Isolated raised bilirubin (unconjugated bilirubin; Gilbert's syndrome)
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Isolated raised bilirubin without anaemia: fasting recheck
Fasting laboratory tests
- Total and conjugated bilirubin (the unconjugated fraction is deduced)
- FBC
- AST
- ALT
- GGT
- Alkaline phosphatase
Do not order
- UGT1A1 genotyping (outside the fee schedule): pointless to establish Gilbert's syndrome. For a predominantly unconjugated bilirubin without haemolysis, the UK guideline concludes Gilbert's syndrome and reassures; it reserves genetic testing for unconjugated bilirubin > 40 µmol/L (looking for Crigler-Najjar syndrome) [1].
With anaemia, or unconjugated bilirubin > 40 µmol/L: look for haemolysis
Fasting laboratory tests
- Total and conjugated bilirubin
- FBC
- Reticulocyte count
- Haptoglobin
- LDH
Sources (5)
- Newsome PN, Cramb R, Davison SM, et al. Guidelines on the management of abnormal liver blood tests (British Society of Gastroenterology, Association of Clinical Biochemistry and Laboratory Medicine, British Association for the Study of the Liver). Gut. 2018;67(1):6-19.
- Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am J Gastroenterol. 2017;112(1):18-35.
- Agence européenne des médicaments. Reyataz (atazanavir) : résumé des caractéristiques du produit (information produit EPAR), rubrique 4.4, consulté le 11 octobre 2026.
- ANSM, Base de données publique des médicaments. Résumé des caractéristiques du produit IRINOTECAN KABI 20 mg/ml, solution à diluer pour perfusion, rubriques 4.4 et 5.2, consulté le 11 octobre 2026.
- Nelson M, Mulani SR, Saguil A. Evaluation of Jaundice in Adults. Am Fam Physician. 2025;111(1):25-30.