Unconjugated Hyperbilirubinemia

I can't find another category for this q to go in.

I am a 20 year old male, drink very occasionally (approx once per month, no more than 3 bottles of lager) don't smoke or take drugs, on no long term meds

Investigation into the above is as follows:

Ultrasound - clear
Mri scan - clear
Copper urinalysis - clear
Blood smear - stomatocytes, atypical lymphs and target cells.

Most recent LFT:

Albumin: 47 g/L
Alk Phos: 60 u/L
Alt/SGPT serum: 13 u/L
Serum gamma GT: 15 u/L
Serum total bilirubin: 94 umol/L

Nobody has any idea what is going on. I currently feel extremely sleepy throughout the day. And have mild jaundice of the sclera. Otherwise I am ok. I have just started on Liv 52.

Any idea what may be causing this?

[Thomas D Schiano, MD]

as all the liver tests are normal except bilirubin, you most likely has gilbert's disease.  however, if you are anemic you may have a hemolytic anemia.  please have them fractionate the bilirubin level to see if direct or indirect.

[iflyj]

The bilirubin is unconjugated. The only other abnormality they have found is the abnormal cells. Could this be related or is it likely that they are related to something else? Would anemia have been picked up by blood tests? If so then no I am not anemic. Thanks for your help.

[Thomas D Schiano, MD]

even though you are not anemic the blood smear appears abnormal, suggesting maybe there is some mild hemolysis ongoing, leading to the elevated bilirubin level

[iflyj]

Thanks for the reply. What may be causing the hemolysis? I have been told that stomatocytes and target cells could signify chronic liver disease in some cases which is the only reason I have not been discharged from clinic. Is this still a possibility even though all my other liver tests, biochemistry and hematology is completely normal? I have since started to feel mild pain and discomfort in the upper-right quadrant. Many thanks.