Bilirubin is a yellow pigment resulting from the natural breakdown of heme, a component found in red blood cells. The liver processes bilirubin, making it water-soluble, and excretes it through bile into the stool. When the body cannot process or eliminate bilirubin quickly enough, it accumulates in the bloodstream, leading to hyperbilirubinemia, which manifests as jaundice (a yellowing of the skin and eyes). High levels of unconjugated bilirubin, especially in newborns, can be toxic and may signal an underlying health issue.
How Bilirubin Becomes Elevated
Elevated bilirubin pathways differ between adults and newborns. In almost all infants, hyperbilirubinemia is unconjugated because the liver is not yet mature enough to efficiently process the pigment for excretion, a condition known as physiological jaundice. Newborn red blood cells also break down faster, creating a higher initial load for the immature liver to handle. Breast milk jaundice, which peaks later, involves factors that increase the reabsorption of bilirubin from the intestines.
In adults, elevated bilirubin is categorized by where the problem occurs. Pre-hepatic causes involve excessive destruction of red blood cells, such as hemolytic anemia, which overwhelms the liver. Hepatic causes include liver diseases like hepatitis or cirrhosis, where damaged liver cells cannot process bilirubin effectively. Post-hepatic causes, such as gallstones or tumors, involve a blockage in the bile ducts, preventing the processed, conjugated bilirubin from being excreted into the intestine.
Clinical Treatments for Rapid Reduction
For dangerously high bilirubin levels, medical intervention is necessary to prevent complications, particularly in infants. Phototherapy is the primary treatment for newborns with significant hyperbilirubinemia. This procedure involves placing the infant under special blue-green lights, which penetrate the skin and change the bilirubin molecule’s structure. This converts the fat-soluble, unconjugated bilirubin into a water-soluble form that the body can excrete directly through urine and stool.
If severe, rapidly rising bilirubin does not respond to intensive phototherapy, an exchange transfusion may be required. This involves systematically removing small amounts of the infant’s blood and replacing it with donor blood, which dilutes and removes circulating bilirubin. For adults, rapid reduction focuses on treating the root cause, such as administering medications to stop red blood cell destruction in hemolytic conditions. Surgical or endoscopic procedures may also be necessary to relieve a bile duct obstruction caused by gallstones or a tumor, allowing the processed bilirubin to drain.
Lifestyle and Nutritional Support
For adults dealing with chronic or mildly elevated bilirubin, particularly in conditions like Gilbert’s syndrome, lifestyle and nutritional adjustments support liver function. Maintaining adequate hydration helps flush the body and supports the excretion of bile and toxins. Fiber-rich foods, such as whole grains, legumes, and cruciferous vegetables, bind to bilirubin in the intestines. This binding prevents the pigment from being reabsorbed into the bloodstream, promoting its elimination through the stool.
Avoiding substances that strain the liver is important. This includes eliminating alcohol consumption and limiting highly processed foods, which often contain excessive sugars and unhealthy fats. For individuals with Gilbert’s syndrome, elevated bilirubin episodes are often triggered by stress, fasting, or illness. Managing stress through sufficient sleep and relaxation techniques can help stabilize bilirubin levels and reduce symptomatic flare-ups.
Recognizing When to Seek Emergency Care
While mild jaundice is common, especially in newborns, certain signs necessitate immediate medical attention. In infants, parents should watch for signs of kernicterus, which is brain damage caused by extremely high bilirubin levels. Symptoms include lethargy or difficulty waking, a high-pitched or inconsolable cry, poor feeding, and arching the neck or body backward.
For adults, severe hyperbilirubinemia can signal acute liver failure or a complete blockage, requiring prompt evaluation. Seek emergency care if jaundice is accompanied by extreme fatigue, a high fever, sudden and severe abdominal pain, or confusion. The appearance of dark, tea-colored urine and pale, clay-colored stools also indicates that bilirubin is not being properly excreted and is a warning sign.