What is jaundice

Jaundice is a symptom, caused by various diseases, which makes the skin, mucous membranes and the eyes a yellow colour.

The yellow colour is caused by a substance in red blood cells called bilirubin (which comes from old red blood cells that have completed their life cycle and are supposed to be recycled in the liver ands delivered to the bile to be reused as bile fluid, but which instead travels to various tissues to discolour them).

The reason that jaundice may have is due to the following:

• too much bilirubin is produced than the liver can adequately destroy or recycle
• a defect of the liver causing an inability to destroy or recycle bilirubin
• blockages of the bile ducts

Facts about jaundice

• About 50% of all new born babies will get jaundice in the day or within a week after they are born, but it usually goes away within a week of its onset
• Jaundice that occurs within the first 24 hours of birth or after one week of birth is not normal and needs to be investigated
• All newborn babies are normally tested for jaundice every 8-12 hours for the first day of their life
• All newborn babies are recommended to have a follow-up appointment within 2-3 days of leaving the hospital to test bilirubin levels, especially for premature babies
• Premature babies are more likely to have jaundice than normal term babies
• Infection of the liver is one of the most common reasons people get jaundice
• Two of the most common health conditions which cause jaundice are – hepatitis and malaria
• One of the most prominent and obvious signs of jaundice is yellowing of the skin and of the whites of the eyes
• Jaundice can lead to brain damage in babies if it is not treated properly

Symptoms of jaundice

The main symptoms of jaundice are:

• Yellowing of the white part of the eyes
• Yellowing of the mucous membranes
• Yellowed skin

If the level of bilirubin gets too high, the colour in the body (eyes, skin and mucous membranes) can change to a darker yellow, almost brownish colour.

Main causes of jaundice

Haemolytic anaemia

This type of anaemia is caused by the destruction of red blood cells and can also cause jaundice to occur. This type of anaemia is normally detected through a blood test.

Liver problems

The main reason why jaundice occurs is usually due to a disorder of the liver and the following are the most common conditions of the liver to cause jaundice:

• Autoimmune hepatitis
• Biliary atresia
• Viral hepatitis

Malaria

Another very common reason that causes jaundice is malaria and this is due to the effect of the parasite on the liver. The liver is not able to function properly in people with malaria and this can cause jaundice symptoms.

Newborn babies

It is quite normal for healthy newborn babies to have develop jaundice after the first day of life, to within one week and it normally goes away afterwards. The main reasons for jaundice in a newborn baby are:

• Breast feeding jaundice
• Breast milk jaundice
• New born (neonatal) jaundice

It is not normal for newborn babies to have jaundice within the first 24 hours of life, or after one week of birth – this signifies that there is some underlying disorder causing it. As hospitals in Australia check newborn babies bilirubin levels on the first day and after 2-3 days, any disorders are normally quickly detected so they can be appropriately treated.

Other disorders

A number of other disorders than the ones listed above can cause jaundice to occur:

• Crigler-Najjar syndrome
• Dubin-Johnson syndrome
• Gilbert’s syndrome
• Lucey-Driscoll syndrome
• Niemann-Pick disease
• Q fever
• Rotor’s syndrome

Prevention of jaundice

Non-preventable risk factors

Jaundice may be unpreventable in certain circumstances:

• Certain rare conditions – there are a number of rare conditions which have jaundice as a distinguishing symptom of the disorder. Some of these rare conditions are: Crigler-Najjar syndrome, Dubin-Johnson syndrome, Gilbert’s syndrome, Lucey-Driscoll syndrome, Niemann-Pick disease, Rotor’s syndrome
• Haemolytic anaemia – People with haemolytic anaemia, a condition which causes destruction of the haemolytic blood cells, are at risk of developing anaemia. This is due to the body’s inability to recycle the bilirubin from the red blood cells in the liver and this causes a build-up in the body and jaundice ensues
• Hepatitis – people with hepatitis (especially autoimmune or viral hepatitis) are highly at risk of developing jaundice as a symptom of their condition. This is due to the liver being unable to recycle the bilirubin as it is not functioning properly, so the bilirubin builds up in the body and jaundice ensues
• Liver bile duct issues – people who have functional problems with the bile ducts in their liver can develop jaundice, as the bile is part of the process the liver uses to recycle the bilirubin and if the bile is not able to be produced properly, this means that there can be a build-up of bilirubin in the body and jaundice occurs as a result of the malfunction
• Liver disease – in any type of liver disease the liver cannot properly recycle the bilirubin and it builds up in the body resulting in jaundice as one of the symptoms, which is not easily preventable
• Newborn babies – at least 50% of all newborn babies have some form of jaundice and while this is completely normal (in most cases), it is just not preventable. Premature babies seem to be more affected than full term babies
• Rare, genetic disorders – people with certain rare, genetic disorders have jaundice as a symptom of their disorder and this is not possible to prevent

