Bilirubin Test | Know About Your Body’s Bilirubin (with pictures, videos, FAQs)

We have definitely heard severally that they are things that when present in many quantities in our body, can lead to health complications. Today, this post will focus on one of such things which is bilirubin.

In this article, Healthsoothe aims to expatiate on all there is to know about bilirubin, as well as the bilirubin test which is done to check the levels of bilirubin in the body.

We will explain what causes imbalances in bilirubin levels, what affects bilirubin, how you can maintain a healthy level of bilirubin, as well as the effects of imbalances in bilirubin levels.

Alright, enough intro. Let’s proceed.

Bilirubin – What is it?

Bilirubin is produced naturally during the breakdown of red blood cells. It's a yellowish chemical found in bile, which is a fluid found in your liver. This fluid aids in the digestion of your meals.

A healthy liver removes the majority of bilirubin from the body. Bilirubin may seep into your bloodstream if your liver is injured. Excessive bilirubin in your blood might lead to health concerns. Bilirubin may also be found in urine, making it seem extremely black.

What are the Types of Bilirubin?

If you’re looking at your test results, you’ll probably notice a few kinds of bilirubin, including:

• Unconjugated (indirect) bilirubin. This type is created when hemoglobin from red blood cells is broken down, bound to a protein in the blood called albumin, and transported to the liver.
• Conjugated (direct) bilirubin. This type is created when bilirubin attaches to (conjugates with) glucuronic acid in the liver before being excreted. This type of bilirubin is what makes your urine yellow.
• Total bilirubin. This refers to all of the bilirubin in your bloodstream.

Your doctor might say you have low bilirubin levels if any of these are outside of the usual range. 

High Bilirubin Levels

Typically, bilirubin levels fall somewhere between 0.3 and 1.0 milligrams per deciliter (mg/dL). Anything above 1.2 mg/dL is usually considered elevated.

What are the Symptoms of High Bilirubin?

If you have high bilirubin, your symptoms will depend on the underlying cause. You can have mildly high bilirubin and have no symptoms at all.

With moderately high bilirubin, you may only have jaundice, which is a yellowish color in your eyes and skin. Jaundice is the main sign of high bilirubin levels.

Other general signs of illnesses that cause high bilirubin can include:

• Abdominal pain or swelling
• Chills
• Fever
• Chest pain
• Weakness
• Light-headedness
• Fatigue
• Nausea
• Vomiting
• Unusually dark urine

What Causes High Bilirubin?

Having high bilirubin can be a sign of several conditions. Your doctor will take your symptoms, as well as any other test results, into account to help narrow down a diagnosis. The following are known to be the cause of high bilirubin levels:

Gallstones

Gallstones happen when substances like cholesterol or bilirubin harden in your gallbladder. Your gallbladder is responsible for storing bile, a digestive fluid that helps break down fats before they enter your intestines.

Symptoms of gallstones include:

• Pain in your upper right abdomen or right below your chest
• Back pain between your shoulders or in your right shoulder
• Feeling sick
• Throwing up

Gallstones may form if your body is already producing too much bilirubin due to a liver condition or if your liver is creating too much cholesterol. They can also be a complication of an infection of your bile ducts or from a blood disorder.

Bilirubin builds up when your gallbladder is blocked and can’t drain properly.

Gilbert’s syndrome: Gilbert’s syndrome is a genetic liver condition that causes your liver to not process bilirubin properly. This causes the bilirubin to build up in your bloodstream.

This condition often doesn’t cause symptoms, but when it does, they can include:

• Jaundice
• Nausea
• Vomiting
• Diarrhea
• Minor abdominal discomfort

Liver dysfunction

Any condition that affects the function of your liver can cause bilirubin to build up in your blood. This is a result of your liver losing its ability to remove and process bilirubin from your bloodstream.

