High bilirubin - Revision history

Maram.Ghiti@anthonynolan.org: /* Guidance */

2024-06-05T13:40:29Z

Guidance

Maram.Ghiti@anthonynolan.org: /* Guidance */

2024-05-23T16:02:04Z

Guidance

Maram.Ghiti@anthonynolan.org: /* Guidance */

2024-05-23T16:00:31Z

Guidance

Maram.Ghiti@anthonynolan.org: /* Guidance */

2024-05-23T15:59:24Z

Guidance

Maram.Ghiti@anthonynolan.org: /* Explanation of Condition */

2024-05-23T15:59:16Z

Explanation of Condition

Maram.Ghiti@anthonynolan.org: /* Explanation of Condition */

2024-05-23T15:57:43Z

Explanation of Condition

Maram.Ghiti@anthonynolan.org: /* Explanation of Condition */

2024-05-23T15:57:17Z

Explanation of Condition

Maram.Ghiti@anthonynolan.org at 15:56, 23 May 2024

2024-05-23T15:56:43Z

Maram.Ghiti@anthonynolan.org: /* Guidance */

2024-05-23T15:55:57Z

Guidance

Maram.Ghiti@anthonynolan.org: /* Guidance */

2024-05-23T15:55:07Z

Guidance

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 If unconjugated bilirubin is <70% of the total, but the LFTs are normal, this should be a case-by-case discussion with a senior medical officer or donor consultant.
-If bilirubin levels are elevated in any capacity and associated with abnormal LFTs, the donation should be stopped and the donor should be referred to Hepatology on an urgent basis via their GP.
+If bilirubin levels are elevated and this is associated with abnormal LFTs, the donation should be stopped and the donor should be referred to Hepatology on an urgent basis via their GP.
 ==Version==

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 If bilirubin is >30umol/L but <3x the upper limit of normal, diagnose Gilbert’s syndrome if the FBC and LFTs are normal AND the unconjugated bilirubin is ≥70% of the total bilirubin.
-If a diagnosis of Gilbert's Syndrome is suspected, the donor's GP should be informed and advised to repeat the bilirubin levels post-donation to ensure normalisation or improvement.
+If Gilbert's Syndrome is diagnosed based on blood tests, the donor's GP should be informed and advised to repeat the bilirubin levels post-donation to ensure normalisation or improvement. The donor should also be informed of the diagnosis (with emphasis on its benign nature).
 If unconjugated bilirubin is <70% of the total, but the LFTs are normal, this should be a case-by-case discussion with a senior medical officer or donor consultant.

← Older revision		Revision as of 16:00, 23 May 2024
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	If bilirubin is >30umol/L but <3x the upper limit of normal, diagnose Gilbert’s syndrome if the FBC and LFTs are normal AND the unconjugated bilirubin is ≥70% of the total bilirubin.		If bilirubin is >30umol/L but <3x the upper limit of normal, diagnose Gilbert’s syndrome if the FBC and LFTs are normal AND the unconjugated bilirubin is ≥70% of the total bilirubin.
		+
		+	If a diagnosis of Gilbert's Syndrome is suspected, the donor's GP should be informed and advised to repeat the bilirubin levels post-donation to ensure normalisation or improvement.

	If unconjugated bilirubin is <70% of the total, but the LFTs are normal, this should be a case-by-case discussion with a senior medical officer or donor consultant.		If unconjugated bilirubin is <70% of the total, but the LFTs are normal, this should be a case-by-case discussion with a senior medical officer or donor consultant.

← Older revision		Revision as of 15:59, 23 May 2024
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	If bilirubin levels are elevated in any capacity and associated with abnormal LFTs, the donation should be stopped and the donor should be referred to Hepatology on an urgent basis via their GP.		If bilirubin levels are elevated in any capacity and associated with abnormal LFTs, the donation should be stopped and the donor should be referred to Hepatology on an urgent basis via their GP.
−

