Should I undergo Mediterranean anemia screening for high indirect bilirubin levels?

Whether screening for thalassemia is necessary for indirect bilirubin elevation needs to be determined based on specific causes. If there is long-term mild jaundice, family genetic history, or hemolytic symptoms, screening is usually recommended; If there is no clear cause and the values are mildly abnormal, immediate inspection may not be necessary. Indirect bilirubin elevation is common in hemolytic diseases or bilirubin metabolism disorders. Mediterranean anemia, as a type of hereditary hemolytic anemia, can lead to increased destruction of red blood cells and an increase in indirect bilirubin levels. Typical manifestations include pale complexion, fatigue, splenomegaly, and some patients may experience recurrent jaundice. Laboratory tests show a decrease in hemoglobin and an increase in reticulocyte count, which can be confirmed by combining hemoglobin electrophoresis or genetic testing. For those who exhibit the above symptoms, screening can help clarify the cause and guide fertility counseling. Non hemolytic factors such as Gilbert syndrome may also cause a simple indirect increase in bilirubin, which is a benign abnormality in bilirubin metabolism and usually does not require special treatment. Transient factors such as neonatal physiological jaundice, transfusion reactions, or drug-induced hemolysis are often accompanied by clear causes and significant fluctuations in values. Such situations can be temporarily screened through medical history screening. If the indirect bilirubin continues to exceed the upper limit of the normal value by more than twice, or is combined with abnormal direct bilirubin, liver and gallbladder system diseases should be prioritized for exclusion.

It is recommended to bring a complete blood routine, liver function report, and family history data to the hematology department or genetic counseling clinic. Doctors will determine the necessity of screening based on clinical manifestations and dynamic changes in laboratory data, and may also suggest improving auxiliary examinations such as iron metabolism and G6PD enzyme activity. In daily life, it is necessary to avoid factors such as oxidative drugs and vigorous exercise that can induce hemolysis, and regularly monitor hemoglobin and bilirubin levels.