Several things can affect the function of your liver, including:

• cirrhosis
• liver cancer
• autoimmune disorders involving the liver, such as autoimmune hepatitis or primary biliary cholangitis

Common symptoms of liver dysfunction include:

• jaundice
• pain or swelling of your abdomen
• swelling of your legs or ankles (edema)
• exhaustion
• nausea
• vomiting
• easy bruising
• dark urine
• pale, bloody, or black stools
• itchy skin

Hepatitis

Hepatitis happens when your liver becomes inflamed, often due to a viral infection. When it’s inflamed, your liver can’t easily process bilirubin, leading to a build-up of it in your blood.

Hepatitis doesn’t always cause symptoms, but when it does, they can include:

• jaundice
• exhaustion
• dark urine
• abdominal pain
• nausea
• vomiting

Bile duct inflammation

Your bile ducts connect your liver to your gallbladder and the opening of your small intestine, called the duodenum. They help to move bile, which contains bilirubin, from your liver and gallbladder into your intestines.

If these ducts become inflamed or blocked, bile can’t be properly drained. This can lead to an increased level of bilirubin.

Symptoms of bile duct inflammation may include:

• pale stools
• dark urine
• jaundice
• itching
• nausea
• vomiting
• unexplained weight loss
• fever

Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy is a temporary condition that can happen during the last trimester of pregnancy. It causes bile drainage from your liver to either slow down or stop entirely.

This makes it harder for your liver to process bilirubin from your blood, leading to high bilirubin levels.

Symptoms of intrahepatic cholestasis of pregnancy include:

• itchy hands and feet without a rash
• jaundice
• gallstone symptoms

Hemolytic anemia

Hemolytic anemia happens when blood cells break down too quickly in your bloodstream. It’s sometimes passed down genetically, but autoimmune conditions, an enlarged spleen, or an infection can also cause it.

Symptoms of hemolytic anemia include:

• exhaustion
• difficulty breathing
• dizziness
• headaches
• abdominal pain
• chest pain
• jaundice
• cold hands or feet
• High total bilirubin may also be caused by the following:
• Cirrhosis
• A reaction to blood transfusion and drugs
• Very strenuous exercise, such as marathon running, can increase your bilirubin levels.

What are the Potential Risks of High Bilirubin?

High bilirubin levels are usually a sign that something is not working as expected in your liver or gallbladder. Some of these conditions aren’t too serious, but it’s important to monitor and treat them.

Higher than usual levels of bilirubin may indicate different types of liver or bile duct problems.

Anyone with jaundice, which is the main sign of high bilirubin levels, should contact their doctor. If your doctor isn’t immediately sure what’s causing your high bilirubin levels, you may need to return for additional blood, liver function, or other tests.

Low Bilirubin Levels

This is when the level of bilirubin in your body is lower than normal. Typically, bilirubin levels fall somewhere between 0.3 and 1.0 milligrams per deciliter (mg/dL). Anything below 0.3 mg/dL is usually considered low.

What are the Symptoms of Low Bilirubin?

Low bilirubin levels usually don’t cause any symptoms. Most people don’t even know they have low bilirubin levels until their doctor orders a blood test.

If you have low bilirubin levels and notice any unusual symptoms, make an appointment with your doctor. You may have an unrelated condition that needs treatment.

What are the Causes of Low Bilirubin?

There aren’t any health conditions that cause low bilirubin levels. But consuming certain substances can temporarily lower them.

These include:

• caffeine
• nonsteroidal anti-inflammatory drugs (NSAIDs) called salicylates, such as aspirin
• barbiturates
• Penicillin

Consuming any of these a few hours before a blood test can make your bilirubin levels appear low in your test results.

To avoid this, don’t take any of these substances for at least eight hours before a blood test. Your doctor might also give you additional instructions on other things to avoid before the test for accurate results.

What are the Potential Risks of Low Bilirubin?

There’s no clear link between low bilirubin levels and any medical conditions. However, some research suggests that bilirubin acts as an antioxidant. Antioxidants protect tissues throughout your body from damage by substances that can cause cells to break down.

