Trip Answers

Question answered:04/03/08

ATTRACT cannot comment directly on whether isolated raised bilirubin is sufficient to diagnose gilbert’s syndrome. At ATTRACT we simply report the evidence we find and leave any interpretation down to the health professional.

GP notebook contains a chapter on raised bilirubin (1), within this there is suggested protocol for investigation of a slightly raised isolated bilirubin in an asymptomatic patient in primary care. This states:

“Recommended investigation for isolated raised bilirubin in primary care (1):

values <1.5 times upper limit of normal (ULN)
 suggested that should retest LFTs in 1-3 months unless clinical suspicion of  disease

values >1.5 ULN:
 it is suggested that confirm proportion of indirect (unconjugated) bilirubin
  Gilbert's syndrome is probable if >70%, unconjugated: no further    testing needed if non-progessive on interval retesting, unless clinical   suspicion of haemolysis
 if bilirubin is increasing on restesting
  then consider haemolysis and test haptoglobin, LDH and blood count   with reticulocyte count 

values > 3 x ULN:  
 it is probable that raised bilirubin is a result of disease process
  further investigation required
   consider ultrasound (conjugated >50%) or haemolysis     (unconjugated >70%)

Notes:
values up to 20% over ULN are likely to be statistical rather than clinical 'abnormals'
referral to secondary care is indicated if bilirubin is raised > 2 ULN (unexplained by laboratory tests)”  

The NLH Q&A service answered the following question in 2005, “is an isolated raised bilirubin level sufficient to make a diagnosis of gilbert's syndrome in an otherwise well patient in primary care? if not what other investigations need doing to make the diagnosis in primary care” (2). The answer to this question can be viewed in full at: http://www.clinicalanswers.nhs.uk/index.cfm?question=945

1.http://www.gpnotebook.co.uk/simplepage.cfm?ID=x20070406183836295600&linkID=70009&cook=yes

 

---

DISCLAIMER: TRIPanswers is a collection of clinical questions and answers.  Each provider will have their own methodology in answering questions and these are likely not to be as rigorous as systematic review.  If you have any doubt as to the implications of this contact the Q&A Service Provider for further information. This document is presented for information purposes only. This document cannot and should not be used as a basis of diagnosis or choice of treatment, and is in no way intended to replace professional medical care or attention by a qualified practitioner. TRIPanswers and TRIP Database Ltd are not responsible or liable for, directly or indirectly, ANY form of damage whatsoever resulting from the use/misuse of information contained in or implied by this document.  Also, ensure you have read the terms and conditions for using the site.