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.
The Derek Janiak Hepatobiliary Forum 
dude, you’re like the Nate Silver of bilirubin. (you can use that in your Twitter bio if you want.)