liver function tests

high AST and high ALT

Q: What do my lab results mean if I have high liver enzymes as seen in image?

Question: Can someone help me. What does this mean. I don’t want to start googling because then I will give myself a panic attack. Trying not to self diagnose myself. Can’t wait till end of the month for doctor to call and go over results.

high AST and high ALT

Your results show high AST and high ALT which both are of liver function tests
While both are elevated, the ALT is raised almost double AST which suggests liver disease.
Common liver diseases are hepatitis B or C, biliary obstruction, or fatty liver.
Recommended to go for Lipid profile tests, HCV-Ab and HBs-Ag tests to make sure there’s no liver disease is going to advance.

ALT 34 ALP 113

Q: ALT 34 ALP 113 is this bad or good?

Question: ALT is 34 U/L, ALP is 113 U/L
Is this good?


Since the normal ALT, a liver enzyme, is up to 31 U/L, your number is slightly elevated, ALP, the alkaline phosphatase enzyme for biliary canals, is normal if up to 100 U/L, therefore your 113 is mild elevated.

To conclude, your results have mild elevated ALT enzyme and ALP enzyme which suggest a inflammation of the liver.


Retest liver enzymes and ALP a week later to make sure that results goes higher to be clearly indicative, or go down to be certainly normal.

In the while, taking some minerals and immunity-boosters supplements is a good hint to allow the body proteins to stabilize.

ALT 34 ALP 113
jaundice bilirubin look in urine and eyes

Bilirubin Levels Chart (Normal, Low, High Bilirubin Levels Explained)

Bilirubin Levels Chart is a table of common bilirubin levels that cause jaundice yellowish color of the skin and eyes sclera, including normal bilirubin levels, high bilirubin levels, and low bilirubin levels in the same place.

Where bilirubin comes from and where does bilirubin go to?

Bilirubin comes from the degradation of hemoglobin and cells breakdown by spleen or other organs, bilirubin enters bloodstream as large insoluble molecule which has the term (unconjugated), when reaches the liver, hepatic cells perform chemical reaction to make bilirubin soluble in the blood by bound it to the glucuronic acid by the enzyme glucuronyltransferase which then called (conjugated), conjugated bilirubin go from the liver to the intestine and undergoes reduction to the form called stercobilirubin which give the stool its yellowish color, another part of direct bilirubin go to urine through the kidney after being transformed to a compound called urobilinogen (urine dye) which gives the urine the yellowish color.

Measuring Bilirubin at the lab: scientists measure conjugated bilirubin and report it as (direct bilirubin), and measures total bilirubin values, then calculated the unconjugated bilirubin by subtracting direct from the total, the result is the estimated indirect bilirubin (unconjugated)

When your doctor requests a bilirubin test, this means direct bilirubin (DBil), indirect bilirubin, and total-value bilirubin (TBil), the bilirubin test for the newborns is “total bilirubin and/or indirect bilirubin”

Hyperbilirubinemia, Jaundice, icterus are medical terms for high bilirubin levels in the blood and urine, clearly, jaundice means a yellow discoloration of the skin and icterus means discoloration of the eyes, while kernicterus is a medical condition that means brain cells damage due to high bilirubin levels in the blood, usually at levels such as 30 mg/dl, Bilirubin is a highly neurotoxic substance.
Medical shortcodes for TSB, DSB, ISB are total, direct, indirect serum bilirubin respectively.
Total bilirubin is the sum of all bilirubin forms in the blood and does not represent a different type of bilirubin in the body.

The bilirubin showed in urine and skin at serum bilirubin levels between 3.0 to 5.0 mg/dl, skin jaundice and eyes yellowish discoloration appear, urine color become dark yellow or as light tea when direct bilirubin is high in the blood when indirect bilirubin is higher than 25mg/dl in the blood, it may show greenish plasma color as a result of the severe elevation of indirect bilirubin (due to increased activity of biliverdin reductase enzyme which reduces biliverdin to bilirubin).

what does dark yellow jaundice urine look like?

Comprehended bilirubin levels chart for all ages (adults and newborns)

Low bilirubin levels explained

Low levels of bilirubin are generally not concerning and are not monitored as there are no studies confirming the risk for a low level of bilirubin.

Bilirubin results like:

  • Total bilirubin less than 0.4 is not a concern of abnormalities.
  • Indirect less than 0.3 is another insignificant bilirubin level.

Normal bilirubin levels

Normal bilirubin level is a bilirubin value that means there are no diseases that could be found in the sources of synthesis, processing, and removing of bilirubin.

  • normal bilirubin values lie between reference ranges, the lower limit, and the upper limit.
  • Direct bilirubin 0, 0.1, 0.2, and 0.3 is normal results and cannot be a cause of jaundice unless indirect bilirubin continue to be high.
  • Indirect bilirubin 0.8, 0.7, 0.6, 0.5,0.4, and 0.3 are all normal levels of blood bilirubin.
  • Total bilirubin level 0.9,0.8,0.7,0.6,0.5,0, and 4.0 are normal and not jaundice whatever is the result of direct and indirect bilirubin.

