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Conjugated hyperbilirubinaemia

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Conjugated or direct hyperbilirubinaemia occurs when the the liver is able to conjugate bilirubin, but the excretion is impaired.

Causes include:

  • failure of bilirubin excretion by hepatocytes:
    • Dubin-Johnson syndrome
    • Rotor's syndrome
  • obstruction to biliary flow i.e. cholestasis, both intra-hepatic and extra-hepatic

The proportion of conjugated bilirubin with respect to the total raised bilirubin can give a clue as to cause of jaundice.

20-40% of total: more suggestive of hepatic than posthepatic jaundice

40-60% of total: occurs in either hepatic or posthepatic causes

> 50% of total: more suggestive of posthepatic than hepatic jaundice

Note that if conjugated bilirubin is less than 20% of total then the cause of hyperbilirubinaemia is secondary to haemolysis or constitutional e.g. Gilbert's disease, Crigler-Najjar syndrome

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