Version July 2025
LDH: lactate dehydrogenase.
* The National Institutes of Health maintains a searchable database of drugs, herbal medications, and dietary supplements that have been associated with liver injury. The hyperbilirubinemia induced by drugs or supplements usually resolves within 48 hours after the drug is discontinued.
¶ Laboratory studies that support the diagnosis of hemolysis include low hemoglobin level, an increased reticulocyte count, and signs of red blood cell destruction (increased LDH or low haptoglobin). Evaluation of a peripheral smear can confirm the presence and determine the cause of hemolytic anemia. Refer to UpToDate content on hemolytic anemia.
Δ Patients with hemolysis may also have Gilbert syndrome. This should be suspected in the presence of severe hyperbilirubinemia compared with the degree of hemolysis.
◊ Serum bilirubin levels fluctuate in patients with Gilbert syndrome. They are usually less than 4 mg/dL (51.3 micromol/L) and can be normal. Certain associated pathologic conditions or physiologic events can increase the plasma bilirubin concentrations to higher values, but usually less than 6 mg/dL (102.6 micromol/L).
§ If repeat testing has not been performed to confirm persistent isolated unconjugated hyperbilirubinemia (over at least 3 months), liver tests should be repeated.
