What can cause elevated total bilirubin?

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Total bilirubin rises when either production of bilirubin is increased or the body’s ability to clear or excrete it is impaired. In hemolytic (prehepatic) jaundice, rapid red blood cell breakdown increases unconjugated bilirubin; even though the liver works to conjugate it, the overall bilirubin load goes up, elevating total bilirubin. In hepatic jaundice, liver injury or impaired conjugation reduces the liver’s ability to process bilirubin, so bilirubin accumulates and total levels rise, with both direct and indirect fractions often affected. Since both mechanisms can elevate total bilirubin, the option that includes both conditions is the best choice.