurs due to several long-term conditions that damage the liver, including hepatitis. When bilirubin levels remain high over time, it may be a sign of severe liver disease like cirrhosis.

Excessive and long-term consumption of alcohol can lead to liver damage, including hepatitis, cirrhosis, and fatty liver disease. Because it’s damaged, your liver may be unable to empty bilirubin, resulting in increased levels of bilirubin in the blood.

For instance, for people with alcohol-induced hepatitis, bilirubin levels can be greater than 5mg/dL.

In hemolytic anemia, the red blood cells break down too quickly. The increased destruction of the red blood cells causes the bilirubin level to rise.

This means that hemolytic anemia can cause jaundice. The blood condition can also cause dizziness and weakness.

Gallstones are hard masses that form in your gallbladder, a pouch that stores bile. Gallstones can block the tubes that drain the bile, which usually leads to bilirubin buildup in the blood.

Besides jaundice, other symptoms of gallstones include pain, nausea, vomiting, and fever.

Gilbert syndrome is a common genetic disorder that affects the way the liver processes bilirubin. The condition can cause the bilirubin level to be slightly elevated, usually less than 2mg/dL.

People with Gilbert syndrome might experience fatigue. They might also develop mild jaundice—especially when they:

The first sign of high bilirubin levels is jaundice. This can start with the yellowing of the whites of the eye. With a further increase in bilirubin, the skin starts getting a yellowing tinge, maybe even eventually turning the color of a green apple.

Jaundice of the skin might be harder to recognize in darker skin tones. Looking for color changes to other parts of the body that jaundice can affect can be key. Besides the eyes, you can look for color changes to the gums or inner lips.

Other symptoms of jaundice include:

Other signs and symptoms you may experience depend on the underlying cause of the high bilirubin levels. In some conditions, the bilirubin levels get high without causing any symptoms.

In babies, jaundice is also the main sign of high bilirubin levels. Jaundice will typically first show on the face and then, as the levels increase, spread to the chest, belly, arms, and legs. Babies’ eyes can also appear yellow.

Besides jaundice, signs of high bilirubin levels in a baby may include:

If your healthcare provider suspects you may have a liver problem, they may order a bilirubin test. A bilirubin test can check for excess levels of bilirubin and tell a lot about the health status of your liver. The test can be performed through a urine sample, but it most often performed as a blood test. The blood is drawn usually from the vein of your arm using a small needle.

A high bilirubin level may mean that there is some problem in your liver. However, that’s not always the case. High bilirubin levels can also occur from taking certain medications, doing strenuous exercise, or eating certain foods.

Your healthcare provider can also recommend more tests, such as a liver function test, urine test, and an ultrasound, to look for the specific cause behind high levels of bilirubin.

While most newborns have higher levels of bilirubin that level out on their own, sometimes levels that stay too high for too long can cause a type of brain damage known as kernicterus. Kernicterus can lead to hearing loss, as well as problems with vision and teeth.

There are several conditions that can cause high bilirubin levels either before reaching the liver, after leaving the liver or within the liver itself.

Some conditions cause high bilirubin levels before it reaches the liver.

This is the pre-hepatic or the “pre-liver” phase. The cause is hemolytic anemia and the reabsorption of internal pools of blood by the body.

Hemolytic anemia occurs when too many red blood cells break down before the end of their natural life cycle.

If the liver is not working properly, it may be unable to make bilirubin water-soluble. This may result in too much bilirubin building up in the liver. Causes for this include:

Once bilirubin has left the liver, in the “post-hepatic phase,” its levels may be high because it is unable to leave the body.

This may be a result of a blockage in one of the other organs that assist excretion, such as from gallstones in the gallbladder.

Other causes may include inflammation or cancer of the gallbladder, which produces bile, or pancreatitis.

Gilbert’s syndrome is a mild form of high bilirubin. The levels go up and down because Gilbert’s syndrome slows down the process of removing it from the body.

The fluctuation is rarely enough to cause the skin to yellow, but some people may experience symptoms, such as stomach pain or fatigue.

Doctors estimate that about 1 in 3 people with Gilbert’s syndrome do not experience any symptoms at all. In fact, doctors often discover the condition with a blood test performed for some other reason.

The test results will show measurement values for the bilirubin in your bloodstream. There are actually two different types of bilirubin in your bloodstream: the bilirubin that goes to your liver for processing, and the bilirubin that comes out of your liver. Your test will show these values separately, as well as your total bilirubin. It’ll usually show them as milligrams of bilirubin per deciliter of blood, or mg/dL.

The bilirubin that goes to your liver for processing is “unconjugated,” which means it’s not water-soluble (dissolvable in water). It’s bound to a protein in your blood called albumin that helps carry it to your liver. When your liver processes the bilirubin, it unbinds it from the albumin and binds it to a sugar molecule, making it water-soluble. This allows it to mix with bile and pass through your intestines.

“Conjugated” bilirubin is the bilirubin your liver processed. Sometimes it’s called “direct” bilirubin on your test results. That’s because this type can be measured directly. Unconjugated bilirubin can’t be measured directly. It’s measured by subtracting the value of conjugated bilirubin from the value of total bilirubin in your blood. Unconjugated bilirubin may be called “indirect” bilirubin on your test results.