Recommendation: if it’s the first time you take a bilirubin test, there is no further investigation when results is normal, if you’re on medication, then you’re just fine and continue to keep it normal.

Borderline Bilirubin results:
Are the bilirubin levels that reach the normal upper limits or slightly above, can’t be taken seriously as jaundice, and need for new test after a few days, sometimes borderline bilirubin levels show up when the person is on medications.

  • Bilirubin direct 0.4 with normal indirect and total bilirubin results.
  • Bilirubin indirect level is 0.9 and total is 1.0 mg/dl.
  • Bilirubin total is 1.1 and normal direct and indirect bilirubin.

False bilirubin results:
Lab errors must be confirmed by retesting bilirubin after a few days, physiological causes as dehydration show pale yellow skin and deep yellow eye’s white area which may be confused with jaundice, results may be as:

  • Bilirubin direct level is higher than the total bilirubin level, for instance; direct 1.0 and total 0.8 mg/dl.
  • Bilirubin levels show slight increase above the upper normal limit; for ex. Total 1.1 and 1.2 mg/dl.
  • Total bilirubin results are very low: 0, 0.1, 0.2, 0.3 mg/dl which could be false low results or wrong test.

High bilirubin levels (hyperbilirubinemia)

Causes of hyperbilirubinemia:

  • High Direct bilirubin helps in diagnosis the liver function and post hepatic jaundice caused by obstruction of bilirubin in common bile ducts (obstructive jaundice) by gallstones, tumors, or scarring of bile ducts, also some diseases cause liver function failure such as viral hepatitis, alcoholic liver disease, and drug reactions.
  • High Indirect bilirubin helps in diagnosis of pre-hepatic jaundice caused by rapid hemolysis of red blood cells of infants or adults such as hemolytic anemia, pernicious anemia, also blood  transfusion reaction, and Cirrhosis cause high indirect jaundice, inability to produce the enzyme which converting indirect to direct is a common cause of jaundice without a disease, this case known as inherited Gilbert syndrome and cause relative elevation in indirect bilirubin.

High bilirubin (total) is either due to:

  1. High indirect bilirubin level with normal or slightly elevated direct bilirubin, commonly seen by those with excessive hemolytic anemia for any cause and newborn jaundice due to new birth immaturity or RH incompatibility between mother and baby, may be called hemolytic jaundice, for example:
  • Indirect bili. 3.0 high, direct bili. 0.3 normal.
  • Indirect bilirubin 10.0 very high, slightly elevated direct bilirubin 0.5 mg/dl.

2. High direct Bilirubin level with normal or slightly elevated indirect bilirubin, commonly seen in results of obstructive jaundice due to hepatitis A for children or stones, for example:

  • Direct bilirubin 7.5 mg/dl high, indirect bilirubin normal 0.6 mg/dl.
  • Direct bilirubin 11.0 mg/dl high, indirect bilirubin slightly elevated 0.9 mg/dl.

3. Both conjugated and unconjugated bilirubin is elevated, values are almost the same, commonly results from hepatic diseases, for instance:

  • Direct bilirubin 9.0 mg/dl, indirect bilirubin 8.0 mg/dl.
  • Indirect bilirubin 12.0 mg/dl, direct bilirubin 11.5 mg/dl.

Common bilirubin levels in infant newborns:

newborn jundice
Newborns high bilirubin on skin
  • 1 day after birth: direct 0.2, indirect 3.5 mg/dl, total is 3.7
  • 2 days: direct 0.3, indirect 5.0, and total is 5.3
  • 1 week to 10 days after birth: indirect 13.0, direct 1.0, and total bilirubin 14.0 mg/dl.
  • 2 weeks: should be reduced towards the normal limits, if increased; may show total bilirubin over 20 mg/dl, which is very high and incubation is required, extremely elevated total bilirubin higher than 30 mg/dl is a serious condition and may lead to Kernicterus which is deadly brain damage.

For treatment and follow up tests of newborn jaundice, please visit this topic; jaundice in newborns, and bilirubin blood test results.

High bilirubin with no visible disease
Gilbert, Crigler-Najjar syndrome, and alcohols are common reasons for high bilirubin levels without an obvious disease.

  • In Crigler-Najjar syndrome, at birth or in infancy the child show jaundice with Severe unconjugated hyperbilirubinemia, if bilirubin is extremely elevated can cause condition called kernicterus, the accumulation of unconjugated bilirubin in the brain and nerve tissues and lead to brain damage and death.
  • In Gilbert’s syndrome: also has the medical terms constitutional hepatic dysfunction and familial non-hemolytic jaundice, seen by accident during checkup testing, the one still be confused where and when he acquired this bilirubin, all hemolytic tests and hepatic causes are absent, the bilirubin still constantly at near high levels for all the life as the original reason is “born with gene mutation caused abnormal bilirubin metabolism”

Remarks: Hereditary jaundice show steady bilirubin levels and continuous follow up.

