Reviewed By: Pramod Kerkar, MD, FFARCSI

Bilirubin is a byproduct formed with the catabolism of hemoglobin in our body. The levels of bilirubin determine the health of the liver. Elevation in the levels of bilirubin reveals that there are some underlying diseases related to liver and red blood cells. It is represented by yellowish discoloration of the skin, eyes, and nails termed as jaundice. This disorder is common in neonates soon after birth. A rise in bilirubin levels can be caused by viral infection of liver, alcohol, medicines, gallstones, and infections of the gallbladder, liver diseases, hemolytic anemia, and many more.

What Can Cause Bilirubin Levels To Be Elevated?

What Can Cause Bilirubin Levels To Be Elevated?

Bilirubin is yellowish brown pigment which is formed due to the breakdown of RBC cells in the body. Hemoglobin of the red blood cells breaks down into bilirubin that is carried to the liver by albumin. The liver plays an important role in the excretion of excess bilirubin. It converts bilirubin in the conjugated form (soluble form) and supplies to the gallbladder for storage. Then, bilirubin is secreted in bile juice and is excreted through stool. Only a trace amount of bilirubin circulates in the blood.

The normal value of bilirubin in the blood in adults is 1.2 mg/dL and in children below 18 years is 1 mg/dL. Yellowish discoloration of skin is visible when bilirubin level crosses 3 mg/dL. Any disease of the liver, gallbladder, or red blood cells can trigger an increase in the levels of bilirubin in the blood. The main causes of elevation of bilirubin levels in the blood are over-production, incapability of liver to filter bilirubin, less metabolism of bilirubin in the liver, and reduced excretion of the pigment.

The Diseases That Can Cause High Bilirubin Levels Are Following-

Liver Diseases

Chronic liver diseases like viral hepatitis, alcoholic and non-alcoholic cirrhosis, autoimmune diseases of the liver, infections of the liver, liver cancer, etc can lead to improper functioning of the liver, thereby resulting in the improper metabolism of bilirubin. Congenital diseases like Gilbert syndrome and Dubin-johnson syndrome also disturb the metabolism of bilirubin. These liver diseases cause the buildup of bilirubin in the blood as the liver cannot convert bilirubin in conjugated form for excretion.

Gallbladder Diseases

After leaving the liver, bilirubin is stored in the gallbladder before excretion through stool. Any damage or blockage in the gallbladder or bile ducts caused by infections, stones or tumors can result in high bilirubin levels. Cholestasis is a condition characterized by blockage in the bile duct or less secretion of bile by the liver leading to the decreased flow of bile, thereby elevating bilirubin levels.

Hemolytic Anemia

Hemolytic anemia is caused by premature breakdown of red blood cells. The increased breakdown of red blood cells results in the increase in the levels of bilirubin. Inherited diseases like sickle cell anemia can also trigger hemolytic anemia. Sickel cell anemia is marked by crescent-shaped red blood cells that lead to premature destruction of RBCs.

Autoimmune diseases like lupus, some leukemias, lymphomas, and infection with Epstein-Barr virus can also induce hemolytic anemia that can cause high bilirubin levels.

Medications

Certain medicines like rifampin, probenecid, chlorpromazine, erythromycin, estrogens, and anabolic steroids can be harmful toxins for liver cells in high doses. They can induce elevation of bilirubin levels.

Alcohol

Too much consumption of alcohol leads to damage to the liver by the development of scars and fibrosed tissues. This result in malfunctioning of liver and can cause liver cirrhosis if not managed properly. This improper functioning of the liver can lead to accumulation of bilirubin in the blood due to reduced metabolism.

Conclusion

Bilirubin is a byproduct of the normal breakdown of red blood cells. The levels of bilirubin are regulated by the liver. Any affections of the liver, gallbladder or any disease of red blood cells induce the elevation of bilirubin. This results in jaundice which is marked by yellowish discoloration of the skin, the sclera of eyes and nails.

Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: July 31, 2018

This article does not provide medical advice. See disclaimer

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