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High total bilirubin level in the blood

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High total bilirubin level in the blood

What is high total bilirubin in the blood called?

  • Hyperbilirubinemia

What is the normal level of total bilirubin in the blood?

If you need to know which are the bilirubin reference ranges or you require more information about the role of bilirubin in the blood you can visit: Normal bilirubin level in the blood

What does a high total bilirubin level in the blood mean?

The bilirubin comes from the degradation of red blood cells. After several chemical reactions it arise what is called indirect bilirubin or unconjugated bilirubin that is not water-soluble.

Some of this unconjugated bilirubin pass through the liver and it is again transformed into a water-soluble bilirubin called direct bilirubin or conjugated bilirubin. Total bilirubin is the addition of both types of bilirubin in the blood.

In newborns, in the first days of life (approximately two weeks) the bilirubin level must be studied with their corresponding reference tables. The bilirubin level in newborns are very high. In a full term pregnancy they are a matter of concern when they are above 18 mg/dl at the birth moment. The information that we provide here are for adults only.

In adults, hyperbilirubinemia can be a sign of

  • Liver disease
  • Bile duct obstruction (there is an increase in conjugated bilirubin)
  • Hemolytic anemia (there is an increase in unconjugated bilirubin)

However, the correlation between the bilirubin level in the blood and the possibility of suffering those diseases is not reciprocal. The bilirubin is not always high in case of the existence of those diseases. There are people with just a slight bilirubin increase that may die from a fulminant hepatitis.

Total bilirubin blood values are usually given in mg/dl but sometimes you can see those values in µmol/l following the International System of Units (SI). In case your values are in µmol/l you can convert them using this tool:

µmol/l
  • Mild hyperbilirubinemia (1.2 – 1.8 mg/dl in adults):

    The bilirubin level in the blood is a bit high.

    It is advisable to look the other parameters related with the liver function. (AST, ALT and GGT). If they are correct and you do not have any symptom it is not a matter for concern. Take a new blood test in a few months and it is probable that the bilirubin level will be adequate.

  • Moderate hyperbilirubinemia (1.8 – 3 mg/dl in adults):

    Moderate hyperbilirubinemia needs a study with your doctor. He will decide along with your medical history if further screening test are necessary.

    It can be due to Gilbert’s disease, a benign hereditary disease with a high incidence (about 2% to 7% can suffer it). It is characterized by stomach pains or fatigue.

  • Marked hyperbilirubinemia(3 - 6 mg/dl in adults) :

    The bilirubin level in the blood is very high.

    Above 2.5 or 3 mg/dl jaundice is common. Jaundice is a yellowing of the skin and the whites of the eyes because the bilirubin has accumulated in the tissues. First, it can be seen in sclerotic of the eyes and when bilirubin is above 6 mg/dl it can be seen in the skin. Jaundice is not a disease, it is just a symptom.

    Jaundice requires treatment and follow-up of your doctor.

    Marked hyperbilirubinemia can be due to:

    • Hemolytic anemia: Bilirubin does not usually exceed 5 mg/dl
    • Hepatitis: The higher the bilirubin level is the worst is the prognostic. You can feel fatigue, nausea, vomiting and muscle pain.
    • Bile duct disorders (cholangitis or gallstones): You can have fever, dark urine and itching.
    • Other liver disorders: cirrhosis, liver cancer, etc.

    Your doctor will study your blood test and your symptoms to get a diagnosis.

  • Severe hyperbilirubinemia (> 6 mg/dl in adults):

    Severe hyperbilirubinemia requires urgent medical attention to avoid brain damage. If your doctor considers it appropriate you may require hospitalization.

    In newborns when the bilirubin is above 20 mg/dl Crigler-Najjar syndrome should be suspected.

Which factors can raise total bilirubin blood levels?

There are some circumstances or drugs than can raise your total bilirubin level in the blood:

  • Alcoholism
  • Drugs
    • Antibiotics
      • Novobiocin
    • Antineoplastics
      • Azathioprine
      • Methotrexate
    • Oral Contraceptives
    • Anti-diabetic medication
      • Chlorpropamide
    • Antihypertensives
      • Methyldopa
    • Antituberculars
      • Rifampicin
    • Morphine
    • Uricosuric
      • Allopurinol
      • Probenecid

Which diseases can raise your total bilirubin level in the blood?

There are different diseases why the total bilirubin level in the blood can be higher than normal:

  • Jaundice
  • Hepatitis
  • Hepatic cirrhosis
  • Gallstones
  • Primary biliary cirrhosis
  • Cholangitis
  • Cholestasis
  • Hemolytic anemia
  • Hereditary spherocytosis
  • Sickle cell disease
  • Hemolytic disease of the newborn
  • Pancreatic cancer
  • Gallbladder cancer
  • Liver cancer
  • Gilbert's syndrome
  • Crigler–Najjar syndrome
  • Dubin–Johnson syndrome
  • Rotor syndrome
  • Malaria
  • Cholecystitis
  • Thalassemia

What can I do to lower the total bilirubin level in the blood?

