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is an elevation in indirect billirubine related to liver disease? No an elevation of DIRECT or CONJUGATED bilirubin is associated with liver/bile duct disorders. An elevation of INDIRECT or UNCONJUGATED bilirubin can be caused by Gilbert's Syndrome which is a benign genetic disorder or hemolytic anemia which is the premature destruction of red blood cells. ".....Normally 90% or more of measured serum bilirubin is unconjugated (indirect-reacting). When the total bilirubin level is elevated and fractionation shows that the major portion (≥90%) is unconjugated liver disease is never the explanation. Instead the clinician should suspect one of two explanations: Gilbert disease or hemolysis. If the patient is young and healthy an inherited decrease in the inability to conjugate bilirubin is likely and is referred to as Gilbert syndrome. It is seen in about 5% of the general population and causes only mild hyperbilirubinemia without symptoms. It is not associated with liver disease. Interestingly fasting and intercurrent illnesses such as influenza often make the level of unconjugated bilirubin even higher in those with Gilbert syndrome. This syndrome is easily diagnosed when all standard liver-test results are normal and 90% or more of the total bilirubin is unconjugated. There is no need for an imaging study or liver biopsy in cases of suspected Gilbert syndrome. Elevations of the unconjugated bilirubin level when the conjugated bilirubin level remains normal may also indicate an increased load of bilirubin caused by hemolysis. Anemia and an elevated reticulocyte count are usually present in such cases (Table 4)...."

2014-11-12 11:09:10

Emma