Bilirubin Total

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

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

Bilirubin is a yellow pigment produced 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 through stool (which gives it a brown color), while a smaller amount is excreted in urine (giving it a yellow tint).

If the liver isn’t functioning properly—or if bile flow is blocked—bilirubin can build up in the blood and cause jaundice, a yellowing of the skin and eyes.


What does a bilirubin test measure?

A bilirubin test measures how much bilirubin is in your blood to help assess liver function and red blood cell turnover. Labs typically report:

  • Total bilirubin: The sum of direct and indirect bilirubin.

  • Direct (conjugated) bilirubin: Processed by the liver; 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, along with ALT, AST, ALP, albumin, and total protein.


Why is this test ordered?

Your clinician may order a bilirubin test 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 medication-related liver effects

  • Follow up on abnormal liver enzyme results


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 may help identify causes:

  • High indirect bilirubin: hemolysis, Gilbert syndrome, or reduced hepatic uptake/conjugation

  • High direct bilirubin: cholestasis or bile duct obstruction (e.g., gallstones, strictures), liver injury, or certain medications

Note: Slightly abnormal results don’t always indicate disease. Exercise, fasting, certain foods, or medications can affect bilirubin levels. Clinicians interpret results alongside other tests (ALT, AST, ALP, GGT, albumin, INR) and your clinical history.


Related tests

  • ALT, AST, ALP, GGT – assess liver injury or bile flow issues

  • Albumin, PT/INR – evaluate liver synthetic function

  • CBC, haptoglobin, LDH, reticulocyte count – assess for hemolysis


What if my bilirubin is high?

If your bilirubin is elevated—or if you notice yellowing of the skin or eyes, dark urine, pale stools, itching, fatigue, or right upper abdominal pain—discuss results with your healthcare provider. Follow-up may include repeat labs, imaging of the liver and bile ducts, and reviewing current medications or supplements.


Note on newborns:
Bilirubin testing is very common in newborns, as temporary elevations (neonatal jaundice) are frequent and usually resolve with monitoring and support.

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

Bilirubin can build up when the liver can’t process it efficiently or when red blood cells break down faster than normal. A visible sign of high bilirubin is jaundice—yellowing of the skin and the whites of the eyes. Other symptoms can include dark urine, pale or gray stools, itching, fatigue, poor appetite, and upper-right abdominal discomfort.


Common Causes

Liver and Bile System Issues

(More often raise direct/conjugated bilirubin)

  • Viral hepatitis

  • Alcohol- or drug-related liver injury

  • Cholestasis or bile duct blockage (e.g., gallstones, strictures)

  • Cirrhosis

  • Medication effects (certain antibiotics, anabolic steroids, antifungals — always review with your clinician)

Red Blood Cell Breakdown (Hemolysis)

(More often raises indirect/unconjugated bilirubin)

  • Hemolytic anemia (autoimmune, inherited, infection-related, or medication-induced)

  • Transfusion reactions

  • Gilbert syndrome – a common, benign condition that can cause mild elevations during fasting, illness, or intense exercise

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


When to Seek Care

  • Contact your clinician for any new jaundice or persistently elevated bilirubin.

  • Seek urgent or emergency care if jaundice is accompanied by:

    • Fever or severe abdominal pain

    • Confusion or drowsiness

    • Unusual bleeding or bruising

    • Rapidly worsening symptoms


What Your Clinician May Do Next

  • Repeat or confirm labs and review related tests: ALT, AST, ALP, GGT, albumin, INR

  • Check for hemolysis markers: CBC, haptoglobin, LDH, reticulocyte count

  • Review medications and supplements, including over-the-counter and herbal products

  • Order imaging (e.g., abdominal ultrasound) if bile duct obstruction is suspected

  • Test for specific conditions, such as viral hepatitis, autoimmune liver disease, or inherited disorders


Treatment (Depends on the Cause)

  • Medication adjustments if a drug effect is suspected

  • Gallstones or bile duct obstruction: minimally invasive procedures or surgery

  • Hepatitis or inflammatory liver disease: targeted therapy and supportive care

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

  • Gilbert syndrome: no specific treatment required; bilirubin may fluctuate naturally


What You Can Do Now

While there’s no way to “flush out” bilirubin at home, you can help protect your liver and support recovery:

  • Avoid alcohol and recreational drugs

  • Take prescribed medications only as directed; avoid unnecessary supplements

  • Eat a balanced diet rich in vegetables, fiber, and lean proteins

  • Limit processed foods, sugar, and saturated fats

  • Maintain a healthy weight and exercise regularly (avoid prolonged fasting if you have Gilbert syndrome)


Special Note on Newborns

High bilirubin is very common in newborns and usually temporary. All infants are screened shortly after birth. Your pediatric team will guide you on monitoring and treatments (such as phototherapy) if needed. Seek care promptly for worsening jaundice, poor feeding, or lethargy.

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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. 

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