Total Bilirubin

Bilirubin testing checks for levels of bilirubin in your blood. Bilirubin (bil-ih-ROO-bin) is an orange-yellow substance made during the normal breakdown of red blood cells. Bilirubin passes through the liver and is eventually excreted out of the body.


Higher than normal levels of bilirubin may indicate different types of liver problems. Occasionally, higher bilirubin levels may indicate an increased rate of destruction of red blood cells (hemolysis).

Also Known As:  Total BilirubinTBILNeonatal BilirubinDirect BilirubinConjugated BilirubinIndirect BilirubinUnconjugated Bilirubin, TB


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Test Panel: Total Bilirubin, Conjagated Bilirubin, Unconjugated Bilirubin, ALT, AST, ALP, Total Protein, Albumin, Globulin, A/G ratio, GGT,

Why Get Tested :

  • or the diagnosis of jaundice.
  • To differentiate different types of jaundice.
  • For the follow-up of a patient with treatment.
  • To assess the progress of the disease.
  • This test is done to evaluate the liver functions.
  • This is done in a patient with hemolytic anemia in adults.
  • It is also done to evaluate the hemolytic anemia in the newborn.

When to Get Tested:

Your doctor may order a bilirubin test if you:

  • Show signs of jaundice
  • Have anemia, or low red blood cells
  • Might be having a toxic reaction to drugs
  • Have a history of heavy drinking
  • Have been exposed to hepatitis viruses
  • Have cirrhosis

You might also have your bilirubin tested if you have symptoms like:

  • Dark urine
  • Nausea and vomiting
  • Abdominal pain or abdominal swelling
  • Clay-colored stools
  • Fatigue

When Bilirubin Test Orderd:

A health practitioner usually orders a bilirubin test in conjunction with other laboratory tests (alkaline phosphataseASTALT) when someone shows signs of abnormal liver function. A bilirubin level may be ordered when a person:

Other symptoms that may be present include:

  • Dark, amber-colored urine
  • Nausea/vomiting
  • Abdominal pain and/or swelling
  • Fatigue and general malaise that often accompany chronic liver disease

Measuring and monitoring bilirubin in newborns with jaundice is considered standard medical care.

Tests for bilirubin may also be ordered when someone is suspected of having (or known to have) hemolytic anemia as a cause of anemia. In this case, it is often ordered along with other tests used to evaluate hemolysis, such as complete blood countreticulocyte count, haptoglobin, and LDH.

Sample Required

  1. This test is done in the serum of the patient.
  2. The random sample can be taken and no need for a fasting sample.
  3. From infants, the blood may be collected from the heel.
  4. The sample is stable at 4 °C for 3 days and protects it from the light.

Precautions for Sample :

  1. Avoid hemolysis.
  2. Avoid shaking of the tube that may lead to inaccurate results.
  3. Do not expose the tube to light. Exposure to light like the sun or even artificial light may decrease the value.
  4. If there is a delay in the test then keep the sample away from the light and refrigerate it.

Normal Values:

AgePremature  mg/dLFull-term   mg/dLAdult   mg/dL
Cord blood<2 mg<2.0 
0 to 1 day<8.01.4 to 8.7 
1 to 2 days<12.03.4 to 11.5 
3 to 5 days<16.01.5 to 12.0 
5 days to 60 years  0.3 to 1.2
60 to 90 year  0.2 to 1.1
>90 year  0.2 to 0.9

Raised Bilirubin level is seen in:

  1. Some infections, such as an infected gallbladder, or cholecystitis.
  2. Some inherited diseases, such as Gilbert’s syndrome. 
    1. Although jaundice may occur in some people with Gilbert’s syndrome, the condition is not harmful.
  3. Diseases that cause liver damage, such as hepatitis, cirrhosis, or mononucleosis.
  4. Diseases that cause blockage of the bile ducts, such as gallstones or cancer of the pancreas.
  5. Rapid destruction of red blood cells in the blood, such as from sickle cell disease or an allergic reaction to blood received during a transfusion (called a transfusion reaction).
  6. Medicines that may increase bilirubin levels. This includes many antibiotics, some types of birth control pills, indomethacin (Indocin), phenytoin (Dilantin), diazepam (Valium), and flurazepam (Dalmane).

Decreased Bilirubin level is seen in:

  1. Medicines that may decrease bilirubin levels. This includes vitamin C (ascorbic acid), phenobarbital, and theophylline.

Causes of direct hyperbilirubinemia:

  • When more than 50% is direct bilirubin.
    1. Gallstones.
    2. Gallbladder tumors.
    3. Inflammatory scarring or obstruction of extrahepatic ducts.
    4. Can be resolved by the surgery.
    5. Dubin-Johnson syndrome.
    6. Rotor syndrome.
    7. Drugs may cause cholestasis.

Causes of Indirect hyperbilirubinemia:

  • When less than 15 to 20 % is direct bilirubin.
    1. Increased RBC hemolysis ( Erythroblastosis fetalis).
    2. Sickle cell anemia.
    3. Hepatitis.
    4. Cirrhosis.
    5. Crigler-Najjar syndrome.
    6. Gilbert syndrome.
    7. Congenital enzyme deficiency.
    8. Drugs
    9. Transfusion reactions.
    10. There is no role of surgery.

Table showing the Different type of Jaundice and their causes

Type of JaundiceCausesPathophysiology
Unconjugated hyperbilirubinemiaExtravascular hemolysisHeme is converted to unconjugated bilirubin
 Right heart failure and CirrhosisThere is a defect in the delivery of unconjugated bilirubin to liver
 Hypothyroidism and Crigler-Najjar syndromeThere is a defect in the conjugation of bilirubin in the hepatocytes
 Drugs like Rifampicin  and Gilbert syndromeThere is a defect in the uptake of unconjugated bilirubin into hepatocytes
Conjugated hyperbilirubinemiaMechanical obstruction by tumors, stones or strictures, and primary biliary cirrhosisThere is a defect in the flow of conjugated bilirubin through canaliculi and bile ducts. Called cholestatic jaundice.
 Drugs like estrogen and cyclosporineDubin-Johnson syndromePregnancyThere is a defect in the transmembrane secretion of conjugated bilirubin into the canaliculus. This is also called hepatocellular jaundice 
 SepsisLike above

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