Relation of Direct & Indirect Bilirubin

My brother is suffering from Viral Hepatitis and his Serum Bilirubin Tests are as under:

October 20 2010
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Total Bilirubin    : 17.52 mg%
Direct Bilirubin   : 10.61 mg%
Indirect Bilirubin : 6.91 mg%
SGPT : 42.60 Units/Litre

November 03 2010
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Total Bilirubin    : 14.24 mg%
Direct Bilirubin   : 6.97 mg%
Indirect Bilirubin : 7.27 mg%
SGPT : 22.70 Units/Litre

Within 12 days, although Total Bili & Direct Bili have gone down but INDIRECT BILI has Increased.

Why it is so, any suggestions and precautions?

[sachinagarwal]

Any replies please...?

[mikesimon]

"...Bilirubin levels can be used to identify liver damage/disease or to monitor the progression of jaundice. Increased total or unconjugated (indirect) bilirubin may be a result of hemolytic, sickle cell or pernicious anemias or a transfusion reaction. If conjugated(direct) bilirubin is elevated, there may be some kind of blockage of the liver or bile ducts, hepatitis, trauma to the liver, cirrhosis, a drug reaction, or long-term alcohol abuse...."
From: http://www.labtestsonline.org/understanding/analytes/bilirubin/test.html

Gilbert's Syndrome is also a possibility when you have a normal direct bilirubin and an elevated indirect bilirubin. Gilbert's is a genetic disorder in which indirect bilirubin is elevated. It is considered to be a benign disorder and not a threat to the health of the patient.

In my opinion the bottom line is that an elevated direct bilirubin suggests a liver or bile duct disorder whereas an elevated indirect bilirubin suggests a non-liver issue.

Good luck,
Mike