Bilirubin is a yellowish substance in your blood. It forms after red blood cells break down, and it travels through your liver, gallbladder, and digestive tract before being excreted.

Typically, bilirubin levels fall somewhere between 0.3 and 1.2 milligrams per deciliter (mg/dL). Anything above 1.2 mg/dL is usually considered high.

The condition of having high bilirubin levels is called hyperbilirubinemia. It’s usually a sign of an underlying condition, so it’s important to follow up with a doctor if test results show you have high bilirubin.

Many babies are also born with high bilirubin, causing a condition called newborn jaundice. This causes yellow-tinted skin and eyes. It happens because, at birth, the liver often isn’t yet fully able to process bilirubin. This is a temporary condition that usually resolves on its own within a few weeks.

Read on to learn more about the symptoms of high bilirubin and what can cause it.

If you have high bilirubin, your symptoms will depend on the underlying cause. You can have mildly high bilirubin and have no symptoms at all. Or, with moderately high bilirubin, you may only have jaundice, a yellow cast to your eyes and skin. Jaundice is the main sign of high bilirubin levels.

Other general signs of many of the illnesses that cause high bilirubin can include:

  • abdominal pain or swelling
  • chills
  • fever
  • chest pain
  • weakness
  • lightheadedness
  • fatigue
  • nausea
  • vomiting
  • unusually dark urine

Having high bilirubin can be a sign of several conditions. Your doctor will take your symptoms, as well as any other test results, into account to help narrow down a diagnosis.

Gallstones

Gallstones happen when substances like cholesterol or bilirubin harden in your gallbladder. Your gallbladder is responsible for making bile, a digestive fluid that helps break down fats before they enter your intestines.

Symptoms of gallstones include:

  • pain in your upper right abdomen or right below your chest
  • back pain between your shoulders or in your right shoulder
  • feeling sick
  • throwing up

Gallstones may form if your body is already producing too much bilirubin due to a liver condition or if your liver’s creating too much cholesterol. They can also be a complication of an infection of your bile ducts or from a blood disorder. Bilirubin builds up when your gallbladder’s blocked and can’t drain properly.

Gilbert’s Syndrome

Gilbert’s syndrome is a genetic liver condition that causes your liver to not process bilirubin properly. This causes it to build up in your blood stream.

This condition often doesn’t cause symptoms, but when it does, they can include:

  • jaundice
  • nausea
  • vomiting
  • diarrhea
  • minor abdominal discomfort

Liver dysfunction

Any condition that affects the function of your liver can cause bilirubin to build up in your blood. This is a result of your liver losing its ability to remove and process bilirubin from your bloodstream.

Several things can affect the function of your liver, including:

Common symptoms of liver dysfunction include:

  • jaundice
  • pain or swelling of your abdomen
  • swelling of your legs or ankles (edema)
  • exhaustion
  • nausea
  • vomiting
  • easy bruising
  • dark urine
  • pale, bloody, or black stools
  • itchy skin

Hepatitis

Hepatitis happens when your liver gets inflamed, often due to a viral infection. When it’s inflamed, your liver can’t easily process bilirubin, leading to a buildup of it in your blood.

Hepatitis doesn’t always cause symptoms, but when it does, they can include:

  • jaundice
  • exhaustion
  • dark urine
  • abdominal pain
  • nausea
  • vomiting

Bile duct inflammation

Your bile ducts connect your liver to your gallbladder the opening of your small intestine, called the duodenum. They help to move bile, which contains bilirubin, from your liver and gallbladder into your intestines.

If these ducts become inflamed or blocked, bile can’t be properly drained. This can lead to an increased level of bilirubin.

Symptoms of bile duct inflammation may include:

  • pale stools
  • dark urine
  • jaundice
  • itching
  • nausea
  • vomiting
  • unexplained weight loss
  • fever

Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy is a temporary condition that can happen during the last trimester of pregnancy. It causes bile drainage from your liver to either slow down or stop entirely. This makes it harder for your liver to process bilirubin from your blood, leading to high bilirubin levels.

Symptoms of intrahepatic cholestasis of pregnancy include:

  • itchy hands and feet without a rash
  • jaundice
  • gallstone symptoms

Hemolytic anemia

Hemolytic anemia happens when blood cells break down too quickly in your bloodstream. It’s sometimes passed down genetically, but autoimmune conditions, an enlarged spleen, or an infection can also cause it.

Symptoms of this hemolytic anemia include:

  • exhaustion
  • difficulty breathing
  • dizziness
  • headaches
  • abdominal pain
  • chest pain
  • jaundice
  • cold hands or feet

In many cases, high bilirubin isn’t a sign of anything that needs immediate treatment.

But if you notice any of the following symptoms, call your doctor or head to urgent care just in case:

  • intense abdominal pain or tenderness
  • drowsiness or disorientation
  • black or bloody stools
  • vomiting blood
  • a fever of 101°F or higher
  • easy bruising or bleeding
  • red or purple skin rash

High bilirubin levels are usually a sign that something’s not quite right in your liver or gallbladder. Some of these conditions aren’t too serious, but it’s important to monitor and treat them.

Anyone with jaundice, the main sign of high bilirubin levels, needs to see their doctor. If your doctor isn’t immediately sure what’s causing your high bilirubin levels, you may need to return for additional blood, liver function, or other tests.