17845 Bilirubin

Overview

Bilirubin (say: bil-ee-ROO-bin) is a yellow substance your body makes all the time. It is created when old red blood cells are broken down and replaced with new ones. Your liver then processes the bilirubin and passes it out of the body in a substance called bile (a digestive fluid) — mostly through your stools (poo), and a little through your urine (pee). 'Bilirubin 17845' is simply a laboratory code used for a bilirubin blood test, so this article is about bilirubin testing and what different bilirubin levels can mean. When bilirubin builds up faster than your body can clear it, it can show up as yellowing of the skin and the whites of the eyes — this is called jaundice.

Very common. Bilirubin tests are among the most frequently ordered blood tests, and mild rises are often found by chance in otherwise healthy people. Jaundice in newborns is also extremely common and is usually temporary.

Anyone can have a bilirubin test. Levels may rise in newborn babies, in people with liver or gallbladder conditions, in people whose red blood cells break down quickly, and in people with inherited patterns such as Gilbert's syndrome. It can also rise temporarily when you are unwell, dehydrated, or fasting (not eating for a while).

Symptoms

Common symptoms

• Often no symptoms at all — a raised level is spotted on a routine blood test
• Yellow tinge to the skin or the whites of the eyes (jaundice)
• Pale, clay-coloured stools (poo)
• Dark yellow or brown urine (pee)
• Feeling tired, weak, or generally unwell
• Itching skin (more likely with certain liver or bile duct problems)
• Feeling sick or off your food
• Discomfort under the ribs on the right side

Symptoms in children

• Yellowish skin, especially on the face, then spreading to the body
• Yellow whites of the eyes
• Sleepiness or being harder to wake for feeds
• Feeding less well or fewer wet nappies
• In older children: tiredness, tummy pain, or dark urine and pale stools

Symptoms in older adults

• Yellowing that may be noticed first by family or carers
• Confusion or unusual drowsiness alongside jaundice (needs urgent medical review)
• Unexplained weight loss or loss of appetite
• Itching, dark urine, and pale stools
• Tiredness that is put down to age but is new or getting worse

Causes

Main causes

• Gilbert's syndrome — a common, harmless inherited pattern where bilirubin runs slightly high, especially when you are tired, ill, or not eating
• Fast breakdown of red blood cells (called haemolysis), which releases extra bilirubin
• Liver inflammation or liver damage, from many possible causes including infections, alcohol, and fatty liver
• Blockage or narrowing of the bile ducts, for example by gallstones
• Some medicines and herbal products that affect how the liver handles bilirubin
• Temporary causes such as dehydration, long fasting, or being unwell with another illness
• In newborns, an immature liver and a larger volume of red blood cells — this is normal and usually settles
• Inherited conditions affecting how the liver processes bilirubin (these are uncommon)

Risk factors

• A family history of Gilbert's syndrome or other inherited liver or blood conditions
• Heavy or long-term alcohol use
• Being overweight, which raises the chance of fatty liver
• Having gallstones or a history of gallbladder problems
• Certain blood conditions where red cells break down quickly
• Some medicines, supplements, or herbal remedies
• Recent infection or severe illness
• Being a newborn, especially if born early or small

When to see a doctor

See a doctor urgently if:

• You notice new yellowing of your skin or the whites of your eyes
• You have dark urine with pale stools
• Jaundice with fever, chills, or shaking
• A newborn with jaundice that is deepening or spreading, or a baby who is feeding poorly and very sleepy

Book a routine appointment if:

• A bilirubin result on a blood test has come back higher than the normal range
• You feel persistently tired and your skin or eyes sometimes look slightly yellow
• You have itching, tummy discomfort, or changes in your bowel habits that are not settling
• You want to understand what your liver blood tests mean — your GP or pharmacist can talk this through with you

Diagnosis

Your doctor starts by talking with you about your symptoms, your health history, any medicines or supplements you take, and your alcohol intake, then examines you — looking at your eyes and skin and gently feeling your tummy. The key test is a blood test that measures total bilirubin and often splits it into two parts (sometimes called 'direct' and 'indirect', or 'conjugated' and 'unconjugated' bilirubin). That split helps your doctor work out whether the bilirubin is building up because of how it is made, how the liver processes it, or because bile cannot flow out properly.

Tests that may be done

• A bilirubin blood test, which may report total bilirubin and its two parts
• Other liver blood tests (often called a liver function test or liver panel), including liver enzymes
• A full blood count to check for anaemia or signs of red cells breaking down
• Urine tests to look for bilirubin or other changes
• An ultrasound scan of the tummy to look at the liver, gallbladder, and bile ducts
• Further imaging such as a CT or MRI scan, depending on what the first tests show
• In newborns, a small blood sample or a light sensor placed on the skin (a bilirubinometer) to measure levels

What to expect at your appointment

Most people need only a blood test and a conversation. Results usually come back within a few days, though some labs take longer. If your level is only slightly raised and everything else is normal, your doctor may simply repeat the test in a few weeks. If levels are higher or other tests are abnormal, you may be referred for a scan or to a specialist. Being told you need more tests can feel unsettling — ask what the tests are checking for, and bring someone with you if that helps.

