Isolated Raised Bilirubin


This guideline applies to adults over 18 years.



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




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


Advice and Guidance

Please send advice and guidance requests via e-RS to: http://rms.cornwall.nhs.uk/primary_care_clinical_referral_criteria/rms/primary_care_clinical_referral_criteria/gastro/rcht_hepatology_advice_and_guidance




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:


For patients:




Page Review Information


Review date

April 2024

Next review date

April 2026


Speciality Lead GP


Dr Madeleine Attridge (Hepatology lead GP)







Dr Hyder Hussaini (Consultant Hepatologist RCHT)

Anna Barton (Principal Clinical Biochemist)