Preventable risk factors

There are ways to prevent jaundice from occurring or reducing severity of symptoms:

• Malaria – there are are a number of strategies that can be used to prevent a malaria infection from occurring, but once infected, jaundice will occur as one of the symptoms
• Q Fever – there are are a number of strategies that can be used to prevent a q fever infection from occurring, but once infected, jaundice will occur as one of the symptoms

Complications of jaundice

There are some complications that can result due to jaundice:

Kernicterus (Bilirubin Encephalopathy)

This rare neurological disorder is a complication which occurs in some newborn babies that have severe jaundice, which is caused when their level of bilirubin is too high. If the amount of bilirubin in the baby’s body is extremely high or if the baby is very sick, the bilirubin can start to move out of the blood and into the brain which can lead to very serious neurological complications such as brain damage. The only way to prevent this complication is to diagnose and treat jaundice as soon as possible.

Liver failure

If the cause of the jaundice (particularly in adults and children) is not treated or managed effectively and the condition is particularly severe and adversely affects the liver in a major way (severe obstruction of the liver or bile ducts), it can result in liver failure.

When to see a doctor about jaundice

All newborn babies are recommended to have their bilirubin levels checked twice in the first 24 hours of their life, followed by another check at 2-3 days of life. If a baby has elevated bilirubin levels in the first 24 hours or after one week of birth, this indicates an abnormality and will be further investigated.

Any baby which displays any of the symptoms of jaundice after one week of birth should be taken to a doctor for diagnosis and treatment.

Any child or adult that displays any of the symptoms of jaundice should visit their doctor for immediate diagnosis and treatment, to prevent worsening of their condition and any possible complications.

People who have any of the rare, genetic disorders which have jaundice as one of the identifying symptoms must monitor their condition and visit their doctor as required.

People who have been diagnosed with disorders of the liver, malaria or Q fever must take their medication as recommended and their doctor if they have any worsening of symptoms.

Diagnosis of jaundice

Jaundice is initially diagnosed through the following methods:

• Medical history – the doctor will ask a series of questions about the severity and duration of symptoms, your diet, when they started and how often they occur
• Physical examination – a doctor will examine the person with suspected jaundice to see if an obvious cause can be determined through the physical examination of different parts of the body
• Blood test – a blood test will be requested to measure levels of bilirubin and other liver and bile duct substances in the blood to determine if there are any problems

Diagnostic tests

Further tests can be recommended if these do not provide an exact cause:

• CAT scan – a computerised tomography scan produces clear images of the liver and bile duct
• Liver biopsy – a small portion of liver tissue is removed to examine if a serious problem with the liver is suspected (including malignancy
• MRI – an MRI test produces clear images of the liver and bile duct
• Ultrasound – an ultrasound test produces clear images of the liver and bile duct

These tests or scans look at the bile duct and/or liver to determine what is causing the jaundice.

Conventional treatment of jaundice

Treatment of jaundice depends on the underlying disorder that causes it.

Haemolytic anaemia

The treating of haemolytic anaemia depends on the severity of the condition and usually consists of any one or more of the following:

