Symptom Guide

Yellow Skin or Eyes: What Tests Reveal

Yellowing of skin or eyes (jaundice) is always a sign of a medical condition that needs investigation. Here's what blood tests find: and when it's urgent.¹

Written by Suman Konda, Clinical Pharmacist · Based on peer-reviewed sources · Editorial policy · Not medical advice

Last updated: 31 August 2026 · How we check our content

Quick answer

Jaundice, yellow skin and eyes, happens when bilirubin from broken-down red blood cells builds up in the blood, becoming visible around 2 to 3 mg/dL. It is a sign, not a disease: high indirect bilirubin points to haemolysis or Gilbert's syndrome, high direct to liver disease or bile duct blockage.

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 roughly 2 to 3 mg/dL is the level at which jaundice usually becomes visible to the eye.

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.² 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?

Go to hospital immediately if jaundice comes with: Fever and shaking chills (cholangitis, infected blocked bile duct, life-threatening), confusion or drowsiness (liver failure), severe abdominal pain, dark urine + pale/clay-coloured stools (complete bile duct blockage), or jaundice in a newborn baby (especially in first 24 hours).

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)

Key points

Jaundice is a sign of three problem types: pre-liver (haemolysis), liver, or post-liver (bile duct blockage).
Visible jaundice usually means total bilirubin above roughly 2 to 3 mg/dL.
Bilirubin fractions point to the cause: indirect suggests haemolysis or Gilbert's, direct suggests liver or bile duct disease.
ALT and AST rise in liver cell damage; ALP and GGT rise in bile duct problems.
Viral hepatitis A, B and E are the commonest causes of acute jaundice in adults globally.
The page details which jaundice patterns are emergencies and need urgent care.

References

Sources cited on this page. PubMed links open the original abstract.

Fargo MV, Grogan SP, Saguil A. Evaluation of jaundice in adults. Am Fam Physician. 2017;95(3):164–168. PMID 28145671
Malik GF, Saqib M, Khan F, Kashif M. Viral Hepatitis – The Road Traveled and the Journey Remaining. Hepat Med. 2022;14:13–26. PMID 35300491 · doi:10.2147/HMER.S352568
Kappus MR. Acute Hepatic Failure and Nutrition. Nutr Clin Pract. 2020;35(1):30–35. PMID 31872503 · doi:10.1002/ncp.10462

Pre-hepatic, hepatic, and post-hepatic jaundice, why the distinction matters

Jaundice (yellowing of skin and whites of eyes) has three anatomical causes, and blood tests can usually distinguish between them:

Pre-hepatic (before the liver): Caused by excessive breakdown of red blood cells (haemolysis), producing more bilirubin than the liver can process. Blood tests show a raised unconjugated (indirect) bilirubin, normal liver enzymes (ALT, ALP), and signs of haemolysis: low haemoglobin, raised LDH, low haptoglobin, reticulocytosis. Examples: sickle cell crisis, autoimmune haemolytic anaemia, malaria, transfusion reaction.
Hepatic (the liver itself): The liver is damaged and cannot conjugate or excrete bilirubin normally. Both conjugated and unconjugated bilirubin are raised. Liver enzymes are elevated: ALT and AST typically rise more than ALP in hepatocellular damage (hepatitis, alcohol, paracetamol overdose). Albumin is low and prothrombin time is prolonged in severe disease.
Post-hepatic (obstructive / cholestatic): The bile duct is blocked, preventing bilirubin from reaching the gut. Conjugated (direct) bilirubin is predominantly raised. ALP and GGT rise more prominently than ALT. Stools become pale (no bile pigment reaching the gut) and urine becomes dark. Common causes: gallstones in the common bile duct, head-of-pancreas cancer, primary sclerosing cholangitis.

Which jaundice is an emergency?

Most jaundice in adults needs urgent assessment, but specific patterns are emergencies:

Acute liver failure (jaundice + confusion + coagulopathy): Can deteriorate to cerebral oedema and death within days. Causes include paracetamol overdose, viral hepatitis (hepatitis A or E), and ischaemic hepatitis ("shock liver"). Coagulopathy (INR above 1.5) with encephalopathy in a person with no prior liver disease meets the diagnostic definition of acute liver failure³ and needs same-day hepatology assessment, since separate King's College criteria are then used to decide whether urgent liver transplant listing is needed.
Cholangitis (Charcot's triad: fever + right upper quadrant pain + jaundice): Infection of the bile duct, usually caused by a gallstone blocking a duct. Requires emergency ERCP (endoscopic stone removal) and antibiotics.
Neonatal jaundice: Normal in the first few days of life as fetal haemoglobin breaks down, but jaundice appearing in the first 24 hours or persisting beyond 2 weeks requires urgent investigation to exclude biliary atresia or haemolytic disease.

Painless progressive jaundice in an older adult, especially with weight loss, suggests pancreatic cancer or cholangiocarcinoma until proven otherwise, CT and CA 19-9 tumour marker are first-line alongside bilirubin fractionation.

Medical Disclaimer: This page is for general educational purposes only. It does not constitute medical advice. Always consult a qualified doctor before making any health decisions.