Racial differences in serum total bilirubin levels in health and in disease (pernicious anemia)
R. Carmel, E. T. Wong, J. M. Weiner and C. S. Johnson
Common usage prescribes a single normal range for serum bilirubin levels.
However, we have not only confirmed that men have higher levels than women
but have discovered significant racial differences as well. Among 1,538
healthy Americans, blacks had lower mean bilirubin levels than whites of
European origin, Latin Americans, and Asians. These racial differences,
which were more pronounced among women than men, were maintained in
pernicious anemia. Even though bilirubin levels rose in our 174 patients
with this disease, they continued to be lower among blacks than among
whites and Latin Americans. Moreover, the actual bilirubin level changes
caused by pernicious anemia were themselves smaller among blacks. The
racial differences, thus, persisted in pernicious anemia despite similar
degrees of anemia, whereas the sex differences disappeared. We suggest that
the lower serum bilirubin levels in blacks in health and disease do not
stem primarily from lower bilirubin production than in whites.