	==Version==		==Version==

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 In addition, some conditions result in the liver being slower than usual at processing bilirubin. One such condition is Gilbert's Syndrome, which is a recessively-inherited genetic disorder in which the UDP-1 enzyme is deficient.
-In Gilbert's Syndrome, unconjugated bilirubin levels increase in times of physiological stress (e.g. infection, dehydration) up to 3x the normal level.
+In Gilbert's Syndrome, unconjugated bilirubin levels temporarily increase in times of physiological stress (e.g. infection, dehydration), though bilirubin levels typically don't exceed 3x the upper limit of normal.
-Gilbert's Syndrome is entirely harmless and is not an exclusion to donating.
+Gilbert's Syndrome is entirely harmless and is not an exclusion to donating. It is suspected that around 1 in 20 people in the UK have Gilbert's Syndrome, and often will not be aware until it is incidentally picked up on a blood test.
 Other genetic disorders also affect the liver's ability to process bilirubin, but in these cases bilriubin can become dangerously elevated (e.g. Crigler-Najjar Syndrome, Rotor Syndrome).

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 Bilirubin initially circulates in the body as unconjugated bilirubin. In this form, it is bound to albumin which acts as its vehicle to transport it around the body.
-Unconjugated bilirubin arrives at the liver, and is processed into conjugated bilirubin.
+Unconjugated bilirubin arrives at the liver where it is processed into conjugated bilirubin.
 Conjugated bilirubin is excreted through the bile ducts into the bowel where it is excreted in stool. Conjugated bilirubin is also excreted through urine.

@@ Line 29: / Line 29: @@
 - Conjugated bilirubin
-Blood tests usually differentiate between the types of bilirubin, but sometimes only a "total bilirubin" result may be available.
+Blood tests usually differentiate between the types of bilirubin, but sometimes only a "total bilirubin" result may be available initially.
 Bilirubin initially circulates in the body as unconjugated bilirubin. In this form, it is bound to albumin which acts as its vehicle to transport it around the body.

← Older revision		Revision as of 15:56, 23 May 2024
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	If bilirubin levels are elevated in any capacity and associated with abnormal LFTs, the donation should be stopped and the donor should be referred to Hepatology on an urgent basis via their GP.		If bilirubin levels are elevated in any capacity and associated with abnormal LFTs, the donation should be stopped and the donor should be referred to Hepatology on an urgent basis via their GP.
		+
		+
		+	==Version==
		+	Version 1, Edition 1
		+
		+	====Date of Last Update====
		+	23rd May 2024

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 If bilirubin levels are <30umol/L and the FBC is abnormal, this can suggest an inherited or haemolytic anaemia, and appropriate work-up should be undertaken for this possibility. If such a diagnosis is made, see the relevant page for details on whether the donation can proceed (some types of anaemia are an exclusion).
-If bilirubin is >30umol/L but <3x the upper limit of normal, diagnose Gilbert’s syndrome if the FBC and LFTs are normal, and the unconjugated bilirubin is ≥70% of the total bilirubin.
+If bilirubin is >30umol/L but <3x the upper limit of normal, diagnose Gilbert’s syndrome if the FBC and LFTs are normal AND the unconjugated bilirubin is ≥70% of the total bilirubin.
 If unconjugated bilirubin is <70% of the total, but the LFTs are normal, this should be a case-by-case discussion with a senior medical officer or donor consultant.
-If bilirubin levels are elevated in any capacity and associated with abnormal LFTs, the donation should be stopped and the donor should be referred to Hepatology via their GP on an urgent basis.
+If bilirubin levels are elevated in any capacity and associated with abnormal LFTs, the donation should be stopped and the donor should be referred to Hepatology on an urgent basis via their GP.

@@ Line 54: / Line 54: @@
 If bilirubin levels are <30umol/L, Gilbert's syndrome can be diagnosed if the FBC and LFTs are normal without the need for a split bilirubin test.
-If bilirubin levels are <30umol/L and the FBC is abnormal, this can suggest an inherited or haemolytic anaemia, and appropriate work-up should be undertaken for this possibility. If such a diagnosis is made, see the relevant page for details.
+If bilirubin levels are <30umol/L and the FBC is abnormal, this can suggest an inherited or haemolytic anaemia, and appropriate work-up should be undertaken for this possibility. If such a diagnosis is made, see the relevant page for details on whether the donation can proceed (some types of anaemia are an exclusion).
 If bilirubin is >30umol/L but <3x the upper limit of normal, diagnose Gilbert’s syndrome if the FBC and LFTs are normal, and the unconjugated bilirubin is ≥70% of the total bilirubin.