question: My Sister-in-law was diagnosed 4 months ago with squamous cell carcinoma of the lung with metastasis to the humerous and pelvis.  She presented today with a bilirubin of 15, but her liver enzymes are normal and there is no biliary obstruction.  Over the past year, she was having a problem with anemia for which no one could find a cause.  Could her elevated bilirubin level be related to some sort of hemolytic anemia leaving an increased amount of bilirubin in the bloodsream?