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Why is the unconjugated bilirubin higher than the conjugated one?

Q: I had jaundice two years back cured with precautions and proper care. The bilirubin levels came down from 7 to 1.5 gradually. But last week my bilirubin came out to be 3.3. The total part consists of 0.7 (conjugated) and 2.6 (unconjugated). After checking me the doctor found nothing abnormal clinically and told me to be under care as the medical fitness level was still not achieved. He was surprised why the unconjugated part was greater than the conjugated part which is not common. Can you please tell me what is the reason for that? We don't have much qualified doctors in our locality. Can you please suggest me what medical tests I need to get done and what precautions I need to maintain?

A:I would recommend rechecking the bilirubin level to confirm that it is truly high. When the unconjugated bilirubin is that high the condition is called unconjugated hyperbilirubinaemia, provided all other liver tests are normal. The two most common causes for unconjugated hyperbilirubinemia are haemolytic anaemias, and Gilbert's disease. If you do not have anaemia you most likely have Gilberts disease. This condition is not likely to cause you any problem and is associated with a normal life span. The unconjugated bilirubin in Gilbert's disease tends to increase with viral illnesses, and with prolonged fasting.

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