What causes yellow skin and eyes?
Jaundice occurs when bilirubin — a yellow pigment from broken-down red blood cells — builds up in the blood. The yellow colour deposits in skin, eyes (sclera) and sometimes darkens urine. Jaundice is not a disease itself — it's a sign of one of three types of problems: pre-liver (too many red cells breaking down), liver (liver cells damaged), or post-liver (bile duct blocked).
Blood tests to diagnose jaundice
1. Bilirubin (Total, Direct, Indirect) — First test
The pattern of which bilirubin fraction is elevated points to the cause. High indirect = haemolysis or Gilbert's syndrome. High direct = liver disease or bile duct blockage. Total bilirubin above 2.5 mg/dL causes visible jaundice.
2. LFT (Liver Function Tests) — Liver damage marker
SGPT/ALT and SGOT/AST rise in liver cell damage (hepatitis). ALP and GGT rise in bile duct problems (cholestasis). The pattern helps distinguish hepatocellular (liver cell) from cholestatic (bile duct) jaundice.
3. Hepatitis Viral Markers
Hepatitis A IgM, Hepatitis B surface antigen (HBsAg), Hepatitis E IgM — viral hepatitis is the most common cause of acute jaundice in adults globally. Hepatitis A and E are spread via contaminated water and food.
4. CBC — Rules out haemolytic anaemia
Low haemoglobin + high indirect bilirubin + normal LFT = haemolytic jaundice. The liver is fine — red cells are breaking down too fast. Causes: sickle cell crisis, G6PD deficiency reaction, autoimmune haemolysis.
When is jaundice an emergency?
Common causes by age group
| Age Group | Most Common Causes |
|---|---|
| Newborns | Physiological jaundice, blood group incompatibility, G6PD deficiency |
| Children & Young Adults | Hepatitis A, E (contaminated water), Gilbert's syndrome |
| Adults 20–50 | Hepatitis B, C, alcoholic hepatitis, gallstones |
| Elderly (>60) | Gallstones, pancreatic cancer (painless jaundice = investigate urgently) |