Elevated Bilirubin

Since October 2012 I have had elevated total bilirubin levels (3.3, 3.9, 4.2, 2.9, 5.0). My last blood test which was done on 2/19/13 showed the total bilirubin to be 5. I had two biopsies done. The first biopsy was done in August 2011 and was read  differently by two pathologists with different results. The first pathologist reading showed grade 1 inflammation stage 0 fibrosis. The second pathologist reading who viewed those same slides stated that the biopsy showed grade 2 of 4, stage 2 of 4 with positive autoimmune markers. My blood work ANA marker came back positive and the rest of the markers came back negative.

I had a second biopsy done in Dec 2012 which stated moderate activity grade 3 of 4, stage 2-3 of 4 with no autoimmune features detected. My hepatologist said that bilirubin does not fluctuate with HCV and wants me to do another biopsy. She believes there is an autoimmune condition. I take cholestyramine when the itching becomes severe. I asked her if cholestyramine could lower bilirubin she said no and on another visit she said yes. I do not believe I have autoimmune hepatitis as the blood work and biopsy did not show it and refused to do a third biopsy. I also had a CT and MRI scan which ruled out any gallstones or billary obstruction. I believe it is just HCV causing the elevation in bilirubin. I have been trying to find out what is going on with me since October 2012 with no answers. What is your opinion on this?

[Thomas D Schiano, MD]

HCV should not cause an eleavted bilirubin in the absence of cirrhosis unless you have an overlap syndrome with autoimmune hepatitis.  Instead of getting a 3rd biopsy it might be worth getting an expert liver pathologist to read the slides.  i would recommend dr isabel fiel here at Mount sinai.