Reasons to Track Bilirubin Levels After Starting Medication
More Programs and Publications Featuring Dr. Kyle Riding
In this program:
Why would a doctor want to track bilirubin levels after starting a patient on new medication? Medical laboratory scientist Dr. Kyle Riding discusses reasons to track bilirubin levels, bilirubin scenarios that are cause for concern, and oxidative stress situations that may cause hemolytic crisis.
Transcript
Interviewer:
Dr. Riding, why would a physician want to track bilirubin levels after starting a new medication?
Dr. Kyle Riding:
So there are two great reasons why a physician would want to track bilirubin levels and probably do a full liver function test, a full LFT panel, when patients start certain medications or start to show some less than ideal side effects after starting a new medication. The two reasons are, let's start with number one, the most common reason is that the physician is concerned that that medication, even though it's being used to treat the patient, help the patient and it is working, our liver is the detoxifier of our body. So any medication we put into our body, our liver processes it to detoxify it and eventually excrete it. It helps us excrete those compounds. Well, sometimes the medications that the providers give, and they did it for a good reason, they did it because the medication was needed, well, sometimes that medication can damage the liver as the liver tries to detoxify it. And so the provider may be checking for liver toxicity, also called hepatotoxicity, that the medication may be causing. The other reason, which is less likely, pretty drastically less likely, but still a possibility, is some medications, when a patient takes them, can actually...this is rare. I want to preface this. I don't want to scare anyone. I don't want anyone to think this is common, okay?
When you have medications, follow up with your providers and take their advice and use services like the ones here at Diverse Health Hub to inform you, but this is rare. I don't want anyone thinking this is common. But some medications can actually cause hemolytic anemias in susceptible patients. All right? So there are some patients who when they take certain medications, their immune system just goes a little haywire and goes, "I don't like this drug." and the immune system's response is to make an antibody, and sometimes that antibody can target the drug when it's sitting on the red cell surface, okay? Causing hemolytic anemia. Easy for me to say. Now, the other thing that could happen is there are some inherited conditions such as a G6PD deficiency, where medications can actually cause a bit of what we call oxidative stress, basically a chemical stress to red cell membranes. And if the patient is deficient in this important enzyme called G6PD, well, they don't have the cellular machinery to repair that oxidative stress, and so the red cells rupture when they take certain meds. Now, there's also foods that can cause this, this oxidative stress, so it's not just medications that can do this. So I want to promise all of you, that is rare. The more likely reason is they're checking for hepatotoxicity.
Interviewer:
And I feel like there are actually a lot of people that have G6PD but may not even know it. They might not be anemic or anything like that. So...
Dr. Kyle Riding:
Yes.
Interviewer:
Let's say it's super common, but I think in certain populations, that tends to be more common. But for those who at least do know that they have G6PD deficiency, what kind of steps do they need to take with their providers to at least say, "Hey, should I be paying attention to this drug that I'm taking?" or how can they be careful on their own as far as just making sure that their liver...reducing any chance of oxidative stress?
Dr. Kyle Riding:
The thing with patients who have known G6PD deficiency, remind your provider and ask them whenever they prescribe a new medicine, "Hey, you know I have G6PD. Is this a risk for me? Okay? Is this oxidative? What should I be looking out for in terms of signs or symptoms of a hemolytic crisis if this medication impacts me?" You can also follow up with your pharmacy team as well. Your pharmacist can look up to find out if the medication your provider has prescribed is a potential cause of hemolytic crisis in G6PD-deficient patients. I will actually tell you, the concern about people who have G6PD deficiency but don't know it, is common enough that when I worked at a large medical center that had a very robust oncology program, when a patient came in and needed certain chemotherapeutics that we know could cause hemolytic crisis, the providers ordered a stat, an immediate G6PD deficiency screen, before giving that medication to make sure that we didn't risk the patient going into a hemolytic crisis.
So providers are usually quite cognizant about what medications and treatment regimens could cause this, lead to that hemolytic crisis, but you as the patient, remember, you got to be your own best advocate and simply ask the question, "Hey, doc, just want to confirm this medication is low risk for any complications with G6PD." And make sure you just bring that to the forefront of their brain. Because, remember, the provider has been seeing many patients in a day, they're hearing out your current concern, they're worried about you, they're working for you. But all of us have medical histories that can be from low complexity to really high complexity, and just giving them that little reminder is being an active team member with them, and that's what they want as well. They want to see you be an active member in your own care, so it's a great question to ask.
Interviewer:
Yeah, and I think also, just to go back to G6PD again, the interesting thing about it is, one of the reasons why people really don't know that they have is because there's really no physiological symptoms, unless if there's something added, basically. You have to have some kind of environmental factor, you have to intake something in order for it to really be prevalent that this is an issue, an abnormality for your body. So it's very important to bring these questions up to your providers.
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