Bilirubin – Direct and Indirect

My doctors visit last Friday was as close to a clean bill of health as possible. As we always do, we asked a few questions on the blood test results. Our questions were focused on the bilirubin as the total spiked up to 5.9. My surgeon has come to grips with saying I have Gilbert’s syndrome and although we already agreed, he gave more information that was very convincing.

Although the total bilirubin is high, it’s composed of two parts: direct and indirect. The direct level is a result of liver function, whilst the indirect is from Gilbert’s syndrome or high red blood cell destruction. The surgeon said “GIH, Gilbert’s indirect hemolysis” which must’ve been a way for him in med school to remember the causes of indirect bilirubin, but wouldn’t “GHI” make more sense? I’m not one to argue with a surgeon about his memorization techniques.

Once I got home, I plotted my historical bilirubin numbers. The top plot is the 10 years leading up to the liver transplant and the bottom plot is post-transplant


The total bilirubin doesn’t tell the whole story; my total bilirubin is at a high level, close to pre-transplant levels, but the direct bilirubin shows extremely different trends. Pre-transplant there is a slow increase of both total bilirubin and direct bilirubin indicating slow liver failure whereas post-transplant, the direct bilirubin has plummeted to almost non-existent.

Yet another reason to trust the docs when they say: quit worrying about the bilirubin numbers, especially since the direct number is very low.

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