How should I approach the diagnosis of Gilbert's Syndrome in a patient with isolated unconjugated hyperbilirubinemia?

When approaching the diagnosis of Gilbert's syndrome in a patient presenting with isolated unconjugated hyperbilirubinemia, the primary consideration is the patient's overall well-being ². While most individuals presenting with jaundice typically require admission or referral to secondary care due to the potential for serious underlying causes, Gilbert's syndrome is an exception ². If the person is well, Gilbert's syndrome can be diagnosed and managed in primary care ².

It is crucial to rule out any red flag signs and symptoms that would necessitate urgent admission for same-day secondary care assessment ². These include a bilirubin level greater than 100 micromol/L, an abnormal clotting profile or signs of coagulopathy, abnormal renal function, suspected paracetamol overdose, or if the patient is frail or has significant co-morbidities ². If any of these red flags are present, or if the jaundice is unexplained, immediate referral is required ².

If the patient is well and other serious causes of jaundice have been excluded, a diagnosis of Gilbert's syndrome can be made in primary care ². Individuals diagnosed with Gilbert's syndrome should be fully reassured, as it is not associated with liver disease or ill health ².