High Bilirubin Levels

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. 

Normal vs. High Bilirubin Levels

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.

Bilirubin Levels in Newborns

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.

What Can Cause Your Bilirubin Levels to Be High?

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

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 

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.

Alcohol-related Liver Disease

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.

Hemolytic Anemia

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 

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

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:

• Are exerting themselves
• Are stressed
• Have an infection
• Have not eaten

Symptoms of High Bilirubin Levels

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:

• Dark or brown-colored urine
• Pale or clay-colored stools
• Itching

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.

Symptoms of High Bilirubin Levels in Babies

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:

• Not waking up easily or sleeping well 
• Not breastfeeding or sucking from a bottle well
• Being fussy
• Not producing at least four to six wet diapers in 24 hours and three to four stools per day by the fourth day

Testing Bilirubin Levels

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.

Testing Bilirubin Levels in Babies

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.

To prevent this, healthcare providers should check for jaundice every eight to 12 hours during the baby’s first two days. Then the baby should be checked again when they are between three and five days old since this is when a baby’s bilirubin level is typically highest. 

To treat jaundice in babies, healthcare providers use light therapy or phototherapy. For this, the baby is placed under special lights to reduce high bilirubin.