High Bilirubin- On Stelara

[Jandersen20]

My 17 year old son started Stelara in February. His blood work with the GI showed normal bilirubin in April. He just had his physical with his PCP and his bilirubin came back higher than normal. Nothing crazy high, but higher than normal. Could the Stelara potentially cause your bilirubin to increase? I’m feeling uneasy about it just wondering what could be causing this. His PCP is going to retest in 1 month. Is this normal?

 

[my little penguin]

Let his Gi know
Livers are their specialty
Was it just outside the limits ?
Or 2-3 x the normal limit ?
How was his liver function numbers (Ast ,alt etc..)?
Ds has had high alt or ast more than a few times over the years
Mostly one of
Or due to abx
Sometimes his liver was irritated from mtx but went back to normal

Definitely check with Gi
Ours did repeat in 2 weeks.

 

[Jandersen20]

Yes, I will let his GI know and the PCP sent his lab results to his GI as well.
Bilirubin was 1.8 in April and I believe it was 3 this time.
I wonder what would cause his bilirubin to raise in a matter of 3 months. Wonder if it could be Stelara.
In your post, what does abx mean?

 

[my little penguin]

Antibiotics is abx
Any pain relievers taken ?
Tylenol?

 

[my little penguin]

Also did they check the rest of the liver function numbers ?
Ast
Alt ?
Were those normal ???

 

[my little penguin]

These results may vary slightly from laboratory to laboratory. Normal results may be slightly different for women and children, and results may be affected by certain foods, medications or strenuous exercise. Be sure to tell your doctor about any foods or medications you've taken and your activity levels so that your results can be interpreted correctly.

Lower than normal bilirubin levels are usually not a concern. Elevated levels may indicate liver damage or disease.

Higher than normal levels of direct bilirubin in your blood may indicate your liver isn't clearing bilirubin properly. Elevated levels of indirect bilirubin may indicate other problems.

One common, and harmless, cause of elevated bilirubin is Gilbert's syndrome, a deficiency in an enzyme that helps break down bilirubin. Your doctor may order further tests to investigate your condition. Bilirubin test results also may be used to monitor the progression of certain conditions, such as jaundice.

From

https://www.mayoclinic.org/tests-procedures/bilirubin/about/pac-20393041
Did he exercise before his blood test at all ?

 

[Jandersen20]

Also did they check the rest of the liver function numbers ?
Ast
Alt ?
Were those normal ???

I don’t believe the PCP checked those other numbers, but maybe he did. I’ll have to get a copy. I’m going to let the GI know on Monday and the PCP is faxing her a copy of the lab results.

 

[Jandersen20]

From

https://www.mayoclinic.org/tests-procedures/bilirubin/about/pac-20393041
Did he exercise before his blood test at all ?

He does exercise, but he didn’t right before his appointment.
Getting the hepatitis booster vaccine wouldn’t raise bilirubin would it? He was a hep non responder, so he’s repeating the 3 doses of his hep vaccine. He received 2 already within the last couple months, and the last one in about 5 months…

 

[Maya142]

What is the range given for bilirubin? On my daughter's blood work, it says Total bilirubin should be under 1.4 mg/dL. Online, it says the reference range is usually <1.2mg/dL. So if that's the case, your son's is more than double the upper limit at 3. And then his bilirubin in April was also high, if it was 1.8. If it was high both times, then I'd be less likely to think it's a random virus or a response to a vaccine (though I couldn't find evidence that the vaccine would increase his bilirubin), and more likely a reaction to a drug like Stelara. Is he just on Stelara or is he on other medications?

But if it's just the one time, then typically "wait and watch" is the approach doctors take. If it's really concerning, you would know. My daughter's AST, ALT, Alkaline Phosphatase, GGT and CRP were all so high last fall that she was hospitalized for further testing and a possible liver biopsy and we got a call from the doctor within hours of having blood work.

Typically, Bilirubin is done with AST, ALT and other liver tests - in a CMP (Comprehensive Metabolic Panel) or Hepatic Function Panel. I would get a copy of the blood work so you know what tests were done and how high they were.

 

[crohnsinct]

What did the GI say?
FWIW - my girls have bilirubin that bounces around quite a bit. It is over limit most months and then dips in range for a bit. I think unless all of the liver numbers are wonky or there are other alarming labs it is a wait and watch situation.

i have consistently high bilirubin so they ran a more specific bilirubin test and turns out I have Gilbert’s Syndrome. They say it is a benign condition. But even I pop back down to normal on occasion. My girls likely have it as well but we have never tested them.

 

[Jandersen20]

Good to know, thank you! We are retesting Bilirubin in a month. All other blood work looks good. The AST and ALT were also good.
Thank you!!

 

[Pangolin]

Tangentially related: although high bilirubin levels are the usual clinical focus, low bilirubin levels are associated with higher inflammation in Crohn's patients.

 

[Jandersen20]

Tangentially related: although high bilirubin levels are the usual clinical focus, low bilirubin levels are associated with higher inflammation in Crohn's patients.

Oh wow, I didn’t know that. Very interesting. Thank you!