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What causes fluctuation of bilirubin level?

Q: I am a 26 years old student suffering from jaundice for the last 10 months. I also have dull pain near rib cage area. I underwent hepatitis B and C tests, but both showed non reactive. I also underwent abdomen scan, which came normal. 10 months back, my bilirubin level was 2.4 mg/dl, but now it is fluctuating between 1 and 1.7 mg/dl. I consulted a doctor and asked him the reason behind the fluctuating bilirubin level. He told me that it is normal. I underwent liver function test (LFT) which showed total bilirubin - 1.6 mg/dl, direct bilirubin - 0.5 mg/dl, indirect bilirubin - 1.1mg/dl, SGOT was 21 IU/L and SGPT - 18 IU/L.

A:You do not have jaundice due to a liver disease, and have a condition called unconjugated hyperbilirubinaemia. This can be due to a congenital (from birth) inefficiency of the enzyme in the body that metabolises (breaks down) bilirubin in the body, or due to an increased production of bilirubin from red cell breakdown.

Please get the following blood tests done and send me the reports: if they are normal, the diagnosis is the first one, and if they are abnormal, the diagnosis is the second one:

  • Full blood count - Hb, WBC, Platelets
  • Reticulocyte count
  • Sickle cell test
  • Haemoglobin electrophoresis.

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