• Blood Transfusion – a full blood transfusion is given to people with haemolytic anaemia that is either severe or life threatening
• Lifestyle changes – a number of lifestyle changes will be recommended depending on the underlying cause of the haemolytic anaemia:
  • Cold-reactive antibodies – keep warm at all times, especially the fingers, toes and ears to avoid triggering anaemia symptoms
  • Glucose-6-phosphate dehydrogenase (G6PD) deficiency – special diet that avoids certain foods, certain substances and certain medications which trigger anaemia symptoms
• Medications – certain medications can help to improve symptoms of haemolytic anaemia, such as:
  • Corticosteroids – these are prescribed for people with autoimmune haemolytic anaemia (AIHA)
  • Hydroxyurea – this medication is prescribed for people with sickle cell anaemia to help the red blood cells form properly and contain normal haemoglobin inside
• Plasmapheresis – this procedure involves taking blood from the veins, separating the plasma (which contains the antibodies) from the rest of the blood, returning plasma (and healthy) antibodies from a donor and the rest of the blood back into the vein and into the body. This treatment may be recommended if other treatments have failed
• Surgery – in some cases, surgery to remove an enlarged or diseased spleen is recommended to prevent it from destroying red blood cells and causing the anaemia
• Blood and marrow stem cell transplant – a new and emerging treatment is to replace the unhealthy bone marrow and blood with your own stem cells. In cases where the bone marrow makes few healthy red blood cells, this treatment may work to enable more healthy red blood cells to be formed. In this procedure, healthy blood and bone marrow stem cells are used from a donor are inserted into a vein (like a blood transfusion) to go into the blood stream and they travel to the bone marrow to start making healthy new red blood cells

Liver disorders

Treatment of liver disorders depends most on the type of disorder (hepatitis A, B and C, liver cirrhosis, autoimmune hepatitis):

• Avoid alcohol and/or drugs – most people who drink heavily or take a lot of drugs eventually develop liver cirrhosis, so the recommended strategy to help the liver is to stop drinking and/or taking drugs
• Medications – there are a number of medications used for people with liver disorders:
  • Corticosteroids – these immune suppressing medications are used for people with autoimmune hepatitis, to slow down the immune system and prevent it from further worsening the function of the liver
  • Interferon alfa-2b – this medication is only prescribed for people with active hepatitis B virus (HBV) replication (and should not be given with lamivudine)
  • Lamivudine – this medication is only prescribed for people with active hepatitis B virus (HBV) replication (and should not be given with interferon alfa-2b)
  • Pegylated interferon – this medication is given to people with active hepatitis C virus (HCV) replication
  • Ribavirin – this medication is given to people with active hepatitis C virus (HCV) replication
• Protected sex – people with hepatitis A, B or C need to ensure they have protected sex as they are infected with a virus and unprotected sex is one way to transfer it to other people
• Surgery – part of a diseased liver can be removed without modifying the function of the liver adversely
• Transplant – in severe cases, where the liver is diseased or not functioning properly any more, a liver transplant can be performed and the liver is replaced with a new one from a donor

Malaria

The main way that malaria is treated is through medication:

• Antibiotics – the antibiotic doxycycline will be prescribed to kill the bacteria causing malaria and prevent further worsening of any symptoms and possible complications
• Anti-malaria medications – these medications are neded to treat the hepatitis (liver disorder) symptoms that often develop with malaria. The most common medications used are: hydroxychloroquine or quinolones

Neonatal jaundice

Conventional treatment recommends the following:

• Intravenous immunoglobulin – in some cases of very severe jaundice in babies, this may be an alternative to a complete blood transfusion. Immunoglobulins are antibodies which may be helpful in babies with rhesus haemolytic jaundice, to reduce bilirubin levels back to normal without having to provide a full blood transfusion
• Keep the baby well hydrated – for babies with elevated bilirubin levels within normally high levels, it is commplace practice to ensure the baby is well hydrated with regular feedings, either with breast milk or formula if not breast feeding. This enables the baby to have more frequent bowel movements. The body gets rid of excessive bilirubin through the stools, so this is a very effective way to quickly reduce jaundice
• Phototherapy – a special light is used on babies that have high bilirubin levels which are not easily reduced simply by increasing feedings. The baby is placed under the artificial blue light in a special enclosure where they are kept warm, as they need to be unclothed for this treatment to work. The light works by breaking down the bilirubin in the skin and allowing it to be excreted more easily by the baby’s body
• Transfusion – a full blood transfusion may be necessary in babies with severe jaundice to refresh their blood with new, normal blood that has normal levels of bilirubin

Q fever

Q fever is normally treated with the following medications:

