Alternate Names: Total bilirubin; Unconjugated bilirubin; Indirect bilirubin; Conjugated bilirubin; Direct bilirubin
How Performed: Adult or child:
Blood is drawn from a vein (venipuncture), usually from the inside of the elbow or the back of the hand. The puncture site is cleaned with antiseptic, and a tourniquet (an elastic band) or blood pressure cuff is placed around the upper arm to apply pressure and restrict blood flow through the vein. This causes veins below the tourniquet to distend (fill with blood). A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. During the procedure, the tourniquet is removed to restore circulation. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.
Infant or young child:
The area is cleansed with antiseptic and punctured with a sharp needle or a lancet. The blood may be collected in a pipette (small glass tube), on a slide, onto a test strip, or into a small container. Cotton or a bandage may be applied to the puncture site if there is any continued bleeding.
How To Prepare: Fast for at least 4 hours before the test.
The health care provider may instruct you to discontinue drugs that affect the test.
Drugs that can increase bilirubin measurements include allopurinol, anabolic steroids, some antibiotics, antimalarials, azathioprine, chlorpropamide, cholinergics, codeine, diuretics, epinephrine, meperidine, methotrexate, methyldopa, MAO inhibitors, morphine, nicotinic acid, oral contraceptives, phenothiazines, quinidine, rifampin, salicylates, steroids, sulfonamides, and theophylline.
Drugs that can decrease bilirubin measurements include barbiturates, caffeine, penicillin, and high-dose salicylates.
Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child’s age, interests, previous experience, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child’s age:
How It Feels: When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.
Risks:
- excessive bleeding
- fainting or feeling lightheaded
- hematoma (blood accumulating under the skin)
- infection (a slight risk any time the skin is broken)
- multiple punctures to locate veins
Why Performed: 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 by phagocytic cells. Hemoglobin 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 conjugated (chemically attached to) with a glucuronide before it is excreted in the bile. Conjugated bilirubin is called direct bilirubin; unconjugated bilirubin is called indirect bilirubin. Total serum bilirubin equals direct bilirubin plus indirect bilirubin. Conjugated bilirubin is excreted into the bile by the liver and stored in the gall bladder or transferred directly to the small intestines.
Bilirubin is further metabolized by bacteria in the intestines to urobilins, which contribute to the color of the feces. A small percentage of these compounds are reabsorbed and eventually appear in the urine, where they are referred to as urobilinogen.
Normal Values:
- direct bilirubin: 0 to 0.3 mg/dl
- total bilirubin: 0.3 to 1.9 mg/dl
Note: mg/dl = milligrams per deciliter
Abnormal Results: Jaundice can occur if bilirubin builds up either because red blood cells are being broken down too fast for the liver, because of disease in the liver, or blockage of the bile ducts. Jaundice is the discoloration of skin and sclera of the eye, which occurs when bilirubin accumulates in the blood at a level greater than approximately 2.5 mg/dl.
If the bile ducts are obstructed, direct bilirubin will build up, causing some of it to 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 indicate:
Increased direct bilirubin may indicate:Additional conditions under which the test may be performed:
Cost:
Special Considerations: Interfering factors:
- hemolysis of blood
- lipids in the blood
- bilirubin is light-sensitive; it decomposes in light
Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.