Based on bilirubin’s potential antioxidant properties, some believe that not having enough of it can leave certain body parts vulnerable to damage.

This damage could potentially lead to a range of conditions, such as:

• Coronary artery disease: Coronary artery disease involves damage to the coronary arteries, which bring fresh blood and oxygen to the heart. A 2016 study explored a theory that higher bilirubin may offer some protection against coronary artery disease, but couldn’t confirm it. It also didn’t find that low bilirubin levels caused an increased risk of coronary artery disease.
• Ulcerative colitis: Ulcerative colitis causes chronic inflammation that can damage your digestive tract. A 2017 study suggests that lower bilirubin levels might make it harder for the body to remove reactive oxygen species. These are linked to inflammation associated with ulcerative colitis. Having a low bilirubin level hasn’t been shown to increase the risk of developing ulcerative colitis, though.
• Brain lesions: A 2018 study suggests that low bilirubin levels could increase your risk of developing deep white matter lesions in your brain, even if you don’t have any other health issues. These lesions are linked to several conditions, including dementia and heart disease.
• Strokes: Low bilirubin levels may also be associated with blood vessel damage, according to a 2009 study. This type of damage can increase your risk of having a stroke. The study notes that women are less likely to have a stroke related to low bilirubin levels.
• Eye disease: A 2017 study found that low bilirubin levels may be a marker for diabetic retinopathy. This is an eye condition that happens when blood vessels near the retina at the back of the eye are damaged.

Keep in mind that much more research is needed before experts can draw any concrete links between bilirubin levels and someone’s risk of developing these conditions.

Bilirubin Levels in New-borns

Many babies have high bilirubin a few days after birth, causing a condition called new-born jaundice. This is a temporary condition that usually resolves on its own within a few weeks.

It happens because newborns have more red blood cells and break them down more quickly, but their livers are not developed enough to keep up.

Prior to being born, the pregnant person’s liver helps with this task. A newborn's liver is only about 1 percent as active as an adult’s.

In most cases, higher bilirubin levels will lead to jaundice between 1 and 3 days after birth. Bilirubin levels can peak as high as 18 mg/dL on the fourth or fifth day, and the jaundice typically clears up within 2 weeks as the liver matures.

Feeding 8 to 12 times per day helps to promote regular bowel movements, which help to remove bilirubin from the body.

In new-borns, high bilirubin levels that don’t level out in a few days to 2 weeks may be caused by or be a sign of:

• lack of certain important proteins due to genetic defects
• bruising due to a difficult delivery
• high levels of red blood cells due to small size, prematurity
• infections
• Blood type incompatibility between mother and child
• abnormal blood cell shapes, such as sickle cell anemia
• Lack of oxygen
• An inherited infection
• A disease affecting the liver

In an infant, high (usually indirect) bilirubin and jaundice can be very dangerous and may be caused by several factors. There are three common types:

• Physiological jaundice: at two to four days after birth, caused by a brief delay in the functioning of the liver and usually not serious
• Breastfeeding jaundice: during the first week of life, caused by a baby not nursing well or low milk supply in the mother
• Breast milk jaundice: after two to three weeks of life, caused by the processing of some substances in breast milk

All of these can be easily treated and are usually harmless if treated. If jaundice occurs within the first 24 hours after birth, or if bilirubin levels are especially high or don’t begin to fall on their own, doctors may intervene with treatments such as:

• Phototherapy
• Intravenous immunoglobulin treatment
• Exchange transfusion

Bilirubin Test

A bilirubin test measures the levels of bilirubin in your blood.