Different labs may have slightly different ranges for what they consider normal bilirubin levels. On average, total bilirubin levels between 0.2 and 1.3 mg/dL are considered normal for children and adults. If your levels are higher, your healthcare provider may want to investigate further to look for the cause. It may suggest a problem that needs attention. But high bilirubin itself won’t usually need treatment.

It’s a little different for newborns. Normal levels for newborns can range anywhere between 1.0 and 12.0 mg/dL. Most of the time, hyperbilirubinemia in newborns is predictable and self-limited. But healthcare providers continue to monitor these cases to make sure bilirubin levels don’t rise too far or too fast. This could indicate a more serious condition, and it could also be toxic to the newborn.

Healthcare providers recommend treatment for newborns when bilirubin levels rise above 15 mg/dL in the first 48 hours or 20 mg/dL after 72 hours. At these levels, unconjugated bilirubin exceeds the amount of available albumin to bind it. The unconjugated bilirubin can cross the blood-brain barrier in newborns and harm their developing brains. It can cause varying degrees of brain damage, called kernicterus.

This risk isn’t the same for children and adults. Adult brains aren’t as vulnerable, and adults aren’t as likely to have such high levels of unconjugated bilirubin. Newborns produce bilirubin faster than adults do, and they conjugate it much slower. There are many more causes of conjugated hyperbilirubinemia in adults. For adults, hyperbilirubinemia might signal a dangerous condition, but the bilirubin itself isn’t dangerous.

You might have higher levels of unconjugated (indirect) bilirubin if your body is breaking down red blood cells faster than your liver can keep up with. This might indicate:

Common causes of unconjugated bilirubinemia in newborns include:

You might have higher levels of conjugated bilirubin (direct) if your body is having trouble clearing it. This might indicate a biliary disease or gallstone disease, such as:

Conditions that affect your liver’s ability to process bilirubin will cause high levels of both types to build up in your blood.

You might have a higher total bilirubin count if something is temporarily stressing your liver, such as a new medicine or a high dose of alcohol. It could also indicate an acute or chronic liver disease. Some causes include:

A healthcare provider will review your symptoms and health history to try and identify likely causes. Different causes will have different treatment options. They may suggest further blood tests or imaging tests to help diagnose your condition. They may also test your bilirubin levels again to make sure they aren’t rising. If bilirubin rises too high in your newborn, they’ll recommend treatment to reduce it.

Phototherapy is the standard treatment to reduce bilirubin levels in newborns. A healthcare provider places your infant under a lamp that emits fluorescent white or blue-spectrum light. The light helps break down the bilirubin into a water-soluble form so that the body can excrete it without conjugating it in the liver. This prevents unconjugated bilirubin from depositing in your newborn’s brain tissue.

Having high bilirubin can be a sign of several conditions. Your doctor will take your symptoms, as well as any other test results, into account to help narrow down a diagnosis.

Gallstones happen when substances like cholesterol or bilirubin harden in your gallbladder. Your gallbladder is responsible for storing bile, a digestive fluid that helps break down fats before they enter your intestines.

Symptoms of gallstones include:

Gallstones may form if your body is already producing too much bilirubin due to a liver condition or if your liver is creating too much cholesterol. They can also be a complication of an infection of your bile ducts or from a blood disorder.

Bilirubin builds up when your gallbladder is blocked and can’t drain properly.

Gilbert’s syndrome is a genetic liver condition that causes your liver to not process bilirubin properly. This causes the bilirubin to build up in your bloodstream.

This condition often doesn’t cause symptoms, but when it does, they can include:

Any condition that affects the function of your liver can cause bilirubin to build up in your blood. This is a result of your liver losing its ability to remove and process bilirubin from your bloodstream.

Several things can affect the function of your liver, including:

Common symptoms of liver dysfunction include:

Hepatitis happens when your liver becomes inflamed, often due to a viral infection. When it’s inflamed, your liver can’t easily process bilirubin, leading to a buildup of it in your blood.

Hepatitis doesn’t always cause symptoms, but when it does, they can include:

Your bile ducts connect your liver to your gallbladder and the opening of your small intestine, called the duodenum. They help to move bile, which contains bilirubin, from your liver and gallbladder into your intestines.

If these ducts become inflamed or blocked, bile can’t be properly drained. This can lead to an increased level of bilirubin.

Symptoms of bile duct inflammation may include:

Intrahepatic cholestasis of pregnancy is a temporary condition that can happen during the last trimester of pregnancy. It causes bile drainage from your liver to either slow down or stop entirely.

This makes it harder for your liver to process bilirubin from your blood, leading to high bilirubin levels.

Symptoms of intrahepatic cholestasis of pregnancy include:

Hemolytic anemia happens when blood cells break down too quickly in your bloodstream. It’s sometimes passed down genetically, but autoimmune conditions, an enlarged spleen, or an infection can also cause it.

Symptoms of hemolytic anemia include: