Abstract

Unconjugated hyperbilirubinemia in adolescents and young adults has to be differentiated clinically as it is associated with different clinical presentation, most commonly Gilbert syndrome (GS) - a benign hereditary bilirubin conjugation defect - versus increased bilirubin production from mild haemolytic disorders such as β-thalassemia trait, with the rare Crigler-Najjar syndromes as important considerations. This publication is made to educates clinicians and medical students. Basic laboratory tests and clinical clues will be important. Liver function tests (LFTs) and hemolysis markers (complete blood count, reticulocyte count, lactate dehy drogenase, etc.), followed by targeted tests such as haemoglobin electrophoresis for hemoglobinopathies and provocative tests (fasting or rifampicin test, phenobarbital trial) for conjugation defects We emphasize how in expensive investigations can confirm the diagnosis, avoiding unnecessary costly workups. Key distinguishing features of GS, Crigler-Najjar type 2, and β-thalassemia trait - including typical bilirubin levels, hematologic indices, genetic basis, and management - are summarized in a comparative table. Early recognition of these benign conditions is crucial for patient reassurance, appropriate counselling (e.g. for carrier traits), and pre venting unwarranted interventions.

DOI: doi.org/10.63721/26JNRP0108

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