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Updated: Jaundice Levels Chart in Newborns (Jaundice Levels 5,12,15,18,20,30 explained)

Jaundice levels chart is to know the normal Jaundice Levels in newborn infants, the risk jaundice levels that need treatment for the newborn baby, and the new guidelines for effective treatment and fasts getting rid of jaundice.
Jaundice has another medical term “icterus” and means a yellowish tinge to the skin and the white part of the eye (sclera) that is caused by an excess of bilirubin in the blood, which is called in medicine hyperbilirubinemia.

Serum indirect bilirubin level is the most common elevated bilirubin in newborns, high direct bilirubin in newborn infants seen in rare conditions of biliary atresia which requires surgical intervention to prevent any liver damage to the child, and in neonatal hepatitis.

Risky Jaundice levels:

The normal total bilirubin level is any value from 0.3 to 1.0 mg/dL. In a newborn, due to less mature liver function and absence of microorganisms (both are processing bilirubin), normal bilirubin level in a newborn under 5 mg/dL, then go higher in many newborns, the infant bilirubin levels usually fall substantially by day 7, the bilirubin risk level in newborns are more than 15 mg/dL before 48 hours old, more than 18 mg/dL before 72 hours old, more than 20 mg/dL anytime for both healthy born or preterm delivery).


Why do Newborns children have jaundice and high bilirubin?

High indirect bilirubin in newborns is a result of accelerated RBCs breakdown due to:

  • Blood type incompatibility between the mother and her newborn, recommended for Blood film examination to observe hemoglobin level, NRBCs and reticulocyte count.
  • Lack of oxygen (hypoxia), Arterial blood gases test is recommended.
  • Diseases that can affect the liver, liver function tests are recommended.
  • Certain congenital infections.

Hyperbilirubinemia risk levels in infants:

  1. Lower Risk: More than or equal to 38 weeks and well, recommended to evaluate for phototherapy and check TSB in 4-24 hours.
  2. Medium Risk: More than or equal to 38 weeks and hyperbili risk factors OR 35 to 37 6/7 weeks and well, recommended to evaluate for phototherapy and check TSB in 4-24 hours.
  3. Higher Risk: 35 to 37 6/7 weeks and hyperbili risk factors, recommended to evaluate for phototherapy and check TSB in 4-24 hours.

Who is at risk of high bilirubin levels?

Hyperbilirubinemia Risk Factors are:

  • TSB/TcB in high-risk zone
  • Jaundice in the first 24 hours
  • ABO incompatibility with positive direct Coomb’s test, known hemolytic disease, or elevated ETCO.
  • Gestational age 35-36 weeks
  • Prior sibling had phototherapy
  • Cephalohematoma or bruising
  • Exclusive breastfeeding, esp. with poor feeding or weight loss
  • East Asian Race

Neurotoxicity Risk Factors

Neurotoxicity level is the bilirubin level at which brain damage is expected.

  • Isoimmune Hemolytic Disease
  • G6PD deficiency, G6PD test is needed with CBC test.
  • Asphyxia
  • Significant lethargy
  • Temperature instability
  • Sepsis, recommended for blood culture and PCR test for specific microbes.
  • Acidosis, observed through ABG test and serum electrolytes test.
  • Albumin less than 3.0 g/dL

How to get rid of jaundice in newborn babies?

According to AAP Phototherapy Guidelines (2004)

  • Lower Neurotoxicity Risk Level is when baby born at more than or equal to 38 weeks and well, doesn’t need to start phototherapy until reaches an approximate threshold 11.7 mg/dl at 24 hours of age.
  • Medium Neurotoxicity Risk Level is when baby born at 38 weeks with neurotoxicity risk factors OR 35 to 37 6/7 weeks and well, start phototherapy when reaches approximate threshold 9.9 mg/dl at 24 hours of age.
  • Higher Neurotoxicity Risk Level is when baby born 35 to 37 6/7 weeks and neurotoxicity risk factors, bilirubin level reaches an approximate threshold 8 mg/dl at 24 hours of age, recommended to start phototherapy.

Which bilirubin level needs incubator phototherapy or at home?

  • Home phototherapy is effective when TSB levels 2-3 mg/dl (35-50 µmol/L), or when there are no risk factors with elevated bilirubin levels in normal born babies.
  • Hospital phototherapy at a specialized incubator are more recommended than the home therapy solutions especially with those preterm newborns with risk factors.

Please read the previous explanation about normal newborn bilirubin levels.
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