• Antbiotics – the antibiotic doxycycline will be prescribed to kill the bacteria causing Q fever and prevent further worsening of any symptoms and possible complications
• Anti-malaria medications – these medications are neded to treat the hepatitis (liver disorder) symptoms that often develop with Q fever. The most common medications used are: hydroxychloroquine or quinolones. Chronic Q fever is much harder to treat than acute Q fever and medications may need to be taken for up to 5 years

Rare, genetic disorders

The rare genetic disorders are difficult to treat, but there are some treatments available:

• Bone marrow transplant – replacing the unhealthy bone marrow with healthy (donor) bone marrow is one treatment used for Niemann-Pick disease as well as Niemann-Pick disease
• Medications – certain medications are used to help treat symptoms of these disorders
  • Anti-convulsants – these medications are used to treat seizures common in people with Niemann-Pick disease
  • Phenobarbital – this medication is used to reduce high bilirubin levels in people with Dubin-Johnson syndrome and Gilbert syndrome
  • Sodium oxybate (GHB) – this is used to treat cataplexy symptoms in Niemann-Pick disease

Alternative / complementary treatment of jaundice

Never try to self-treat or self-diagnose jaundice. It could be fatal. Especially in infants or people with underlying and severe liver disorders

Always seek medical advice and treatment and apply common sense to avoid getting an infection (hepatitis malaria and Q fever) that may cause jaundice symptoms in the first place.

Alternative / complementary treatments should be viewed only as a way of boosting the immune system to help it fight off infection and prevent recurrence. Always consult with your doctor before trying any of the treatments recommended, as they may adversely conflict with your medications.

Herbs

There are a number of excellent herbs which may help to provide relief for symptoms:

• Astragalus (radix astragali) – animal studies show this herb has a protective effect on the liver, spleen and thymus, which may be of benefit in jaundice as the liver, spleen and thymus are all normally involved and are all unhealthy. The studies showed it had a protective effect on the function of the spleen as well as the thymus (which is where T cells are sent to mature – the T cells are some of the white blood cells the immune system uses to fight infection). Consult a doctor if you want to try this herb, as it could interfere with other medications you are taking
• Echinacea (echinacea purpurea) – studies show that the herb echinacea has anti-viral properties and boosts the immune system to fight infections more effectively. Do not use echinacea if you are using any type of medication, especially the interferon or other chemotherapy medications, as there could be adverse interactions and do not use echinacea for longer than two weeks at a time, because it has an immune-dampening effect if used for too long
• Olive leaf – studies show that olive leaf has very potent anti-viral and anti-bacterial properties and helps to boost the immune system to fight infections more effectively. Speak to your doctor about trying olive leaf extract if you are taking any medications before trying it
• St Mary’s thistle (Silybum marianum) – many studies show that the herb St Mary’s thistle protects the liver and can even help the liver to regenerate even better than any medications without any of the side effects (there are no reports of toxicity in humans thus far). Studies also show that it helps the bile ducts and spleen in the same manner too. Studies show that St Mary’s thistle is very useful in treating liver cirrhosis, all types of hepatitis. Consult a doctor if you want to try this herb, as it could interfere with other medications you are taking

Vitamins

There are a number of vitamins which may help to provide relief for symptoms:

• Folic acid – the B vitamin co-factor folic acid is very important in ensuring the red blood cells are healthy and are of a regular, healthy size, which may not be the case in people with haemolytic anaemia. Folic acid also helps to make new red blood cells work efficiently and properly
• Vitamin A – the potent antioxidant vitamin A is needed by the liver (together with the other antioxidant nutrients) to help it detoxify it from any toxins and thus heal more effectively
• Vitamin B12 – it may be necessary to supplement with vitamin B12 (cyanocobalamin), especially because the digestive system is involved when the liver is not functioning properly and particularly the stomach may have an inability to produce enough intrinsic factor to help utilise the vitamin B12 from food
• Vitamin C – the potent antioxidant vitamin C is needed by the liver (together with the other antioxidant nutrients) to help it detoxify it from any toxins and thus heal more effectively
• Vitamin E – the potent antioxidant vitamin E helps to prevent haemorrhaging (internal bleeding) and scar formation on the liver, or other organs. Vitamin E also improves circulation in the body
• Vitamin K – the important vitamin K is needed to help the blood clot, so that when there is an injury, the body sends the clotting factors to the point of injury to stem the flow of blood and start the healing process. Some newborns are given an intravenous injection of vitamin K to help their blood clot properly in some hospitals at birth (instead of warfarin)

Minerals

There are no minerals recommended to help to provide relief for symptoms of jaundice.

