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Question answered:09/08/07 Warning! this question is over two years old.
GP Notebook has a section on raised bilirubin [1] and this includes a suggested protocol for investigating ‘suggested protocol for investigation of a slightly raised isolated bilirubin in an asymptomatic patient in primary care’ [2], this reports:
"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) (1)"
eMedicine (an American resource) has a more comprehensive chapter [3] on Conjugated Hyperbilirubinemia, which might be of interest.
References
1) http://www.gpnotebook.co.uk/simplepage.cfm?ID=349175853
2) http://www.gpnotebook.co.uk/simplepage.cfm?ID=x20070406183836295600&linkID=70009&cook=yes
3) http://www.emedicine.com/med/topic1065.htm
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