Overview

Hyperbilirubinemia or Jaundice is a term which is used to describe a condition which results in the skin and the eyes showcasing a peculiar yellowish tinge. It’s caused by the accumulation of a brownish-yellow substance known as bilirubin in the blood and body’s tissues. Bilirubin is a waste material found in the blood which forms as a result of old or damaged red blood cells breaking down. Ordinarily, bilirubin goes through a metabolization process initiated by the liver that allows it to be excreted safely via stool and urine. However, in cases where the red blood cells get broken down quicker than the usual process or when the optimum functioning of the liver is affected, hyperbilirubinemia can occur.

Depending on the levels of bilirubin present, the color of the skin and the whites of the eyes will differ. This is because bilirubin has a yellowish pigment or coloring. Hence, in case of moderate levels, the skin or the eyes give out a yellowish tinge while in case of high levels, it can even appear brown. Most healthy babies tend to have hyperbilirubinemia – especially in the case of infants born before the 38-week gestation period. As a matter of fact, as per a study by the Centers for Disease Control and Prevention, it has been reported that nearly 60 percent of all newborn babies experience hyperbilirubinemia. That being said, while this condition usually affects infants, Hyperbilirubinemia is a condition which can affect individuals of all ages.

Symptoms

Hyperbilirubinemia may be indicative of a critical problem with the pancreas, blood cells, bile-duct, gallbladder or liver. Some of the most common symptoms to look out for are below:

• Prominent yellow discoloration which affects the eyes and the skin
• Dark colored urine sometimes to a brownish tone
• Pale or clay colored stools
• Vomiting and nausea
• Extreme fatigue
• Bloating
• Abdominal pain
• Loss of appetite
• Heartburn
• Unexplained weight loss
• Constipation
• Muscle and joint pain
• A high fever/ Chills
• Itching of the skin

In the case of infants, as the levels of bilirubin level increase, the spread of jaundice usually starts from the head to the torso, and then progress to the hands and feet. Further, a few more symptoms may be prevalent in newborn’s including:

• Laziness or inactivity
• Unexplained variations in the muscle tone
• High-pitched crying
• Poor feeding patterns
• Seizures or convulsions

If left untreated for long, Hyperbilirubinemia can give rise to several complications, especially in infants. This happens primarily owing to the increase in the toxicity levels in the brain which, in turn, leads to a condition called kernicterus. Kernicterus is characterized by the occurrence of seizures and can result in complications such as Cerebral palsy, Hearing loss, Vision problems, Teeth problems, Intellectual disabilities, irreversible brain damage, and even death.

However, it needs to be mentioned that the chances of getting misdiagnosed are quite common when it comes to jaundice. At times, the skin can turn yellow when there’s an oversupply of beta-carotene – a type of anti-oxidant found mainly in fruits and plants.

Causes

Jaundice can happen as a result of various disease processes and therefore classified into three primary categories.

Pre-hepatic jaundice

Pre-hepatic jaundice is due to a rapid increase in the rate of hemolysis – breakdown/destruction of RBCs.  This inhibits the liver from efficiently excreting high levels of bilirubin from the blood.

Hepatocellular jaundice

Hepatocellular jaundice can occur because of any infection that affects the functioning of the liver. This can meddle with the liver’s ability to function efficiently and prevent the bilirubin from being converted into conjugated bilirubin. Some of the diseases which can cause this interruption include viral hepatitis, cirrhosis, Crigler-Najjar syndrome, Gilbert’s syndrome, and non-alcoholic fatty liver disease.

Post-hepatic jaundice

Also referred to as obstructive jaundice, Post-hepatic jaundice occurs as a result of a disruption to the normal drainage of conjugated bilirubin in the form of bile in the biliary system. The most common cause is due to the presence of a gallstone in the bile ducts or due to strictures of the bile ducts. There are other underlying conditions that may cause jaundice including pancreatic cancer, bile duct carcinoma, cholangitis, congenital malformations etc.

In the case of newborns, some of the most common causes of jaundice include:

• Physiological jaundice
• Maternal-fetal blood group incompatibility (Rh, ABO)
• Breast milk jaundice
• Breastfeeding jaundice
• Cephalohematoma referred to as a formation of blood under the scalp

In some cases, hyperbilirubinemia can also be caused owing to a lack of digestive bacteria in newborns. This, in turn, prevents the proper breakdown of bilirubin also known as neonatal hyperbilirubinemia.

Further, one needs to understand that jaundice as such isn’t indicative of a disease; it actually a symptom or a precursor of something more. Which is why people suffering from jaundice might also have any of the following complications:

• Alcohol abuse
• Liver cancer
• Blood disorders
• Liver infection
• Liver Cirrhosis (Liver scarring owing to excessive alcohol consumption)
• Presence of Gallstones
• Pancreatic cancer
• Hepatitis (Swollen liver that decreases its functionality).
• An overdose or an adverse reaction to the certain type of medications.

Treatment

In order to accurately diagnose jaundice, the consulting doctor will initially ask the patient to furnish his full medical history following which a physical exam will be conducted. Thereon, a diagnostic blood test might be undertaken to check for the presence of hepatitis virus antibodies and to analyze the levels of bilirubin, abnormal red blood cells along with any other substances that are indicative of liver function.

Depending on the nature of jaundice, an appropriate treatment plan will be suggested. If it is caused by viral hepatitis, it will recover on its own as the infection resolves itself. If the cause is other infections, then a specific recovery plan will be devised. For instance, obstruction-induced jaundice will be treated through surgical removal of the obstruction. In case the jaundice has been triggered due to a certain medication, the doctor might advise to change the medication and switch over to an alternative medication. In any case, plenty of rest and fluid consumption will be recommended. The ultimate aim of the treatment is to prevent bilirubin levels from developing to hazardous levels. If the bilirubin has crossed dangerous proportions, blood transfusions will be required in order to get rid of the excess build-up of bilirubin and to rejuvenate the RBCs.