There are multiple causes why the bilirubin level in the blood may be higher than normal. For this reason, it is important to diagnose the underlying disease. Until a valid diagnosis can be found the following tips can help you to lower the total bilirubin.

  • Avoid alcohol consumption
  • Talk to your doctor about the medication you are taking now. Perhaps, it can interfere with your bilirubin level in the blood. There are lots of drugs than can increase the bilirubin level.

Where can I find more information about total bilirubin in the blood?

You can visit our pages about:

Which values are considered a high total bilirubinlevel in the blood?

The following values are considered to be above the normal range:

IMPORTANT: These levels are expressed in mg/dl. They are an example of a healthy man of about 45 years of age with no known disease and not taking any medication. The ranges can be different depending on the laboratory or on your personal circumstances.

The normal range in newborns for the first days of life differ from the following table. You must look for the applicable table for newborns.

Bilirubin
Status
Mild hyperbilirubinemia
1.21 mg/dl1.22 mg/dl1.23 mg/dl1.24 mg/dl1.25 mg/dl1.26 mg/dl1.27 mg/dl1.28 mg/dl
1.29 mg/dl1.3 mg/dl1.31 mg/dl1.32 mg/dl1.33 mg/dl1.34 mg/dl1.35 mg/dl1.36 mg/dl
1.37 mg/dl1.38 mg/dl1.39 mg/dl1.4 mg/dl1.41 mg/dl1.42 mg/dl1.43 mg/dl1.44 mg/dl
1.45 mg/dl1.46 mg/dl1.47 mg/dl1.48 mg/dl1.49 mg/dl1.5 mg/dl1.51 mg/dl1.52 mg/dl
1.53 mg/dl1.54 mg/dl1.55 mg/dl1.56 mg/dl1.57 mg/dl1.58 mg/dl1.59 mg/dl1.6 mg/dl
1.61 mg/dl1.62 mg/dl1.63 mg/dl1.64 mg/dl1.65 mg/dl1.66 mg/dl1.67 mg/dl1.68 mg/dl
1.69 mg/dl1.7 mg/dl1.71 mg/dl1.72 mg/dl1.73 mg/dl1.74 mg/dl1.75 mg/dl1.76 mg/dl
1.77 mg/dl1.78 mg/dl1.79 mg/dl1.8 mg/dl    
Moderate hyperbilirubinemia
1.81 mg/dl1.82 mg/dl1.83 mg/dl1.84 mg/dl1.85 mg/dl1.86 mg/dl1.87 mg/dl1.88 mg/dl
1.89 mg/dl1.9 mg/dl1.91 mg/dl1.92 mg/dl1.93 mg/dl1.94 mg/dl1.95 mg/dl1.96 mg/dl
1.97 mg/dl1.98 mg/dl1.99 mg/dl2 mg/dl2.01 mg/dl2.02 mg/dl2.03 mg/dl2.04 mg/dl
2.05 mg/dl2.06 mg/dl2.07 mg/dl2.08 mg/dl2.09 mg/dl2.1 mg/dl2.11 mg/dl2.12 mg/dl
2.13 mg/dl2.14 mg/dl2.15 mg/dl2.16 mg/dl2.17 mg/dl2.18 mg/dl2.19 mg/dl2.2 mg/dl
2.21 mg/dl2.22 mg/dl2.23 mg/dl2.24 mg/dl2.25 mg/dl2.26 mg/dl2.27 mg/dl2.28 mg/dl
2.29 mg/dl2.3 mg/dl2.31 mg/dl2.32 mg/dl2.33 mg/dl2.34 mg/dl2.35 mg/dl2.36 mg/dl
2.37 mg/dl2.38 mg/dl2.39 mg/dl2.4 mg/dl2.41 mg/dl2.42 mg/dl2.43 mg/dl2.44 mg/dl
