Urologist Questions Urologist

Elevated total and direct bilirubin?

I recently went for a physical and it appears that my total bilirubin resulted in 2.4mg/d and direct bilirubin was 0.3mg/d. All other results from CMP and CBC were within the normal range. Urinalysis reported no bilirubin present. I do not appear jaundiced. Should I be concerned? My biliruben levels were checked twice earlier this year during a trip to the gastroenterologist and both times they were within normal limits. The gastro did find that I had acquired giardiasis, most likely from recent international travel and that my fecal elastase was low. I was treated for the giardiasis and subsequently tested negative, however, my fecal elastase remained low, and I continue to experience bouts of diarrhea and mucous in stool to this day. An MRI of the pancreas was ordered with and without contrast and the results were negative for any abnormalities.

Interestingly, around 20 years ago, after moving into my freshman dorm at university, I fell severely ill after about a week of living there. I had severe nausea, diarrhea, high fever that lasted about a week. My GP at the time ran many blood and stool tests and all were negative for hepatitis and other enteric pathogens. He did notice, however, that my skin appeared to have a yellowish tint and said it was possible that I have Gilbert's Syndrome. Having missed over a week of classes at university, I was anxious to return to my studies and never really followed up. Could it be Gilbert's? I did also fast for around 14 hours prior to my recent physical. Could this have caused elevated bilirubin? Just curious what others think before I have a chance to talk this through with my GP. Thanks for your help!

Male | 39 years old
Complaint duration: 2 days
Medications: lexapro 10mg, vyvanse 50mg, clonazepam 0.5mg PRN
Conditions: Anxiety, adhd, post infectous ibs

2 Answers

The most isolated elevated indirect bilirubin is consistent with Gilbert’s syndrome which is a benign condition without consequences. The other possibility for elevated indirect bilirubin would be hemolysis. In that case, you would be anemic. If that’s the case you need to check Haptoglobin, LDH, and Reticulocyte counts.
Yes, what you are describing is consistent with Gilbert's Syndrome. It is not a reason for concern.