Causes of Gilbert's Syndrome

Causes of Gilbert's Syndrome: Online Medical Books

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Hyperbilirubinemia: Causes
(Professional Guide to Diseases (Eighth Edition))

As erythrocytes break down at the end of their neonatal life cycle, hemoglobin (Hb) separates into globin (protein) and heme (iron) fragments. Heme fragments form unconjugated (indirect) bilirubin, which binds with albumin for transport to liver cells to conjugate with glucuronide, forming direct bilirubin. Because unconjugated bilirubin is fat-soluble and can’t be excreted in the urine or bile, it may escape to extravascular tissue, especially fatty tissue and the brain, resulting in hyperbilirubinemia.

This pathophysiologic process may develop when:

❑ certain factors disrupt conjugation and usurp albumin-binding sites, including drugs (such as aspirin, tranquilizers, and sulfonamides) and conditions (such as hypothermia, anoxia, hypoglycemia, and hypoalbuminemia)

❑ decreased hepatic function results in reduced bilirubin conjugation

❑ increased erythrocyte production or breakdown results from hemolytic disorders, or Rh or ABO incompatibility

❑ biliary obstruction or hepatitis results in blockage of normal bile flow

❑ maternal enzymes present in breast milk inhibit the neonate’s glucuronyl-transferase conjugating activity. (See Causes of hyperbilirubinemia, page 986.)

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