Serum bilirubin and its fractions are of great importance in diagnosis of hepatobiliary disorders as well as haemolysis. However, in haemolysis, total serum bilirubin shows mild to moderate elevation mainly due to indirect bilirubin . The rise is biphasic in hepatocellular illness while it is mainly due to high direct bilirubin in obstructive lesions of the biliary tract. Meanwhile, deep jaundice could be seen in intrahepatic cholestasis due to septicemias or drug toxicity. My question, what is the usual and maximum levels of total serum bilirubin seen in the three causes of jaundice?
Thank you Ishag, was this high total bilirubin due to both hemolysis and hepatocellular affection? As I know malaria is not a direct cause of hepatocellular inflammatory reaction.
Malaria can cause hyperbilirubin mainly by hemolysis but can cause inflammation of the hepatcytes too
The highest serum bilirubin I have ever seen was 42 mg/dl in hepatocellular disease, mainly direct bilirubin.
The highest serum biliruin I have ever seen in obstrcutive jaundice, such as PBC and DILI.
I think the level depends on the practice as well as in different setting
The highest level of bilirubin I have ever seen was 29 mg /dl in a patient with fulminant liver failure due to autoimmune hepatitis
Ruixing Zhang how much was the value of these two high serum bilirubin?
I work at gastroenterohepatology unit, mainly with patients with biliary obstructions. We see a lot of patients with advanced pancreatic head carcinoma and the highest bilirubin level a have seen is around 1000 mmol/l (58.4 mg/dl)
The highest level of bilirubin I've ever seen was 32mg/dl in a patient with biliary obstruction due to Klatskin tumor
The highest level of the serum bilirubin I have ever seen was slightly more than 500 mcmol/L (about 30 mg/dL) in case of the intrahepatic fistula between a large bile duct and a branch of the vena cava inf.
Perhaps there is a population difference and other variable e.g. drugs etc
My highest was in a sickle cell patient who was in crisis and also had hepatic impairment from the current and previous crises. My best memory was that it was around 48mg/ml.
I remember the case of a patient with hepatocellular Jaundice due to a long-standing liver cirrhosis and hepatic function impairement. Bilirubin levels were about 30 mg/dL and its composition was mixed (conjugated and unconjugated). We detected a possible biliary obstruction without any finding. The patient undewent liver transplantation and now he is in good general conditions.
I have seen around 50mg/dl in a patient with sickle crisis with hepatic envolvement (haemolisys and sinusoidal obstruction). Other two patients with toxic hepatitis due to Diclophenac and Flucloxacilin,
We have a paitient today in our Department and in our Liver Unit with Primary Biliary Cirrhosis that has had 41,6 mg /dl.
The highest level of total bilirubin I have ever seen was 20
You asked about my patient"s age. The pt was about 30 years of age
Is 88 mg/dl of Bilirubin, compatible with life? I have experienced Pre test dilution errors with results of 40 mg/dl
60mh recently in a patient with liver failure due to sickle-cell crisis. The patient has been transplanted sucessfully.
Today ; 50 mg/ dl I a liver transplant recipient who has anastomotic biliary structure and undergone stenting 2 times before the current 3rd time.. however ; drug toxicity is largely suggested as a combined patho6.. waiting for further assessment
Bilirubin in clinical practice: a review
http://www.sld.cu/galerias/pdf/sitios/gastroenterologia/bilirrubina.pdf
Unconjugated hyperbilirubinemia results from a derailment of the necessary bilirubin conjugation in the hepatocyte. Hemolytic anemias usually result in mild bilirubin elevation, to about 5 mg per dL (85.5 μmol per L), with or without clinical jaundice .
Conjugated Hyperbilirubinemia
The predominant causes of conjugated hyperbilirubinemia are intrahepatic cholestasis and extrahepatic obstruction of the biliary tract, with the latter preventing bilirubin from moving into the intestines.
Viruses, alcohol, and autoimmune disorders are the most common causes of hepatitis. Intrahepatic inflammation disrupts transport of conjugated bilirubin and causes jaundice.
Conjugated hyperbilirubinemia also may result from problems that occur after the bilirubin is conjugated in the liver. These post-hepatic causes can be divided into intrinsic or extrinsic obstruction of the duct system.
Cholelithiasis, or the presence of gallstones in the gallbladder, is a relatively common finding in adult patients, with or without symptoms of obstruction. Obstruction within the biliary duct system may lead to cholecystitis, or inflammation of the gallbladder, as well as cholangitis or infection.
The highest level of the serum bilirubin i ever seen was 80 mg/dl. Patient with alcoholic liver cirrosis
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