Total Bilirubin

What it is

Bilirubin is a yellowish pigment that is produced when your body breaks down old red blood cells. Red blood cells have a lifespan of about 120 days, and when they reach the end of their life, they are broken down, primarily in the spleen and liver. Bilirubin is a natural waste product of this process.

This bilirubin then travels through your bloodstream to your liver. In the liver, it's processed and then excreted from the body, mainly in bile, which is a fluid that aids digestion. A small amount is also removed by the kidneys. Total bilirubin in your blood is a measure of all the bilirubin present, both the form that hasn't yet been processed by the liver and the form that has.

The typical reference range for total bilirubin in adults is usually up to around 21 umol/l (micromoles per litre).

Why it matters

Measuring total bilirubin in your blood can give your doctor valuable clues about how well your liver is functioning and whether your red blood cells are being broken down at a normal rate.

If bilirubin levels are higher than normal, it can sometimes indicate a problem. This can happen if:

• Your body is breaking down red blood cells too quickly.
• Your liver isn't processing bilirubin effectively.
• There's a blockage in the bile ducts, preventing bilirubin from being excreted from the liver.

When bilirubin builds up in the blood, it can cause a condition called jaundice. Jaundice is a yellowing of the skin and the whites of the eyes. It's often one of the first noticeable signs that something might be amiss.

What can cause it to be high or low

High Total Bilirubin:

Several conditions can lead to an increase in total bilirubin levels. These can broadly be categorised:

• Problems with red blood cell breakdown (haemolysis): If red blood cells are being destroyed faster than usual, more bilirubin is produced. This can be due to conditions like autoimmune haemolytic anaemia or certain inherited blood disorders.
• Liver problems: If the liver is damaged or not working efficiently, it may struggle to process bilirubin. This can be seen in various liver conditions such as hepatitis (inflammation of the liver, which can be caused by viruses or alcohol), cirrhosis (scarring of the liver), or liver damage from certain medications or toxins.
• Bile duct obstruction: If the tubes (bile ducts) that carry bile from the liver to the small intestine become blocked, bilirubin can back up into the bloodstream. Blockages can be caused by gallstones, inflammation of the bile ducts, or tumours in or around the liver or pancreas.
• Gilbert's syndrome: This is a common, harmless genetic condition where the liver has a slightly reduced ability to process bilirubin. It often causes mild, fluctuating elevations in bilirubin, particularly during times of stress, illness, or fasting.

Low Total Bilirubin:

Low total bilirubin levels are generally not considered a cause for concern and are often not clinically significant. In some cases, certain medications might be associated with lower bilirubin levels, but this is usually not something that requires specific medical attention.

Lifestyle factors that may help

While blood test results are influenced by many factors, certain lifestyle choices can support overall liver health and potentially help manage conditions that might affect bilirubin levels. Discussing these with your GP is always the best approach.

• A balanced diet: Eating a diet rich in fruits, vegetables, and whole grains, while limiting processed foods, saturated fats, and excessive sugar, can support liver function.
• Limiting alcohol: For individuals with liver conditions or those prone to elevated bilirubin due to liver issues, reducing or avoiding alcohol intake is often recommended.
• Maintaining a healthy weight: Being overweight or obese can contribute to liver problems like non-alcoholic fatty liver disease (NAFLD), which can affect bilirubin levels.
• Regular exercise: Physical activity can help with weight management and improve overall health, which is beneficial for the liver.
• Avoiding unnecessary medications: Always take medications as prescribed and discuss any concerns about potential liver impact with your doctor.

Questions to discuss with your GP

If your total bilirubin result is outside the normal range, or if you have concerns about your liver health, your GP is the best person to talk to. Here are some questions you might consider discussing:

• What does my specific total bilirubin result mean in the context of my overall health?
• Are there any other tests you would recommend to investigate this result further?
• Could my current symptoms or medical history be related to this bilirubin level?
• What are the potential causes for my elevated or low bilirubin level?
• Are there any lifestyle changes you would suggest to support my liver health?
• What is the recommended plan for monitoring my bilirubin levels in the future?