Why Bilirubin Tests Are Done

Bilirubin testing is usually one of a group of tests to check the health of your liver.¹ Lab Tests Online. Bilirubin. labtestsonline. Accessed Nov. 7, 2022. Bilirubin testing may be done to:

• Test for cirrhosis, hepatitis, and gallstones.
• Determine if you have sickle cell disease or other conditions that cause hemolytic anemia.
• Investigate jaundice — a yellowing of the skin and eyes caused by high levels of bilirubin. This test is commonly used to measure bilirubin levels in newborns with infant jaundice.
• Determine whether there might be a blockage in your bile ducts, in either the liver or the gallbladder.
• Help detect liver disease, particularly hepatitis, or monitor its progression.
• Help evaluate anemia caused by the destruction of red blood cells.
• Help follow how a treatment is working.
• Help evaluate suspected drug toxicity.

Common or other tests that might be done at the same time as bilirubin testing

• Liver function tests: Blood tests that measure certain enzymes or proteins in your blood.
• Albumin and total protein test: Levels of albumin — a protein made by the liver — and total protein show how well your liver is making certain proteins. These proteins are necessary for your body to fight infections and perform other functions.
• Complete blood count: This test measures several components and features of your blood.
• Prothrombin time: This test measures the clotting time of plasma.

Bilirubin Test Procedures

How Do I Prepare for a Bilirubin Test?

There are no specific preparations required for the bilirubin test. If there are any limits, such as what you may eat and drink before the test, your doctor will inform you. If your blood is needed to test for other ailments at the same time, this may be required of you.

In most preparations for this test, patients were advised not to eat or drink anything other than water for four hours before the test was performed. You can drink your usual amount of water before going to the laboratory or collection site.

You may have to stop taking certain medications before the test is performed, but only if your doctor tells you to do so. Examples of drugs that can affect bilirubin levels include antibiotics like penicillin G, sedatives like phenobarbital, diuretics like furosemide (Lasix), and asthma medications like theophylline.

There are many other drugs that can influence bilirubin levels. Talk to your doctor before your test to see if you should stop or continue taking medication.

What Can You Expect During a Bilirubin Test?

Bilirubin testing is done using a blood sample.²Mayo Medical Laboratories. Bilirubin, serum. mayocliniclabs/test-catalog/. Accessed Nov. 7, 2022. Usually, the blood is drawn through a small needle inserted into a vein in the bend of your arm. A small tube is attached to the needle to collect the blood.

You may feel a quick pain as the needle is inserted into your arm. You also may experience some short-term discomfort at the site after the needle is removed. Blood for bilirubin testing in newborns is usually collected using a sharp lancet³Friedman LS. Clinical aspects of serum bilirubin determination. uptodate. Accessed Nov. 7, 2022. to break the skin of the heel. This is known as a heel stick. There may be slight bruising at the puncture site afterward.

Your blood will be sent to a laboratory for analysis. You can usually return to normal activities immediately.

Bilirubin Test Results

Bilirubin test results are expressed as direct, indirect, or total bilirubin. Total bilirubin is a combination of direct and indirect bilirubin. Typically, you'll get results for direct and total bilirubin.

Typical results for a total bilirubin test are 1.2 milligrams per deciliter (mg/dL) for adults and usually 1 mg/dL for those under 18. Typical results for direct bilirubin are generally 0.3 mg/dL.

A bilirubin test measures total bilirubin. It can also give levels of two different types of bilirubin: unconjugated and conjugated.

Unconjugated (“indirect”) bilirubin: This is the bilirubin created from red blood cell breakdown. It travels in the blood to the liver.

Conjugated (“direct”) bilirubin: This is the bilirubin once it reaches the liver and undergoes a chemical change. It moves to the intestines before being removed through your stool.

For adults over 18, normal total bilirubin can be up to 1.2 milligrams per deciliter (mg/dl) of blood. For those under 18, the normal level will be 1 mg/dl. Normal results for conjugated (direct) bilirubin should be less than 0.3 mg/dl.

Men tend to have slightly higher bilirubin levels than women. African-Americans tend to have lower bilirubin levels than people of other races.

These results may vary slightly from laboratory to laboratory. Results may be slightly different for women and children. Results also may be affected by certain foods, medicines, or demanding exercise.

