Our body naturally produces bilirubin. This pigment has important functions but if it is too concentrated in the blood it can cause jaundice and other symptoms .

In this article we will discuss the causes and symptoms of high bilirubin and what treatments are recommended for this disorder.

What is bilirubin?

Bilirubin is a yellow pigment produced as a result of the degeneration of hemoglobin , a protein present in red blood cells that carries oxygen between the lungs and other tissues.

Bilirubin acts mainly as a cellular antioxidant; this reduction in oxidation processes causes less wear and tear on cells. However, the excessive presence of antioxidants can damage the cells.

This pigment is the cause of the color of the bruises and the color of the stool, when it is eliminated through the bile. It also explains the peculiar skin tone of people with jaundice.

Several beneficial properties are attributed to moderately high levels of bilirubin in addition to cell protection, including decreased risk of atherosclerosis and other cardiovascular diseases.

Types of bilirubin

We can distinguish between two types of bilirubin: direct or conjugated and indirect or unconjugated. The sum of the values of both types is called “total bilirubin”.

Indirect bilirubin is that which has not yet reached the liver, where it will become soluble in water, which will allow us to eliminate it through excretion.

Direct bilirubin is produced in the liver from indirect bilirubin. It accumulates in the gallbladder and binds to the bile, through which it will later be eliminated.

Normal and high levels

In healthy adults, normal total bilirubin values are below approximately 1.2 mg/dl (milligrams per deciliter of blood).

Indirect bilirubin is concentrated in the blood at a rate of approximately 0.1 to 0.5 mg/dl, while healthy levels of direct bilirubin are between 0 and 0.3 mg/dl.

Different diseases can cause an increase in the levels of direct or indirect bilirubin in our body , causing various symptoms.

Symptoms of hyperbilirubinemia

Bilirubin concentrations greater than 2 or 2.5 mg/dl of blood may produce jaundice, a term that designates the yellowish pigmentation of the mucosa, eyes, and skin.

For jaundice to be visible on the skin, total bilirubin levels usually need to be above 3 mg/dl , while the whites of the eyes may become yellowish from 2 mg/dl.Other common symptoms are darkening of the tone of the urine and, conversely, pale coloration of the stool.

We distinguish between conjugated or direct hyperbilirubinemia and unconjugated or indirect hyperbilirubinemia depending on whether the disease causing it increases one or the other type of bilirubin.

Causes of high bilirubin

Hyperbilirubinemia is usually caused by diseases of different types , but there are also other causes that may be sufficient for it to develop, such as chemotherapy and the use of antipsychotic drugs, among others.

Direct hyperbilirubinemia

The most common causes of increased levels of conjugated bilirubin are related to liver problems.

  • Hepatitis : damage to liver cells from inflammation can increase levels of direct bilirubin.
  • Liver cirrhosis : diseases such as alcoholism or some viruses can cause liver cells to be replaced by scar tissue; severe cirrhosis causes jaundice.
  • Gallstones and tumors in the pancreas can obstruct the gallbladder, making it difficult to remove bilirubin.
  • Dubin Johnson and Rotor Syndromes : benign hereditary diseases that have jaundice as their main symptom.

Indirect hyperbilirubinemia

Some of the most common causes of unconjugated hyperbilirubinemia are

  • hemolytic anemia : a disorder that causes red blood cells to degrade prematurely, increasing levels of bilirubin and “bad cholesterol.
  • Gilbert’s syndrome : a benign hereditary disease that can cause mild jaundice in periods of stress or if there is poor general health.
  • Crigler-Najjar syndrome : a form of inherited jaundice that can cause brain damage in babies born with it.

Treatment of jaundice

Treatment of jaundice depends on the disease that is causing the increased bilirubin. In general, jaundice is cured by strengthening the liver, since many of its causes are determined by liver disorders.

In cases of gallbladder obstruction a surgical operation is usually required . The treatment of the other diseases that cause hyperbilirubinemia is normally done with medication.

Beyond these assumptions, mild jaundice usually does not require treatment in adults. If it does cause itching, it can be reduced by using cholestyramine, a medication that helps remove bilirubin.

In newborn babies, where elevated bilirubin levels are common and may be of more concern, jaundice is treated with exchange transfusion and light therapy.

Also, drinking lots of water, eating fruits and vegetables, and limiting saturated fats and refined sugars are natural methods of reducing the symptoms of high bilirubin.