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Gilbert's syndrome is very common occurring in approximately 7 percent of the population. It is the most common cause of elevated bilirubin levels found on routine blood work. Gilbert's is an asymptomatic disorder in which the liver has a slightly decreased capacity to clear bilirubin from the body. Bilirubin is produced from hemoglobin (the red pigment of red blood cells) in the bone marrow, the spleen and elsewhere and is carried to the liver in the blood. It undergoes chemical changes in the liver and then is excreted into bile and passes out of the body after further chemical changes in the intestines. Small amounts of bilirubin are normally present in the blood. However, when there is excessive breakdown of red blood cells or interference with bile excretion, the amount is increased and may produce jaundice. On occasion, a person with Gilbert's syndrome may notice some yellowing of the skin during times of stress. In all other ways the liver functions normally, and the condition is considered to be harmless. The diagnosis is usually made when blood work shows an elevated level of bilirubin in a patient who otherwise has a normal exam and normal liver function. Additional blood work or liver biopsy is usually not recommended to make a definitive diagnosis.
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