For this reason, be sure to tell your healthcare provider about your activity levels, as well as any foods or medicines you've taken.

Lower than usual bilirubin levels are usually not a concern. Higher levels of direct bilirubin in your blood may indicate your liver isn't clearing bilirubin properly. This may indicate liver damage or disease. Higher levels of indirect bilirubin may be a sign of other problems.

High bilirubin levels may indicate that the liver is not working properly. High amounts, on the other hand, may be caused by drugs, activity, or particular meals. Bilirubin is also a byproduct of red blood cell breakdown, and an increased level may be due to red blood cell problems rather than liver illness.

Results that are outside of the normal range may not always indicate the presence of a medical issue that requires treatment. Gilbert's syndrome, a benign liver illness, may produce small bilirubin spikes that can be overlooked.

Bilirubin is not normally present in urine. If it is present, it might indicate that there is some kind of liver injury or obstruction going on.

Elevated bilirubin levels in newborns must be discovered and treated as soon as possible. These high amounts may harm growing brain cells, causing cognitive and developmental difficulties, hearing and vision issues, and even death. Your doctor can explain the significance of the findings to you.

One common, and harmless, cause of elevated bilirubin is Gilbert's syndrome, a deficiency in an enzyme that helps break down bilirubin. Your healthcare provider may order more tests to investigate your condition. Bilirubin test results also may be used to monitor certain conditions, such as jaundice.

What happens after a bilirubin blood test

If your blood tests show abnormally high levels of bilirubin, your doctor may order more tests to determine the underlying cause.

Once your doctor has determined the cause of high bilirubin levels, you may need to take more bilirubin blood tests to monitor the effectiveness of your treatment.

If your doctor thinks your liver or gallbladder might not be functioning properly, they may order imaging tests to ensure there are no structural abnormalities.

Does the Bilirubin Test have any Risks?

Performing the bilirubin test has minimal to no risk. You may have little bruising or soreness where the injection entered & exited your arm. This rapidly fades.

When the blood is collected, you may briefly feel moderate pain or a mild pinching sensation. After the needle is taken out, you may feel a throbbing sensation.

You’ll be instructed to apply pressure to the site where the needle entered your skin. A bandage will be placed over the site. Keep this bandage on for at least 10 to 20 minutes.

You should avoid using that arm for heavy lifting for the rest of the day. There are some very rare risks to taking a blood sample:

• lightheadedness or fainting
• hematoma, a bruise where blood accumulates under the skin
• infection, usually prevented by the skin being cleaned before the needle is inserted
• excessive bleeding, or bleeding for a long period afterward, which may indicate a more serious bleeding condition and should be reported to your doctor

The Bottom Line

High bilirubin levels are usually a sign that something is not working as expected in your liver or gallbladder. Some of these conditions aren’t too serious, but it’s important to monitor and treat them.

Anyone with jaundice, which is the main sign of high bilirubin levels, should contact their doctor. If your doctor isn’t immediately sure what’s causing your high bilirubin levels, you may need to return for additional blood, liver function, or other tests.

While high bilirubin levels can indicate several health issues, low bilirubin levels usually aren’t anything to worry about. In some cases, it could be a side effect of a medication you take or having too much coffee before your blood test.

While low bilirubin levels may be associated with certain conditions, this link still isn’t totally clear. If your test results show you have low bilirubin levels, your doctor will likely just keep an eye out for any other symptoms you have and run another test after some time has passed.

Additional resources and citations

• 1
  Lab Tests Online. Bilirubin. labtestsonline. Accessed Nov. 7, 2022.
• 2
  Mayo Medical Laboratories. Bilirubin, serum. mayocliniclabs/test-catalog/. Accessed Nov. 7, 2022.
• 3
  Friedman LS. Clinical aspects of serum bilirubin determination. uptodate. Accessed Nov. 7, 2022.