A Puzzle - High Bilirubin Normal Transferases - Not Gilberts

[MrAstro]

Dear All,

I'm panicking badly and would like some help. I'm a 47 year old male

I have had a fibroscan about a year ago and I had a reading of 7.8 (10 samples range 5.1 to 10.1). I used to drink most nights - maybe 2-4 standard glasses. I'm a male. I didn't have much of break - there were some years where maybe I had less and some breaks but I was mostly consistent. Mostly I would have had 2-3 glasses. I was overweight and had a sedentary job. I had a BMI of 31.5. Anyway I had some blood tests a few years ago that had very mild elevations of ALT 57 mol and Bilirubin 26 back in 2010 and 2012.

I also had high cholesterol and triglycerides although I don't have diabetes.

Since then I moderated my drinking somewhat and then lately it scared me because I had persistently high ferritin at about 400 to a high of 490. At the moment my ferritin is 420.

I lost weight from 92kg to 70kg on purpose by exercising 1-2 hours walking per day and counting calories religiously. I've kept that weight off for a year.

I have abstained from alcohol absolutely completely for 2 years.

So recently I had a scary blood test - things were supposed to improve and mostly they have improved miraculously. My cholesterol is mostly normal although lately it was just a hair over. My Fasting Glucose is 4.6mmol/l


Albumin  41
Globulin  31
ALP        78
GGT        22
ALT         25
AST        25
LDH        185
T Bilirubin 37H
C Bilirubin 9 H
Ferritin      420
INR = 1

Platelets are about 188K
Haemocrit        0.5
Haemoglobin 174
WCC              6.1
RCC               5.7
ESR               2

They found that I was a carrier phenotype MZ for Antitrypsin but that only has a slightly increased chance of liver disease.

I would say I don't have Gilberts based on the ratio of Direct/indirect bilirubin.

So now that Gilbert's isn't a crutch I'm scared out of my wits and don't understand how everything looks good except for bilirubin, ferritin (slightly elevated - lab range is 30-400 - I'm 420 at my last test.

Over the last year since I lost weight and kept it right off, I walk maybe 15000 steps per day (1.5 hours maybe) - which is a lot of exercise. But a bilirubin score of 37 mmol/l is very scary isn't it when it's not Gilberts disease. at 20 mmol/L you have lost half the excretory capacity of the liver from what I've read.

It doesn't appear to me to be haemolysis based on the results.

I have also had ultrasounds very recently and I don't believe they found anything ie. everything looked pretty good from what I know. (my sister did one). She also did a shear wave ultrasound very recently and got a reading of 1.32 based on multiple samples. So from my understanding moderate fibrosis would occur at 1.37.

I'm seeing a GI Dr. in a few weeks to look at the results but I'm scared out of my wits. I don't understand how I can have normal transferases and high bilirubin without it being Gilberts or Haemolysis - not that I understand my results to rule out haemolysis.

Can someone please give their thoughts on this. I calculated the MELD score at 10 - due to the bilirubin

[MrAstro]

I'm now even a bit more confused because my unconjugated bilirubin component is most of the excess bilirubin - so maybe it really is Gilberts + a bit of liver disease cause the slight elevation on the conjugated component (Direct) - ie. 9 umol/L???? i.e.. most of the elevation is indirect.