Other nutrients

There are a number of other nutrients which may help to provide relief for symptoms:

• Acidophilus – the probiotic acidophilus helps to detoxify the body (and liver) from the effects of excessive ammonia build-up if there is an higher than normal protein intake, either from food or supplements
• Alpha-lipoic acid – the potent antioxidant alpha-lipoic acid is beneficial for the liver to help detoxify it from any toxins
• Carnitine – the amino acid-like substance carnitine helps to transport the fatty acids into the mitochondria for energy to enable the liver to be repair itself
• Co-enzyme Q10 – this powerhouse nutrient helps to enable proper oxygenation and respiration of all the cells in the body. Co-enzyme Q10 also provides maximum energy utilisation by the cells
• Cysteine – many studies show the amino acid cysteine in the form N-acetyl cysteine (NAC) is a really potent antioxidant and together with methionine and glutathione helps to detoxify the the liver of any toxins, significantly prevents liver injury and this enables the liver to regenerate and become healthier
• Digestive enzymes – natural digestive enzymes (not animal-based ones) may help people restore proper digestion in people with certain types of jaundice who also have pale stools and whose bile gland is not functioning properly
• Essential amino acids – a formula which contains all of the 9 essential amino acids is necessary to provide the proteins needed to enable the liver to heal properly and reduce the cause of the jaundice
• Glutathione – the amino acid glutathione is a potent antioxidant which helps the liver detoxify and protects it from further damage
• Lecithin – the choline that makes up lecithin is needed by the body to help break down fatty acids, which is impaired when the liver or bile is not functioning normally
• Methionine – the amino acid methionine (together with cysteine and glutathione) helps to detoxify the the liver of any toxins and this enables the liver to regenerate and become healthier
• Omega-3 essential fatty acids (EFA) – the omega-3 EFA have potent anti-inflammatory properties and also help to ensure there is normal circulation in the body. In addition to this, the omega-3 fatty acids also help the body more effectively handle the fats/oils which are eaten in the diet
• Quinine – the natural substance quinine is used to fight malaria infections and it has now been used to create medication specifically for fighting a malaria infection

Dietary modifications

There are a number of dietary modification strategies which may help to provide relief for symptoms:

• Adequate liquids – it is important to be drinking enough water, diluted fruit juice or herbal tea (such as chamomile, elderberry, peppermint, rosehip) to keep the body well hydrated in order to help it better fight the underlying cause of the jaundice and help the body get rid of the excess bilirubin more quickly
• Avoid drinking any alcohol – drinking alcohol when you have a jaundice from any cause and if you are also taking any type of medication is not recommended. The alcohol can interfere with the action of the medication and it also does not help the body deal with underlying cause of the jaundice
• Increase intake of vegetables – a diet with increased intake of fresh (preferably organic) vegetables (about 5-6 servings per day) is recommended for people with jaundice, to help hydrate the body and provide more antioxidants and other nutrients to help the liver and other digestive organs
• Increase intake of fruits – a diet with increased intake of fresh (preferably organic) fruits (about 3-4 servings per day) is recommended for people with jaundice, to help hydrate the body and provide more antioxidants and other nutrients to help the liver and other digestive organs
• Limit intake of high fat foods – if the liver (or bile ducts) are not functioning properly, they cannot handle fat very effectively. A high fat diet may further exacerbate symptoms, so it is not recommended. Foods high in fat are most high fat dairy foods, most red meats as well as processed and junk foods

Lifestyle modifications

There are a number of lifestyle modifications which may help to provide relief for symptoms:

• Exercise – your doctor will advise you which type of exercises are suitable for your condition and which ones to avoid, especially if they are going to exacerbate your condition
• Protected sex – if you have hepatitis A, B or C, ensure you always practice safe sex because you can easily transfer the infection to your partner(s)
• Rest – it is very important to give the body the best chance at recovery and resting (sleeping or just lying down not being active) will be recommended by your doctor when you have jaundice. Rest allows the body to concentrate its energy on boosting the immune system and using all its resources to getting rid of the excess bilirubin without having to waste resources on other bodily processes
• Stay warm – if you have haemolytic anaemia, you need to ensure you stay warm at all times, especially your toes, fingers and ears need to be kept warm, so turn off the air conditioning, use mittens to take things out of the fridge and rug up on cold days to stay warm

Alternative treatments

There are no other alternative treatments recommended for jaundice.

