Classification and causes of jaundice or asymptomatic hyperbilirubinemia
- Namita Roy-Chowdhury, PhD
Namita Roy-Chowdhury, PhD
- Professor of Medicine and Genetics
- Albert Einstein College of Medicine
- Jayanta Roy-Chowdhury, MD, MRCP
Jayanta Roy-Chowdhury, MD, MRCP
- Professor of Medicine and Genetics
- Albert Einstein College of Medicine
- Section Editors
- Sanjiv Chopra, MD, MACP
Sanjiv Chopra, MD, MACP
- Editor-in-Chief — Gastroenterology and Hepatology
- Section Editor — General Hepatology; Gallbladder and Biliary Tract Disease
- Professor of Medicine
- Harvard Medical School
- Senior Consultant in Hepatology
- James Tullis Firm Chief
- Beth Israel Deaconess Medical Center
- Elizabeth B Rand, MD
Elizabeth B Rand, MD
- Section Editor — Pediatric Hepatology
- Professor of Pediatrics
- University of Pennsylvania School of Medicine
The normal serum bilirubin concentration in children and adults is less than 1 mg/dL (17 micromol/liter), less than 5 percent of which is present in conjugated form. The measurement is usually made using diazo reagents and spectrophotometry. Conjugated bilirubin reacts rapidly ("directly") with the reagents. The measurement of unconjugated bilirubin requires the addition of an accelerator compound and is often referred to as the indirect bilirubin. (See "Clinical aspects of serum bilirubin determination".)
Jaundice is often used interchangeably with hyperbilirubinemia. However, a careful clinical examination cannot detect jaundice until the serum bilirubin is greater than 2 mg/dL (34 micromol/liter), twice the normal upper limit. The yellow discoloration is best seen in the periphery of the ocular conjunctivae and in the oral mucous membranes (under the tongue, hard palate). Icterus may be the first or only sign of liver disease; thus its evaluation is of critical importance.
●Plasma elevation of predominantly unconjugated bilirubin due to the overproduction of bilirubin, impaired bilirubin uptake by the liver, or abnormalities of bilirubin conjugation
●Plasma elevation of both unconjugated and conjugated bilirubin due to hepatocellular diseases, impaired canalicular excretion, and biliary obstruction
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- REFERENCE RANGES
- DISORDERS ASSOCIATED WITH UNCONJUGATED HYPERBILIRUBINEMIA
- Overproduction of bilirubin
- - Extravascular hemolysis
- - Extravasation
- - Intravascular hemolysis
- - Dyserythropoiesis
- - Serum bilirubin concentration
- - Bilirubin overproduction with coexisting liver disease
- - Urobilinogen excretion
- - Gallstones
- Impaired hepatic bilirubin uptake
- Impaired bilirubin conjugation
- DISORDERS ASSOCIATED WITH CONJUGATED HYPERBILIRUBINEMIA
- Biliary obstruction
- Intrahepatic causes
- - Viral hepatitis
- - Alcoholic hepatitis
- - Nonalcoholic steatohepatitis
- - Primary biliary cholangitis
- - Drugs and toxins
- - Sepsis and low perfusion states
- - Malignancy
- - Liver infiltration
- - Inherited diseases
- - Total parenteral nutrition
- - Postoperative patient
- - Following organ transplantation
- - Sickle cell disease
- - Intrahepatic cholestasis of pregnancy
- - End-stage liver disease
- Hepatocellular injury
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS