Re: High bilirubin only!!!

Posted By Carmel on August 14, 1999 at 20:44:23
Dear Doctor,

I'm 33 years old men, heterosexual, married, no inject drug user, never had blood transfusion, never been multisex partner... I'm experiencing since more than 2 months, fatigue, nausea, joint and muscle pain, abdominal pain or disconfort (right side)... After getting the results of my blood tests (see below), my PCP was not able to figure out what's wrong with me.
April/4/99
ALT 22
ALK 72
GGT 24
total bilirubin 1.4 H (0.1-1.3)
urine analysis: microscopic hematuria, but evrything was normal with IVP and renal sono..

TSH 2.66
Cholesterol 201H
hemoglobin 16.0
juin /18/99 (from a different lab)
ALT 19
AST 16
ALK 95
total bilirubin 1.5H (0.1-1.2)
Direct bilirubin 0.5H (0.0-0.4)
Albumin 4.8  
I was also tested for:
HBVag: not detected
Anti-HCV:non reactive
HCV PCR (amplicor kit): not detected
ANA: negative
CRP <5 (within normal range)
Rheumatoid fator  <20 (within normal range)
ESR 1
TSH 2.66
Also, blood account, serum complement, serum protein electrophoresis, creatinine... all normal.
I was so convinced for a while that I had Hep C , which could be responsible for my symptoms and for the microscopic hematuria,  that I was almost sure that the results were false negative. So I asked my PCP to test my blood for cryoglobulin, but it also came back negative.
I don't know what to do and what to believe: my symptoms or the blood test results...  My PCP is running out of options...
Please help!!
Thanks.

[Curious__0]

Posted By Curious! on August 16, 1999 at 17:27:44
HI!
I have seen at least three cases in this forum, all of them have normal livers enzymes but have all have a small increase in both conjugated and non conjugated bilirubin. Now, if you look carefully at the ratio of total/direct  bilirubin (T/D), you can notice that the ratio is always equal to 3 ( 2.1/0.7, 1.5/0.5, 2.3/0.8.... I'm very curiuos about these data and I have some questions:
1- What do you think about this ratio always equal to 3 in these patients?
1- What is in theory the ratio of T/D in a healthy person?
2- Why these patient are diagnosted , Gilbert's syndrome,  and we know that under Gilbert's syndrome conditions, only non conjugated bilirubin is elevated?
3- Do you think that the high value of direct bilirubin is a lab error due perhaps to the diazo reaction which can overestimate the direct bilirubin?
4- It is written in all hepatology books, that an increase of direct bilirubin should be considred as a liver disease. Is this true only if threre is also an increase of liver enzymes? Otherwise, when one should be worry about his bilirubin?
Thank's for your time.

[Robert__0]

Posted By Robert on August 17, 1999 at 16:30:11
I think that this is a very important point. The direct bilirubin shoud not be detectable in the blood of a healthy person. If it is detectable, the concentration is in general very low. The capacity of the liver to conjugate bilirubin is very very high, and so an increase of direct bilirubin shoud be taken seriously... I don't think that the patient will be convinced if you tell him that his has Gilbert's syndrome under these conditions only because his liver enzymes are not elevated...My question is : Is there a specific diagnostic (other than gilbert's)in which both direct and non direct bilirubin are elevated with normal liver enzymes????
Thanks.










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Re: High bilirubin only!!! Laurie 8/18/1999
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