Effective Treatments For High Bilirubin Levels In Adults

High bilirubin levels, also known as hyperbilirubinemia, are more common in newborns than in adults and can be caused by a variety of factors, including liver dysfunction, blood disorders, bile duct obstruction, and hemolytic anemia. While high bilirubin itself does not always require treatment, it can indicate an underlying health condition. Treatment for high bilirubin in adults depends on the underlying cause, and hospitals employ various strategies to address this condition.

Identifying the cause of high bilirubin

High bilirubin levels (hyperbilirubinemia) can be caused by several factors, and identifying the cause is crucial for determining the appropriate treatment. Hyperbilirubinemia itself is not a disease but a symptom of an underlying condition. Here are some ways to identify the cause of high bilirubin levels in adults:

Blood Tests

Blood tests are commonly used to measure bilirubin levels and assess liver function. A blood sample is typically taken from a vein in the arm, and the results help determine if the cause is related to the liver or another condition.

Urinalysis

A urinalysis test evaluates the presence of bilirubin in the urine, which is not normal. This test can provide additional information to support diagnosis and monitoring.

Imaging Tests

Imaging techniques such as ultrasound and computed tomography (CT) scans can help distinguish between biliary obstruction and liver disease, including cancer. These tests provide visual information to help identify the cause of high bilirubin levels.

Liver Biopsy

If there are concerns about possible liver cancer or other liver-related conditions, a liver biopsy may be necessary. This involves taking a small sample of liver tissue for examination.

Genetic Testing

In some cases, genetic testing may be required, especially if the cause is suspected to be related to genetic disorders such as Gilbert's syndrome, Wilson disease, or Crigler-Najjar syndrome. These conditions can affect bilirubin metabolism and cause hyperbilirubinemia.

Review of Symptoms and Medical History

A thorough review of the patient's symptoms and medical history is essential. Factors such as medication use, alcohol consumption, and any underlying health conditions can provide valuable clues about the cause of high bilirubin levels.

Liver function tests

Bilirubin levels are typically measured through blood tests, where a blood sample is collected from a vein in the arm. In certain cases, a transcutaneous bilirubin meter may be placed on the skin, but this usually requires a follow-up blood test. Bilirubin can also be detected in urine, and standard urine tests often include checking for bilirubin. If bilirubin is present in the urine, further blood tests are conducted to measure bilirubin levels.

High bilirubin levels can lead to jaundice, characterised by yellowing skin and eyes. Jaundice is more common in newborns and older adults. In adults, jaundice is often caused by an underlying medical condition, known as pathologic jaundice, and can be more severe. However, jaundice in newborns is usually non-pathologic and less concerning.

Healthcare providers consider bilirubin levels above 1.3 mg/dL as elevated in adults. Various factors, including age and sex, influence the causes and prevalence of high bilirubin levels. For example, newborns can have normal bilirubin levels as high as 12 mg/dL, and their levels tend to decrease over a few days to two weeks.

If high bilirubin levels are detected, doctors will investigate the underlying cause. High bilirubin levels can be caused by liver conditions such as cirrhosis, hepatitis, or gallstones. They can also indicate hemolytic anemia, sickle cell disease, or other conditions causing abnormal red blood cell breakdown. Treating or managing these underlying conditions can help lower bilirubin levels.

Imaging tests

Computerised tomography (CT) scans are another imaging option. CT scans use X-rays and computer processing to create detailed cross-sectional images of the body. CT scans can help detect conditions such as liver tumours or cysts, which can affect the liver's ability to process bilirubin.

Magnetic resonance imaging (MRI) scans may also be used to visualise the liver and other abdominal organs. MRI scans use strong magnetic fields and radio waves to generate detailed images. MRI scans can help identify conditions such as liver cancer or cirrhosis, which can impact bilirubin levels.

In addition to these imaging techniques, doctors may also employ other diagnostic tools such as blood tests, liver function tests, and physical examinations to assess the health of the liver and identify the specific cause of high bilirubin levels in adults.

Treatment strategies

If high bilirubin levels are caused by drugs, a change of medication can resolve the effects. For instance, Gilbert syndrome is a benign genetic disorder characterised by intermittent unconjugated hyperbilirubinemia in the absence of hepatocellular disease or hemolysis. Patients with Gilbert syndrome are typically asymptomatic and exhibit normal liver serum chemistries. In such cases, no specific management is required for most patients.

High bilirubin levels can also be caused by liver problems. A healthcare provider will review symptoms and health history to identify likely causes. Different causes will have different treatment options. They may suggest further blood tests or imaging tests to help diagnose the condition. They may also test bilirubin levels again to make sure they aren't rising. A liver biopsy would be considered if there is a concern about possible liver cancer.

In general, you can reduce the overall stress on your liver by eliminating alcohol and drugs, including over-the-counter medications, and maintaining a healthy diet. A balanced diet including fresh fruits and vegetables, avoiding alcohol, and drinking more water can support liver health and help the liver flush out toxins.

Monitoring and treating

High bilirubin levels can be caused by blood, liver, or bile duct disorders, and can manifest with jaundice, which is the main sign of high bilirubin levels. Jaundice is a yellowish discolouration of the skin and eyes, and can be caused by high levels of unconjugated (indirect) bilirubin. This may be due to your body breaking down red blood cells faster than your liver can process them. In adults, jaundice is usually caused by a medical condition, such as liver disease or hemolytic anemia.

If you notice jaundice, you should contact your doctor. Your doctor will then try to identify the underlying cause of your high bilirubin levels. This may involve additional blood, liver function, or other tests. Treatment will depend on the underlying cause. For example, if high bilirubin levels are caused by drugs, a change of medication can resolve the effects.

High bilirubin levels can often be reduced by supporting your liver health. This can be done by maintaining a healthy, balanced diet with fresh fruits and vegetables, avoiding alcohol, and drinking plenty of water.

Frequently asked questions