2.45 mg/dl2.46 mg/dl2.47 mg/dl2.48 mg/dl2.49 mg/dl2.5 mg/dl2.51 mg/dl2.52 mg/dl
2.53 mg/dl2.54 mg/dl2.55 mg/dl2.56 mg/dl2.57 mg/dl2.58 mg/dl2.59 mg/dl2.6 mg/dl
2.61 mg/dl2.62 mg/dl2.63 mg/dl2.64 mg/dl2.65 mg/dl2.66 mg/dl2.67 mg/dl2.68 mg/dl
2.69 mg/dl2.7 mg/dl2.71 mg/dl2.72 mg/dl2.73 mg/dl2.74 mg/dl2.75 mg/dl2.76 mg/dl
2.77 mg/dl2.78 mg/dl2.79 mg/dl2.8 mg/dl2.81 mg/dl2.82 mg/dl2.83 mg/dl2.84 mg/dl
2.85 mg/dl2.86 mg/dl2.87 mg/dl2.88 mg/dl2.89 mg/dl2.9 mg/dl2.91 mg/dl2.92 mg/dl
2.93 mg/dl2.94 mg/dl2.95 mg/dl2.96 mg/dl2.97 mg/dl2.98 mg/dl2.99 mg/dl3 mg/dl
Marked hyperbilirubinemia
3.01 mg/dl3.02 mg/dl3.03 mg/dl3.04 mg/dl3.05 mg/dl3.06 mg/dl3.07 mg/dl3.08 mg/dl
3.09 mg/dl3.1 mg/dl3.11 mg/dl3.12 mg/dl3.13 mg/dl3.14 mg/dl3.15 mg/dl3.16 mg/dl
3.17 mg/dl3.18 mg/dl3.19 mg/dl3.2 mg/dl3.21 mg/dl3.22 mg/dl3.23 mg/dl3.24 mg/dl
3.25 mg/dl3.26 mg/dl3.27 mg/dl3.28 mg/dl3.29 mg/dl3.3 mg/dl3.31 mg/dl3.32 mg/dl
3.33 mg/dl3.34 mg/dl3.35 mg/dl3.36 mg/dl3.37 mg/dl3.38 mg/dl3.39 mg/dl3.4 mg/dl
3.41 mg/dl3.42 mg/dl3.43 mg/dl3.44 mg/dl3.45 mg/dl3.46 mg/dl3.47 mg/dl3.48 mg/dl
3.49 mg/dl3.5 mg/dl3.51 mg/dl3.52 mg/dl3.53 mg/dl3.54 mg/dl3.55 mg/dl3.56 mg/dl
3.57 mg/dl3.58 mg/dl3.59 mg/dl3.6 mg/dl3.61 mg/dl3.62 mg/dl3.63 mg/dl3.64 mg/dl
3.65 mg/dl3.66 mg/dl3.67 mg/dl3.68 mg/dl3.69 mg/dl3.7 mg/dl3.71 mg/dl3.72 mg/dl
3.73 mg/dl3.74 mg/dl3.75 mg/dl3.76 mg/dl3.77 mg/dl3.78 mg/dl3.79 mg/dl3.8 mg/dl
3.81 mg/dl3.82 mg/dl3.83 mg/dl3.84 mg/dl3.85 mg/dl3.86 mg/dl3.87 mg/dl3.88 mg/dl
3.89 mg/dl3.9 mg/dl3.91 mg/dl3.92 mg/dl3.93 mg/dl3.94 mg/dl3.95 mg/dl3.96 mg/dl
3.97 mg/dl3.98 mg/dl3.99 mg/dl4 mg/dl4.01 mg/dl4.02 mg/dl4.03 mg/dl4.04 mg/dl
4.05 mg/dl4.06 mg/dl4.07 mg/dl4.08 mg/dl4.09 mg/dl4.1 mg/dl4.11 mg/dl4.12 mg/dl
4.13 mg/dl4.14 mg/dl4.15 mg/dl4.16 mg/dl4.17 mg/dl4.18 mg/dl4.19 mg/dl4.2 mg/dl
4.21 mg/dl4.22 mg/dl4.23 mg/dl4.24 mg/dl4.25 mg/dl4.26 mg/dl4.27 mg/dl4.28 mg/dl
4.29 mg/dl4.3 mg/dl4.31 mg/dl4.32 mg/dl4.33 mg/dl4.34 mg/dl4.35 mg/dl4.36 mg/dl
4.37 mg/dl4.38 mg/dl4.39 mg/dl4.4 mg/dl4.41 mg/dl4.42 mg/dl4.43 mg/dl4.44 mg/dl
4.45 mg/dl4.46 mg/dl4.47 mg/dl4.48 mg/dl4.49 mg/dl4.5 mg/dl4.51 mg/dl4.52 mg/dl
4.53 mg/dl4.54 mg/dl4.55 mg/dl4.56 mg/dl4.57 mg/dl4.58 mg/dl4.59 mg/dl4.6 mg/dl
4.61 mg/dl4.62 mg/dl4.63 mg/dl4.64 mg/dl4.65 mg/dl4.66 mg/dl4.67 mg/dl4.68 mg/dl
4.69 mg/dl4.7 mg/dl4.71 mg/dl4.72 mg/dl4.73 mg/dl4.74 mg/dl4.75 mg/dl4.76 mg/dl
