eMedicine Specialties > Gastroenterology > Systemic Disease

Hyperbilirubinemia, Unconjugated: Follow-up

Author: Sandeep Mukherjee, MB, BCh, MPH, FRCPC, Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center
Coauthor(s): Nuri Ozden, MD, Assistant Professor, Department of Internal Medicine, Meharry Medical College
Contributor Information and Disclosures

Updated: Nov 19, 2009

Follow-up

Complications

  • Increased production of bilirubin
    • Hemolysis: Formation of pigment gallstones, reflecting precipitation of calcium bilirubinate, is the major complication of long-standing excessive bilirubin production.
    • Ineffective erythropoiesis (ELB production): Similar to other causes of enhanced bilirubin production, it predisposes to cholelithiasis.
  • Neonatal jaundice, nonphysiologic
    • Maternal milk jaundice: Neurologic damage has not been reported.
    • Maternal serum jaundice (Lucey-Driscoll syndrome): This entity is occasionally associated with kernicterus.

Prognosis

  • Increased production of bilirubin, ineffective erythropoiesis (ELB production): Prognosis for this rare form of ineffective erythropoiesis appears to be excellent.
  • Neonatal jaundice, nonphysiologic
    • Maternal milk jaundice: Jaundice may continue for 4 weeks but promptly resolves when breastfeeding is discontinued. Prognosis is excellent.
    • Maternal serum jaundice (Lucey-Driscoll syndrome): Prognosis is good, but jaundice can persist for several weeks.
  • Impaired conjugation of bilirubin
    • Crigler-Najjar syndrome type I: Unless treated vigorously (ie, orthotopic liver transplant, segmental transplantation), most affected patients die by 15 months of life. Fortunately, more patients are surviving to adulthood because of advances in the treatment of hyperbilirubinemia.
    • Crigler-Najjar syndrome type II (Arias syndrome): Although type II runs a more benign clinical course than type I, several cases of bilirubin-induced brain damage have been reported.
    • Gilbert syndrome: Once the diagnosis is established, only reassurance is necessary because of the excellent prognosis.

Patient Education

 


More on Hyperbilirubinemia, Unconjugated

Overview: Hyperbilirubinemia, Unconjugated
Differential Diagnoses & Workup: Hyperbilirubinemia, Unconjugated
Treatment & Medication: Hyperbilirubinemia, Unconjugated
Follow-up: Hyperbilirubinemia, Unconjugated
Multimedia: Hyperbilirubinemia, Unconjugated
References
Further Reading
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References

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Keywords

unconjugated hyperbilirubinemia, hemolysis, Gilbert syndrome, jaundice, bilirubin levels, high bilirubin, bilirubin level, elevated bilirubin, serum bilirubin, acute hemolytic crisis, paroxysmal nocturnal hemoglobinuria, unconjugated bilirubin, Crigler-Najjar syndrome, Gilbert syndrome, dyserythropoietic, physiologic jaundice, breast milk jaundice

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Contributor Information and Disclosures

Author

Sandeep Mukherjee, MB, BCh, MPH, FRCPC, Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center
Sandeep Mukherjee, MB, BCh, MPH, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Coauthor(s)

Nuri Ozden, MD, Assistant Professor, Department of Internal Medicine, Meharry Medical College
Nuri Ozden, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Medical Editor

Ann Ouyang, MBBS, Professor, Department of Internal Medicine, Pennsylvania State University College of Medicine; Attending Physician, Division of Gastroenterology and Hepatology, Milton S Hershey Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Oscar S Brann, MD, FACP, Associate Clinical Professor, Department of Medicine, University of California at San Diego; Consulting Staff, Mecklenburg Medical Group
Oscar S Brann, MD, FACP is a member of the following medical societies: American Gastroenterological Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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