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 NICE CKS. 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 NICE CKS. If the person is well, Gilbert's syndrome can be diagnosed and managed in primary care NICE CKS.
It is crucial to rule out any red flag signs and symptoms that would necessitate urgent admission for same-day secondary care assessment NICE CKS. 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 NICE CKS. If any of these red flags are present, or if the jaundice is unexplained, immediate referral is required NICE CKS.
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 NICE CKS. Individuals diagnosed with Gilbert's syndrome should be fully reassured, as it is not associated with liver disease or ill health NICE CKS.