4.77 mg/dl4.78 mg/dl4.79 mg/dl4.8 mg/dl4.81 mg/dl4.82 mg/dl4.83 mg/dl4.84 mg/dl
4.85 mg/dl4.86 mg/dl4.87 mg/dl4.88 mg/dl4.89 mg/dl4.9 mg/dl4.91 mg/dl4.92 mg/dl
4.93 mg/dl4.94 mg/dl4.95 mg/dl4.96 mg/dl4.97 mg/dl4.98 mg/dl4.99 mg/dl5 mg/dl
5.01 mg/dl5.02 mg/dl5.03 mg/dl5.04 mg/dl5.05 mg/dl5.06 mg/dl5.07 mg/dl5.08 mg/dl
5.09 mg/dl5.1 mg/dl5.11 mg/dl5.12 mg/dl5.13 mg/dl5.14 mg/dl5.15 mg/dl5.16 mg/dl
5.17 mg/dl5.18 mg/dl5.19 mg/dl5.2 mg/dl5.21 mg/dl5.22 mg/dl5.23 mg/dl5.24 mg/dl
5.25 mg/dl5.26 mg/dl5.27 mg/dl5.28 mg/dl5.29 mg/dl5.3 mg/dl5.31 mg/dl5.32 mg/dl
5.33 mg/dl5.34 mg/dl5.35 mg/dl5.36 mg/dl5.37 mg/dl5.38 mg/dl5.39 mg/dl5.4 mg/dl
5.41 mg/dl5.42 mg/dl5.43 mg/dl5.44 mg/dl5.45 mg/dl5.46 mg/dl5.47 mg/dl5.48 mg/dl
5.49 mg/dl5.5 mg/dl5.51 mg/dl5.52 mg/dl5.53 mg/dl5.54 mg/dl5.55 mg/dl5.56 mg/dl
5.57 mg/dl5.58 mg/dl5.59 mg/dl5.6 mg/dl5.61 mg/dl5.62 mg/dl5.63 mg/dl5.64 mg/dl
5.65 mg/dl5.66 mg/dl5.67 mg/dl5.68 mg/dl5.69 mg/dl5.7 mg/dl5.71 mg/dl5.72 mg/dl
5.73 mg/dl5.74 mg/dl5.75 mg/dl5.76 mg/dl5.77 mg/dl5.78 mg/dl5.79 mg/dl5.8 mg/dl
5.81 mg/dl5.82 mg/dl5.83 mg/dl5.84 mg/dl5.85 mg/dl5.86 mg/dl5.87 mg/dl5.88 mg/dl
5.89 mg/dl5.9 mg/dl5.91 mg/dl5.92 mg/dl5.93 mg/dl5.94 mg/dl5.95 mg/dl5.96 mg/dl
5.97 mg/dl5.98 mg/dl5.99 mg/dl6 mg/dl    
Severe hyperbilirubinemia
6.01 mg/dl6.02 mg/dl6.03 mg/dl6.04 mg/dl6.05 mg/dl6.06 mg/dl6.07 mg/dl6.08 mg/dl
6.09 mg/dl6.1 mg/dl6.11 mg/dl6.12 mg/dl6.13 mg/dl6.14 mg/dl6.15 mg/dl6.16 mg/dl
6.17 mg/dl6.18 mg/dl6.19 mg/dl6.2 mg/dl6.21 mg/dl6.22 mg/dl6.23 mg/dl6.24 mg/dl
6.25 mg/dl6.26 mg/dl6.27 mg/dl6.28 mg/dl6.29 mg/dl6.3 mg/dl6.31 mg/dl6.32 mg/dl
6.33 mg/dl6.34 mg/dl6.35 mg/dl6.36 mg/dl6.37 mg/dl6.38 mg/dl6.39 mg/dl6.4 mg/dl
6.41 mg/dl6.42 mg/dl6.43 mg/dl6.44 mg/dl6.45 mg/dl6.46 mg/dl6.47 mg/dl6.48 mg/dl
6.49 mg/dl6.5 mg/dl6.51 mg/dl6.52 mg/dl6.53 mg/dl6.54 mg/dl6.55 mg/dl6.56 mg/dl
foto de Dr. Javier Muga Bustamante
Written by

Dr. Javier Muga Bustamante

Last update: 27/03/2020

Bibliography

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  • Painter PC, Cope JY, Smith JL. Reference information for the clinical laboratory. In: Burtis CA, Ashwood ER, eds. Tietz textbook of clinical chemistry. Philadelphia:WB Saunders Company, 1999;1803pp.
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  • Severity grading in drug induced liver injury. U.S. National Library of Medicine. Disponible en: https://livertox.nih.gov

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