Side Effect: Increased Bilirubin (hyperbilirubinemia)

What is Increased Bilirubin (hyperbilirubinemia)?

• Bilirubin is a yellow pigment produced by the breakdown and processing of red blood cells in the spleen, liver, and gall bladder.
• Increased bilirubin can result from problems outside of the liver (extra-hepatic), problems with the liver (intra-hepatic), or problems with bile ducts (post-hepatic).
• Extra-hepatic causes are due to increased breakdown of red blood cells, a process known as hemolysis
• A hepatic cause is often due to a liver disease that prevents the liver from processing bilirubin effectively.
  • A post-hepatic cause involves conditions that obstruct the bile ducts which prevent the excretion of bilirubin from the liver and causes it to build up in the bloodstream.

What does Increased Bilirubin (hyperbilirubinemia) look like?

• High levels of bilirubin can lead to a condition known as jaundice, which is characterized by a yellowing of the skin and whites of the eyes, dark colored urine, light colored stool, and itching of the skin.
• Jaundiced is not usually noticed until the bilirubin in the blood increases to 2.5mg/dL, or higher.
• The severity of jaundice can vary depending on the underlying cause and the level of bilirubin elevation.

Who gets Increased Bilirubin (hyperbilirubinemia)?

Common causes of increased bilirubin include:

• viral infections (hepatitis A, B, and C)
• chronic alcohol use
• autoimmune disorders
• medications
• gallstones
• pancreatitis

Patients with cancer can develop increased bilirubin levels due to various reasons:

• Primary liver, gallbladder, or bile duct cancer
• Liver metastases
• Obstruction of bile ducts by the tumor
• Chemotherapy-induced liver damage
• Radiation damage to liver

How to prevent Increased Bilirubin (hyperbilirubinemia)

Prevention of elevated bilirubin levels in patients with cancer may involve:

• treating the malignancy
• adjusting medication dosage when indicated
  • Some patients with a reduced amount of a certain enzyme in their body have trouble breaking down bilirubin and certain medications in these people cause the bilirubin to go up higher than in those with a normal amount of the enzyme
  • The enzyme deficiency is known as Gilbert’s syndrome (pronounced Jeel-bear’s syndrome), and the enzyme of interest is called “UGT1A1”
• avoiding hepatotoxic drugs
• monitoring liver function during treatment.

How to treat Increased Bilirubin (hyperbilirubinemia)

• Treatment of an increased bilirubin in patients with cancer depends on the underlying cause such as treating the underlying malignancy or infection.
• Some medications may need to be adjusted or stopped completely.
• In some cases where there is an obstruction of the bile ducts, interventions such as stenting or surgery may be necessary to relieve the obstruction and reduce bilirubin levels.
• In very advanced cases, such as end stage liver disease, the only treatment may be supportive care.