Cause | Direct-Reacting Bilirubin | Indirect-Reacting Bilirubin | Associated Features |
Liver disease (many types) | Elevated | Elevated or normal | Liver enzyme levels often elevated |
Hemolysis | Normal | Elevation represents more than 90% of total bilirubin | Anemia usual; increased reticulocyte count; normal liver enzyme levels (although LDH may be elevated) |
Gilbert's syndrome | Normal | Elevation represents more than 90% of total bilirubin (common) | No abnormal liver tests; no anemia; onset in late adolescence; fasting makes bilirubin rise |
LDH, lactate dehydrogenase.