Bilirubin is a yellowish substance in your blood. It forms after red blood cells break down, and it travels through your liver, gallbladder, and digestive tract before being excreted.
The condition of having high bilirubin levels is called hyperbilirubinemia. It’s usually a sign of an underlying condition, so it’s important to follow up with a doctor if test results show you have high bilirubin.
It’s also a common temporary condition in newborns.
Read on to learn more about the symptoms of high bilirubin and what can cause it.
Healthy vs. high bilirubin levels
Typically, bilirubin levels fall somewhere between 0.3 and 1.0 milligrams per deciliter (mg/dL). Anything above 1.2 mg/dL is usually considered elevated.
|Healthy bilirubin range||High bilirubin range|
|Less than 24 hours||<6.0 mg/dL||6.0 mg/dL|
|24–48 hours||<10.0 mg/dL||10.0 mg/dL|
|3–5 days||<12.0 mg/dL||12.0 mg/dL|
|7 days||<10.0 mg/dL||10.0 mg/dL|
|Adults||0.3–1.0 mg/dL||2.5 mg/dL|
If you have high bilirubin, your symptoms will depend on the underlying cause. You can have mildly high bilirubin and have no symptoms at all.
With moderately high bilirubin, you may only have jaundice, which is a yellowish color in your eyes and skin. Jaundice is the main sign of high bilirubin levels.
Other general signs of illnesses that cause high bilirubin can include:
- abdominal pain or swelling
- chest pain
- unusually dark urine
Having high bilirubin can be a sign of several conditions. Your doctor will take your symptoms, as well as any other test results, into account to help narrow down a diagnosis.
Gallstones happen when substances like cholesterol or bilirubin harden in your gallbladder. Your gallbladder is responsible for storing bile, a digestive fluid that helps break down fats before they enter your intestines.
Symptoms of gallstones include:
- pain in your upper right abdomen or right below your chest
- back pain between your shoulders or in your right shoulder
- feeling sick
- throwing up
Gallstones may form if your body is already producing too much bilirubin due to a liver condition or if your liver is creating too much cholesterol. They can also be a complication of an infection of your bile ducts or from a blood disorder.
Bilirubin builds up when your gallbladder is blocked and can’t drain properly.
Gilbert’s syndrome is a genetic liver condition that causes your liver to not process bilirubin properly. This causes the bilirubin to build up in your bloodstream.
This condition often doesn’t cause symptoms, but when it does, they can include:
- minor abdominal discomfort
Any condition that affects the function of your liver can cause bilirubin to build up in your blood. This is a result of your liver losing its ability to remove and process bilirubin from your bloodstream.
Several things can affect the function of your liver, including:
- liver cancer
- autoimmune disorders involving the liver, such as autoimmune hepatitis or primary biliary cholangitis
Common symptoms of liver dysfunction include:
- pain or swelling of your abdomen
- swelling of your legs or ankles (edema)
- easy bruising
- dark urine
- pale, bloody, or black stools
- itchy skin
Hepatitis happens when your liver becomes inflamed, often due to a viral infection. When it’s inflamed, your liver can’t easily process bilirubin, leading to a buildup of it in your blood.
Hepatitis doesn’t always cause symptoms, but when it does, they can include:
- dark urine
- abdominal pain
Bile duct inflammation
Your bile ducts connect your liver to your gallbladder and the opening of your small intestine, called the duodenum. They help to move bile, which contains bilirubin, from your liver and gallbladder into your intestines.
If these ducts become inflamed or blocked, bile can’t be properly drained. This can lead to an increased level of bilirubin.
Symptoms of bile duct inflammation may include:
- pale stools
- dark urine
- unexplained weight loss
Intrahepatic cholestasis of pregnancy
Intrahepatic cholestasis of pregnancy is a temporary condition that can happen during the last trimester of pregnancy. It causes bile drainage from your liver to either slow down or stop entirely.
This makes it harder for your liver to process bilirubin from your blood, leading to high bilirubin levels.
Symptoms of intrahepatic cholestasis of pregnancy include:
- itchy hands and feet without a rash
- gallstone symptoms
Hemolytic anemia happens when blood cells break down too quickly in your bloodstream. It’s sometimes passed down genetically, but autoimmune conditions, an enlarged spleen, or an infection can also cause it.
Symptoms of hemolytic anemia include:
- difficulty breathing
- abdominal pain
- chest pain
- cold hands or feet
Many babies have high bilirubin a few days after birth, causing a condition called newborn jaundice. This is a temporary condition that usually resolves on its own within a few weeks.
It happens because newborns have more red blood cells and break them down more quickly, but their livers are not developed enough to keep up.
Prior to being born, the pregnant person’s liver helps with this task. A newborn’s liver is only
In most cases, higher bilirubin levels will lead to jaundice between 1 and 3 days after birth. Bilirubin levels can peak as high as
Feeding 8 to 12 times per day helps to promote regular bowel movements, which help to remove bilirubin from the body.
If jaundice occurs within the first 24 hours after birth, or if bilirubin levels are especially high or don’t begin to fall on their own, doctors may intervene with treatments such as:
Bilirubin levels are usually tested by taking a blood sample.
In newborns, blood is typically taken from the heel. In some cases, doctors might use blood from the umbilical cord.
For adults, blood is usually taken from one arm. You may need to fast prior to your blood test.
There are two types of bilirubin that will be measured: conjugated bilirubin and unconjugated bilirubin. The ratio between these two types of bilirubin will help narrow down the underlying cause of high bilirubin levels.
In some cases, a urine sample will be used to test bilirubin levels. There shouldn’t be any bilirubin present in urine, so any bilirubin found in a urine sample is an indication of an underlying condition.
In many cases, high bilirubin isn’t a sign of anything that needs immediate treatment.
But if you notice any of the following symptoms, call a doctor or head to urgent care just in case:
- intense abdominal pain or tenderness
- drowsiness or disorientation
- black or bloody stools
- vomiting blood
- a fever of 101°F (38.3°C) or higher
- easy bruising or bleeding
- red or purple skin rash
High bilirubin levels are usually a sign that something is not working as expected in your liver or gallbladder. Some of these conditions aren’t too serious, but it’s important to monitor and treat them.
Anyone with jaundice, which is the main sign of high bilirubin levels, should contact their doctor. If your doctor isn’t immediately sure what’s causing your high bilirubin levels, you may need to return for additional blood, liver function, or other tests.
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