Isolated Raised Bilirubin

 

Red flags

• Synthetic failure – jaundice, low albumin, ascites, prolonged INR, encephalopathy
• Features of malignancy –
  • weight loss >60yrs with any of:diarrhoea, back pain, abdominal pain, nausea or vomiting, constipation, new onset diabetes
  • Jaundice in patient >40years

 

Management

ISOLATED RAISED BILIRUBIN:

Most commonly due to Gilbert's syndrome – a benign condition which does not need areferral. It occurs in about 5-8% of the population

Advice and Guidance

Please send advice and guidance requests via e-RS  

http://rms.cornwall.nhs.uk/primary_care_clinical_referral_criteria/rms/primary_care_clinical_referral_criteria/gastro/rcht_hepatology_advice_and_guidance

 

 

Referral

Gilbert’s (mostly unconjugated bilirubin with no haemolysis)

No referral required

 

Suspected Haemolysis (ie predominantly unconjugated bilirubin PLUS anaemia with reticulocytosis)

Refer urgently to haematology.

 

Predominantly conjugated bilirubin (very rare)

Refer hepatology A&G

 

For East-facing Cornwall practices. Please see South & West Devon DRSS Referral Guidelines

 

 

Supporting Information

For professionals:

• Gut – Guidelines on the Management of Abnormal Liver Blood Tests
• Health Technology Assessment – Birmingham and Lambeth Liver Evaluation Testing Strategies (BALLETS): A Prospective Cohort Study
• RCGP e-learning abnormal LFTS

For patients:

• Patient UK – Abnormal Liver Function Tests

 

 

 

Page Review Information

Review date	January 2025
Next review date	January 2027
Speciality Lead GP	Dr Madeleine Attridge (Hepatology lead GP)
Contributors	Dr Hyder Hussaini (Consultant Hepatologist RCHT) Anna Barton (Principal Clinical Biochemist)