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with jaundice

Self care strategies

There are a number of strategies which are recommended to help you better deal with jaundice:

• Avoid all alcohol – it is really important to help speed your recovery to avoid all alcohol, as it puts further strain on a impaired liver and will only worsen symptoms. Excessive alcohol intake is one of the major reasons for the development of liver cirrhosis and liver disease, so try to stop if you have been diagnosed with any form of jaundice. In addition to this, people with any condition that causes jaundice are advised to stop drinking, as it can really exacerbate symptoms quite a lot
• Adequate liquids – it is important to stay well hydrated if you have jaundice from any form, as that will help your body better deal with the high levels of bilirubin and/or liver dysfunction
• Increase intake of vegetables and fruit – it is important to eat enough vegetables (5-7 servings) and fruit (3-4 servings) each day, to help provide all the antioxidants and other nutrients important for helping the liver on its path to health
• Limit intake of high fat foods – a damaged or diseased liver (or bile ducts) cannot provide the body with efficient digestion of fats, so limit high fat intake in the diet by reducing intake of: full fat dairy products, red meats, processed foods and junk foods
• Medications – if you need to take any medications, ensure you monitor yourself for any side effects and let your doctor know so that your dose can be reduced or other medication can be used instead
• Rest – it is really important to rest, sleep or just lie down quietly to help your body heal. Rest allows the body to concentrate its energy on boosting the immune system and using all its resources to getting rid of the excess bilirubin without having to waste resources on other bodily processes
• Supplements – if you want to take any of the supplements suggested for treating jaundice, you must inform your doctor who can advise you if this is appropriate in your situation, given your medical history and any other medications you may be taking. Never self-prescribe as this could produce adverse effects from the combination

Caring for someone with jaundice

Partner

If you have a partner with jaundice, there are a number of strategies you can use to help them:

• Avoid alcohol – it is really important for your partner’s recovery that they avoid all alcohol while they have jaundice symptoms, to prevent worsening of their condition as the liver cannot handle having to process the alcohol when it is not functioning properly and this overburden will cause symptoms to worsen
• Low fat diet with fresh vegetables and fruit – ensure your home has adequate supply of foods which are low fat (unprocessed) and that there are plenty of vegetables and fruits to eat every day. The antioxidants and other nutrients in the vegetables and fruit are needed by your partner to aid their recovery
• Monitor symptoms – you must make sure you monitor your partner’s symptoms, because if their condition starts to worsen, you will be the only one who is at home to identify this and take them to their doctor
• Rest – allow your partner to have adequate rest, to enable them to recover more quickly from the underlying cause of the jaundice

Friends

If you have a friend with jaundice, there are a number of strategies you can use to help them:

• Avoid alcohol – it is really important for your friend’s recovery to avoid all alcohol while they have jaundice symptoms. Their liver is not functioning properly and any alcohol will overburden it and cause worsening of their symptoms, so ensure your social interactions do not involve alcohol

Parents

If you have a child with jaundice, there are a number of strategies you can use to help them:

• Keep baby well hydrated– for babies with elevated bilirubin levels within normally high levels, it is commonplace practice to ensure the baby is well hydrated with regular feedings, either with breast milk or formula if not breast feeding. This enables the baby to have more frequent bowel movements. The body gets rid of excessive bilirubin through the stools, so this is a very effective way to quickly reduce jaundice
• Low fat diet with fresh vegetables and fruit – ensure your home has adequate supply of foods which are low fat (unprocessed) and that there are plenty of vegetables and fruits to eat every day. The antioxidants and other nutrients in the vegetables and fruit are needed by your child to aid their recovery
• Monitor newborns for jaundice – at least 50% of all newborn babies develop some form of jaundice and while this is quite normal in most cases, this is not always the case, especially if it starts after one week of birth. You must take your baby to the hospital if this occurs as it could signify an underlying disorder that needs immediate treatment

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Last reviewed and updated: 14 May 2024