A blood sample is needed. For information on how this is done, see: Venipuncture .
The laboratory specialist spins the blood in a machine called a centrifuge, which separates the liquid part of the blood (serum) from the cells. The bilirubin test is done on the serum.
You should not eat or drink for at least 4 hours before the test. Your health care provider may instruct you to stop taking drugs that affect the test.
Drugs that can increase bilirubin measurements include allopurinol, anabolic steroids, some antibiotics, antimalaria medications, azathioprine, chlorpropamide, cholinergics, codeine, diuretics, epinephrine, meperidine, methotrexate, methyldopa, MAO inhibitors, morphine, nicotinic acid, birth control pills, phenothiazines, quinidine, rifampin, steroids, sulfonamides, and theophylline.
Drugs that can decrease bilirubin measurements include barbiturates, caffeine, penicillin, and high-dose salicylates such as aspirin.
This test is useful in determining if a patient has liver disease or a blocked bile duct.
Bilirubin metabolism begins with the breakdown of red blood cells in many parts of the body. Red blood cells contain hemoglobin, which is broken down to heme and globin. Heme is converted to bilirubin, which is then carried by albumin in the blood to the liver.
In the liver, most of the bilirubin is chemically attached to another molecule before it is released in the bile. This "conjugated" (attached) bilirubin is called direct bilirubin; unconjugated bilirubin is called indirect bilirubin. Total serum bilirubin equals direct bilirubin plus indirect bilirubin.
Conjugated bilirubin is released into the bile by the liver and stored in the gallbladder, or transferred directly to the small intestines. Bilirubin is further broken down by bacteria in the intestines, and those breakdown products contribute to the color of the feces. A small percentage of these breakdown compounds are taken in again by the body, and eventually appear in the urine.
- Direct bilirubin: 0 to 0.3 mg/dL
- Total bilirubin: 0.3 to 1.9 mg/dL
Note: mg/dL = milligrams per deciliter
Normal values may vary slightly from laboratory to laboratory.
Jaundice is a yellowing of the skin and the white part of the eye, which occurs when bilirubin builds up in the blood at a level greater than approximately 2.5 mg/dL. Jaundice occurs because red blood cells are being broken down too fast for the liver to process. This might happen due to liver disease or bile duct blockage.
If the bile ducts are blocked, direct bilirubin will build up, escape from the liver, and end up in the blood. If the levels are high enough, some of it will appear in the urine. Only direct bilirubin appears in the urine. Increased direct bilirubin usually means that the biliary (liver secretion) ducts are obstructed.
Increased indirect or total bilirubin may be a sign of:
Increased direct bilirubin may indicate:
Additional conditions under which the test may be performed:
Factors that interfere with bilirubin testing are:
- Hemolysis (breakdown) of blood will falsely increase bilirubin levels
Lipids in the blood will falsely decrease bilirubin levels
- Bilirubin is light-sensitive; it breaks down in light