If both direct and indirect bilirubin levels are high, it could indicate different possibilities: Liver Disease: Elevated levels of direct and indirect bilirubin may suggest liver diseases, such as hepatitis, cirrhosis, or liver damage. Bile Duct Obstruction: Bilirubin levels can rise when there is a blockage in the bile ducts, preventing the proper flow of bile from the liver to the intestines. Hemolytic Anemia: In this condition, red blood cells get destroyed faster than they can be produced, increasing indirect bilirubin levels. Direct bilirubin levels can also be elevated if the liver cannot process the excess bilirubin efficiently. Medications or Gilbert's Syndrome: Certain medications or benign conditions known as Gilbert's syndrome can induce moderate increases in direct and indirect bilirubin levels without indicating any major health problems. Consult with a doctor to evaluate and understand your test report.