Bilirubin Total

Other names: Bilirubin (total), Bilirubin Total, BILIRUBIN, TOTAL, TOTAL BILIRUBIN

Optimal Result: 0 - 1.2 mg/dL, or 0 - 20.52 µmol/L.

Bilirubin is a yellow pigment made when your body breaks down old red blood cells (from hemoglobin). The liver processes bilirubin and sends it into bile, which is stored in the gallbladder and released into the intestine to help digest fats. Most bilirubin leaves the body in stool (brown color) and some in urine (yellow color).
If the liver isn’t working properly or bile flow is blocked, bilirubin can build up in the blood and cause jaundice—yellowing of the skin and eyes.

What does a bilirubin test measure?

A bilirubin test measures how much bilirubin is in your blood and helps assess liver health and red blood cell turnover. Labs usually report:

  • Total bilirubin: direct + indirect

  • Direct (conjugated) bilirubin: processed by the liver and water-soluble

  • Indirect (unconjugated) bilirubin: not yet processed by the liver

Total bilirubin is often part of a comprehensive metabolic panel (CMP) or hepatic function panel, alongside ALT, AST, ALP, albumin, and total protein.

Why is this test ordered?

Your clinician may order bilirubin to:

  • Evaluate jaundice, dark urine, or pale stools

  • Monitor liver or bile duct conditions (e.g., hepatitis, cholestasis)

  • Check for hemolysis (increased red blood cell breakdown)

  • Review possible medication-related liver effects

  • Follow up on abnormal liver enzymes

How are results interpreted?

Reference ranges vary by lab and age. Typical adult values:

  • Total bilirubin: 0.2–1.2 mg/dL (≈ 3–21 µmol/L)

  • Direct (conjugated): 0.0–0.4 mg/dL (≈ 0–7 µmol/L)

Patterns that can help with diagnosis:

  • Indirect bilirubin high: hemolysis, Gilbert syndrome, or reduced hepatic uptake/conjugation

  • Direct bilirubin high: cholestasis or bile duct obstruction (e.g., gallstones, strictures), some drugs, or liver cell injury

Important: A result slightly outside the range doesn’t always mean disease. Exercise, fasting, certain foods, and medications can affect levels. Clinicians interpret bilirubin with symptoms, history, exam, and other labs (ALT, AST, ALP, GGT, albumin, INR).

Related tests

  • ALT, AST, ALP, GGT — characterize liver injury or bile flow issues

  • Albumin, PT/INR — reflect liver synthetic function

  • CBC, haptoglobin, LDH, reticulocyte count — evaluate hemolysis

What if my bilirubin is high?

Discuss results with your healthcare provider, especially if you notice yellow skin/eyes, dark urine, pale stools, itching, fatigue, or right-upper abdominal pain. Next steps may include repeat labs, imaging of the liver and bile ducts, and a medication/supplement review.

Note on newborns: Bilirubin testing is common in newborns because temporary elevations (neonatal jaundice) are frequent and usually monitored closely.

What does it mean if your Bilirubin Total result is too high?

Bilirubin builds up when the liver can’t process it normally or when red blood cells are breaking down faster than usual. A visible sign is jaundice—yellowing of the skin and the whites of the eyes. Other symptoms can include dark urine, pale/gray stools, itching, fatigue, low appetite, and upper-right abdominal discomfort.

Common causes

Liver and bile system (more often raises direct/conjugated bilirubin):

  • Viral hepatitis, alcohol- or drug-related liver injury

  • Cholestasis/bile duct problems (gallstones, strictures)

  • Cirrhosis

  • Medication effects (e.g., certain antibiotics, anabolic steroids, antifungals; always review with your clinician)

Blood/RBC breakdown (more often raises indirect/unconjugated bilirubin):

  • Hemolysis (autoimmune, inherited conditions, infections, medications)

  • Transfusion reactions

  • Gilbert syndrome (common, benign, can rise with fasting, illness, or strenuous exercise)

Labs often report total, direct (conjugated), and indirect (unconjugated) bilirubin. The pattern helps your clinician narrow the cause.

When to seek care

Contact your clinician for any new jaundice or persistently high results.
Go to urgent care/emergency if jaundice comes with fever, severe abdominal pain, confusion, unusual bleeding/bruising, or rapidly worsening symptoms.

What your clinician may do next

  • Repeat/confirm labs and check related tests: ALT, AST, ALP, GGT, albumin, INR; CBC, haptoglobin, LDH, reticulocyte count (for hemolysis)

  • Review medications/supplements (including over-the-counter and herbal)

  • Imaging of liver and bile ducts (e.g., ultrasound) if obstruction is suspected

  • Targeted tests for hepatitis, autoimmune disease, or inherited conditions

Treatment (depends on the cause)

  • Medication changes if a drug effect is suspected

  • Gallstone or bile duct obstruction: procedures or surgery (often minimally invasive)

  • Hepatitis or inflammatory liver disease: supportive care and condition-specific therapy

  • Hemolysis: treat the underlying trigger (e.g., autoimmune therapy, infection management)

  • Gilbert syndrome: typically no treatment needed; levels may fluctuate

What you can do now

While you can’t “flush out” bilirubin at home, you can reduce liver stress:

  • Avoid alcohol and recreational drugs

  • Use medications only as directed; avoid unnecessary supplements

  • Favor a balanced diet rich in vegetables, fiber, and lean protein; limit highly processed foods and added sugars

  • Maintain a healthy weight and regular, moderate exercise (avoid strenuous fasting if you have Gilbert syndrome)

Special note on newborns

High bilirubin is common in the first days of life and is routinely screened. Your pediatric team will advise on monitoring and treatments (e.g., phototherapy) if needed. Seek care promptly for worsening jaundice, poor feeding, or lethargy.

What does it mean if your Bilirubin Total result is too low?

A low level of total bilirubin in the blood is not a cause for concern. There are some medicines/supplements (like vitamin C) that can cause bilirubin levels to drop, but there are no detrimental effects associated with this. 

Frequently asked questions

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