What is Bilirubin test?

A bilirubin test measures the levels of a yellowish substance called bilirubin that is produced by the breakdown of RBCs in body. Bilirubin is also produced in the liver to help digest food. This test is conventionally done as a part of liver function tests and it helps determine how well the liver is functioning.

Bilirubin test helps determine the total bilirubin present in the body consisting of:

  • Indirect (Unconjugated) bilirubin: Bilirubin present in blood after RBC lysis. It is bound to albumin protein  
  • Direct (Conjugated) bilirubin: Bilirubin bound to sugars and formed in liver.

Total and direct bilirubin can be measured in the blood, from which, one can derive indirect bilirubin levels. If one has liver damage or an increased rate of red blood cell destruction, bilirubin can leak into the blood, build up to unhealthy levels and cause skin and eyes to turn yellow; this condition is called jaundice. A healthy liver removes most of the bilirubin through excretion but a small amount remains in blood.

So, bilirubin can be tested in both blood and urine.

  1. Why is Bilirubin test performed?
  2. How do you prepare for Bilirubin test?
  3. How is Bilirubin test performed?
  4. Bilirubin test results and normal range

A bilirubin test is performed when the following diseases/conditions are present or suspected:

  • Problems in red blood cell production in conditions such as:
    • Haemolytic anaemia
    • Haemolytic disease of the newborn
  • Unhealthy liver and gallbladder caused by conditions such as:
  • This test is also done to monitor treatment of any of the above conditions and to evaluate drug toxicity

The commonly observed symptoms of these conditions are:

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No special preparation is needed for this test.

However, the doctor should be informed if any medications or supplements are being taken. He/she should also know about any current conditions such as pregnancy or allergies.

The test takes less than 5 minutes.

A healthcare professional will withdraw a blood sample. A tourniquet is tied on the upper arm for easy visualization of the targeted vein. The needle insertion site is identified and cleaned with an antiseptic solution. One may feel a slight prick as the needle is inserted into the blood vessel for withdrawal of blood. Swelling and bruising of the site may occasionally occur; however, it usually disappears in some time. Rarely, the needle puncture site may develop an infection.

If the test results show normal levels of bilirubin in blood, it indicates a normal liver and red blood cell metabolism.

Normal results:

Normally, urine contains some amount of bilirubin. However, if it is present at abnormally high or low levels, it indicates some form of liver damage or blockage. The results will also need to be correlated to existing co-morbidities and other test results.

Normal range of bilirubin is as below. However, it may vary from laboratory to laboratory.

  • Total bilirubin: 0.0-1.4 mg/dL
  • Direct bilirubin: 0.0-0.3 mg/dL
  • Indirect bilirubin: 0.2-1.2 mg/dL

Abnormal results:

High bilirubin levels are found in the following conditions:

  • Infections such as cholecystitis and hepatitis
  • Liver damage caused by conditions such as cirrhosis and mononucleosis
  • Gallstone, cancer and tumour of the pancreas
  • Increased rate of red blood cell destruction, sickle cell disease or transfusion reaction
  • Medications such as antibiotics, diazepam, flurazepam, indomethacin and phenytoin
  • Hereditary disorders such as Gilbert’s syndrome or other congenital infections
  • Newborn hypoxia and mother and child blood incompatibility

Low levels of bilirubin are usually not a concern.

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. This information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.


  1. Lab Tests Online. Washington D.C.: American Association for Clinical Chemistry; Bilirubin
  2. Burtis, Carl A., Bruns, David E (Editors). Hemoglobin, iron, and bilirubin. Tietz fundamentals of clinical chemistry and molecular diagnostics. 7th ed. St. Louis, MO: Elsevier; 2015. Chapter 28; p.513–519.
  3. MedlinePlus Medical Encyclopedia: US National Library of Medicine; Bilirubin Blood Test
  4. Williamson, Mary A., Snyder, L. Michael (Editors). Wallach’s interpretation of diagnostic tests: pathways to arriving at a clinical diagnosis. 10th ed. Philadelphia, PA: Wolters Kluwer; 2015. p829–831.
  5. Penn Medicine Lancaster General Health [internet]. Lancaster (PA), USA. Lancaster General Hospital. Bilirubin: Test Overview
  6. McPherson, Richard A, Pincus, Matthew R (Editors). Henry’s clinical diagnosis and management by laboratory methods. 22nd ed. Philadelphia, PA: Elsevier; 2011. p 297–299.
  7. MedlinePlus Medical Encyclopedia: US National Library of Medicine; Jaundice
  8. Center for Disease Control and Prevention [internet], Atlanta (GA): US Department of Health and Human Services, What are Jaundice and Kernicterus?What are Jaundice and Kernicterus?

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