Hi,
Thanks for posting your query at DoctorSpring.com. I am Dr.R.K and I am pleased to assist you.
You have indirect hyperbilirubinemia. There are two possibiities- Gilbert syndrome and hemolysis (damage of red bood cells).
Hemoglobin, reticulocyte count and serm LDH should be tested to see if the indirect hyperbilirubinemia is due hemolysis.
But since you have mentioned CBC is normal, I presume hemoglobin level is normal. Get reticulocyte count and serum LDH test done. If they are normal, then what you have is only Gilbert syndrome. You have a predominant indirect hyperbilirubinemia and the direct component is not significantly raised.
I hope that answers your questions. Please let me know if I can assist you further.
Regards,
Dr.R.K
Patient replied :
Yes LDH and reticulate were both normal.Also hepatitis was negative. Just concerned when I read that Gilbert's is only indirect. But your are saying it is most likely Gilbert's even with direct elevated some?
Hi,
Since hemolysis was ruled out ,the high bilirubin can be only explained as a liver related problem. Since the liver enzymes are within normal limits and only the bilirubin level is increased, it is more of a bilirubin metabolism issue. There are 4 different disorders related to bilirubin metabolism. Of these Gilbert and Crigler najjar syndrome can cause indirect hyperbilirubinemia.
Those with CG type I will not survive beyond infancy. In CG 2 the bilrubin level will be around 5-6. But in Gilbert it stays below 3.
Regarding the slightly increased direct component, the ratio of indirect and direct is increased which is again suggestive of Gilbert syndrome.
Fasting increasing bilrubin levels in Gilbert syndrome. You can check your bilrubin levl after fasting. If it is not increasing, then we can consider yours as Criggler najjar Type II.But most of the features are suggestive of Gilbert only and it is more common than CG II.
Let me know if I can assist you further.
Regards,
Dr.R.K
Patient replied :
Recent test shows bilirubin completely normal..liver function tests all still normal as well. With Gilbert's, could bilirubin go back to normal as it is now?
Yes, the Bilurubin can go back to normal in Gilbert, but usually it stays elevated below 3 mg/dl. That' why I stressed that you will need followup tests. If there is a pattern of slightly elevated Bilurubin we can confirm Gilbert. There are some provocative tests but they are no longer routinely used. If Bilurubin levels are saying normal in repeated testing then the cause could have been something else (like a passing infection, medication etc)
Hope this helps
Thank you
Patient replied :
Do you think I need any more tests at this time .I retested last week with normal bilirubin and normal liver function tests . I tend to worry a lot about my health even though I am in good health, eat a good diet and exercise. With my normal tests now you are saying I don't need to worry? Thank you
Yes, you need not worry at all. All tests are normal, so you there is no reason to worry. At this stage no further tests are required. Thank you