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Routine Blood Work Shows High Bilrubin Total, Iron Serum. Should I Be Worried?

Posted on Tue, 28 May 2013

Question: I had routine bloodwork done at a health fair (attached). My results came back and my Bilirubin Total was high at 1.7 (range listed is 0.2-1.2 mg/dl), my Bilirubin Direct was high at 0.3 (range given is 0.0-0.2 mg/dl) and my Iron Serum was high at 231 (range listed is 40-175 MCG/DL). All other values were normal. Should I be worried? I am uninsured so I don't have a physician. I'm seemingly in good health - no major illnesses, I'm a vegetarian and a healthy weight. Take Advil and Tramadol occasionally for tendonitis in wrist. I'm not sure of what my next step would be. I do take a multi-vitamin, but it does not contain iron.

Answered by Dr. Satyadeo Choubey (34 minutes later)

Hi,

Thanks for visiting Healthcarmagic.

When I went through your lab reports, one thing which worried me was serum iron. Raised serum iron can be manifestation of a disease called hemochromatosis. Usually the patients are asymptomatic in almost 70-75% of cases. Many a times it is diagnosed on routine screening procedures as you have undergone. Disease manifestation is rare before forties in males and fifties in females. But since there is a strong risk of irreversible damage to liver and other organs both the diagnosis and treatment is must.

For the preliminary studies three lab tests are needed : serum iron, serum ferritn and total iron binding capacity to calculate transferrin saturation. All these tests should be done on fasting blood samples. A transferrin saturation of more than 45-50% makes the suspicion stronger and then mutational studies will be needed for confirmation.

Mildly raised isolated bilirubin without raised AST/ALT/alkaline phosphatase has got a little value in adult population, so don't worry for that.

Kindly arrange for the three tests, I have advised..

Best wishes

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Satyadeo Choubey (45 hours later)

Thank you so much for your reply. I have scheduled the blood tests that you mentioned.

So, just to make sure I'm understanding you correctly, I don't need to be concerned about the elevated bilirubin levels?

If it isn't hemochromotosis, is there something else that could raise the iron serum level? Anything else I should be tested for?

Thank you,
XXXXXX XXXXXXX

Answered by Dr. Satyadeo Choubey (9 minutes later)

Thanks for follow up,
Your serum bilirubin is not too high to get worried and usually they make little sense with normal ALT/AST/alkaline phosphatase level.
Serum iron can be raised in conditions usually associated with anemia like thalassemia, sideroblastic anemia etc. since they are not meant for you as your hemoglobin level is normal, it will be nice to have the report of previously described tests first. Moreover, in other conditions, iron level does not rise to this extent and patients are usually symptomatic.

Thanks and best wishes

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Satyadeo Choubey (8 days later)

I had the tests done you requested and I'm attaching the results. The results look normal...should I be doing anything else?
I was taking quite a lot of vitamins before the first test, and stopped taking them a few weeks prior to the second test...would that have anything to do with the results?
Thank you,
XXXXXX

Answered by Dr. Satyadeo Choubey (12 minutes later)

Thanks for follow up.

Your report is fairly normal. Congratulations.

Previous report may be a lab error. Intake of vitamin doesn't influence serum iron profile. So now nothing to worry.

And, Yes, continue your vitamin intake under medical supervision.

Best wishes

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Mohammed Kappan