Treatment

Treatment depends entirely on the cause. Gilbert's syndrome and mild rises with no other problems usually need no treatment at all — just awareness and occasional checks. If a liver condition, gallstones, infection, or a blood problem is found, the treatment targets that specific cause. Newborn jaundice is usually managed by monitoring and, if needed, light therapy in hospital.

Self-care at home

• Stay well hydrated, especially when you are unwell or in hot weather
• Avoid long stretches without eating if fasting tends to raise your bilirubin
• Cut down or stop alcohol if your liver tests are abnormal — ask for support if that feels hard
• Tell your doctor or pharmacist about all medicines, supplements, and herbal products you use
• Keep a note of your symptoms and test dates so you can track changes
• For a newborn, offer frequent feeds and follow your midwife's or health visitor's advice about monitoring

Medical treatments

There is no single 'bilirubin medicine'. Instead, doctors treat the underlying cause. That might mean stopping a medicine that is affecting the liver, treating an infection, or managing a blood condition. For newborn jaundice, babies are often placed under a special light (phototherapy) which helps the body clear bilirubin, and levels are checked regularly. If the bile ducts are blocked, a procedure to clear the blockage may be arranged. Your medical team will explain which approach suits your situation and why.

When is surgery considered?

Surgery is only considered when a physical blockage or problem is found — for example, removing the gallbladder if gallstones are causing blocked bile flow, or other procedures to open a narrowed bile duct. Many people with raised bilirubin never need surgery. If it is suggested, ask what the benefits and risks are for you specifically.

Living with this condition

For most people with mildly raised bilirubin, life carries on exactly as before — you just have a number to keep an eye on. If you have a liver condition, your day-to-day life may include regular appointments, blood tests, and paying a bit more attention to rest, food, and alcohol. Knowing your own pattern — for example, that your levels rise when you are run down — can make results feel less worrying.

Lifestyle tips

• Eat regular meals rather than long stretches without food
• Keep alcohol within low-risk limits, or avoid it if your doctor advises
• Stay active in a way you enjoy — walking, swimming, cycling, or gardening all count
• Aim for consistent sleep and manage stress where you can
• Avoid unnecessary supplements and check with a pharmacist before starting anything new
• Keep up with any monitoring appointments your doctor arranges

Diet and exercise

There is no special 'bilirubin diet'. A balanced, everyday pattern — plenty of vegetables and fruit, whole grains, beans and pulses, some protein, and not too much processed food — supports liver health. If you carry extra weight, gradual, steady weight loss can improve fatty liver. Gentle to moderate exercise most days is helpful and safe for most people. If you have a specific liver condition, ask your doctor or a dietitian whether you need any particular changes.

Mental health and emotional wellbeing

Being told a blood test is abnormal can cause real worry, even when the cause turns out to be harmless. It is common to feel anxious while waiting for results, or to keep checking your eyes in the mirror. Talking it through with your GP, a nurse, or someone you trust usually helps. If worry is affecting your sleep, mood, or daily life, tell your doctor — support is available and you do not have to cope alone.

Prevention

You cannot prevent every cause of raised bilirubin — some, like Gilbert's syndrome, are inherited, and newborn jaundice is a normal part of early life. But you can lower your risk of liver-related causes by limiting alcohol, staying at a healthy weight, eating a balanced diet, avoiding sharing needles, and being careful with medicines and supplements. Getting liver tests checked if you have symptoms or a family history helps problems be found early.

Screening programmes

There is no general population screening programme for bilirubin. Bilirubin is usually included in liver blood tests when there is a reason to check — for example, symptoms, a family history, or monitoring a known condition. All newborn babies in the UK are examined for jaundice as part of routine checks. If you are pregnant, your midwife will explain the newborn checks.

Complications

If left untreated

• If a liver or bile duct problem is missed, it may progress and become harder to treat
• A blocked bile duct can lead to infection of the bile system, which needs urgent treatment
• Long-standing liver disease can lead to scarring of the liver (cirrhosis) and its complications
• Very high bilirubin in newborns, if not monitored, can rarely cause hearing or movement problems — which is why monitoring matters
• Persistent itching and poor sleep can wear you down over time

Long-term outlook

The outlook is good for most people. Mildly raised bilirubin with normal liver tests and no symptoms usually means nothing serious and needs no treatment. When a cause is found, many liver, bile duct, and blood conditions can be managed well, particularly when picked up early. Newborn jaundice almost always settles with simple monitoring and treatment. Keep your appointments, ask questions, and let your medical team know about any new symptoms — that is the most useful thing you can do.

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