Bilirubin Direct

Liver

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No Fasting Required

Details

Breakdown product of hemoglobin; elevated in liver disease or hemolysis, causing jaundice.

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Bilirubin Direct - Comprehensive Medical Test Information Guide

Why is it done?
- Measures conjugated (direct) bilirubin, the form of bilirubin that has been processed by the liver and is ready for excretion into bile
- Evaluates liver function and the ability of the liver to process and excrete bilirubin
- Helps diagnose cholestasis (obstruction of bile flow) and biliary system disorders
- Assesses jaundice and determines if hyperbilirubinemia is due to liver dysfunction or hemolysis
- Monitors liver health in patients with suspected or known liver disease, cirrhosis, or hepatitis
- Investigates biliary obstruction from gallstones, pancreatic cancer, or strictures
- Typically ordered when total bilirubin levels are elevated or when evaluating abnormal liver function tests
Normal Range
- Normal Reference Range: 0.0 to 0.3 mg/dL (milligrams per deciliter) or 0 to 5 µmol/L (micromoles per liter)
- Units of Measurement: mg/dL (standard in United States) or µmol/L (international standard)
- Normal Result: Direct bilirubin levels within the reference range indicate normal liver function and unobstructed bile flow. The liver is properly conjugating and excreting bilirubin.
- Elevated Result: >0.3 mg/dL indicates elevated direct (conjugated) bilirubin, suggesting cholestasis, liver disease, or biliary obstruction
- Note: Reference ranges may vary slightly between laboratories; always refer to the specific laboratory's reference values provided on the test report
Interpretation
- Mildly Elevated (0.3-1.0 mg/dL): May indicate early-stage cholestasis, viral hepatitis, or mild liver dysfunction. Requires clinical correlation with symptoms and other liver function tests.
- Moderately Elevated (1.0-5.0 mg/dL): Suggests significant cholestasis, biliary obstruction (gallstones, tumors), or moderate hepatic dysfunction. Further imaging and investigation typically needed.
- Markedly Elevated (>5.0 mg/dL): Indicates severe cholestasis, complete biliary obstruction, advanced cirrhosis, or acute liver failure. Requires urgent medical evaluation and intervention.
- Interpretation in Context: Direct bilirubin elevation must be interpreted alongside total bilirubin, indirect bilirubin, alkaline phosphatase, GGT, transaminases (ALT/AST), and albumin levels
- Direct Hyperbilirubinemia Pattern: When direct bilirubin comprises >50% of total bilirubin, cholestasis is indicated (hepatic or post-hepatic)
- Factors Affecting Results: Medications (anabolic steroids, oral contraceptives), pregnancy, hemolysis during blood draw, recent blood transfusion, and time of sample collection
- Clinical Patterns: Elevated direct bilirubin with elevated alkaline phosphatase suggests extrahepatic obstruction; elevated with high transaminases suggests hepatocellular injury
Associated Organs
- Primary Organ System: Hepatobiliary system (liver, bile ducts, gallbladder, and pancreas)
- Liver Diseases: Cirrhosis, hepatitis (A, B, C, D, E), fatty liver disease (NAFLD), alcoholic liver disease, drug-induced liver injury, autoimmune hepatitis
- Biliary Obstruction: Gallstones (choledocholithiasis), common bile duct obstruction, pancreatic cancer, cholangiocarcinoma (bile duct cancer), strictures
- Genetic Disorders: Dubin-Johnson syndrome, Rotor syndrome, progressive familial intrahepatic cholestasis (PFIC)
- Pregnancy-Related: Intrahepatic cholestasis of pregnancy (ICP), preeclampsia, HELLP syndrome
- Pancreatic Pathology: Pancreatic cancer obstructing bile ducts, pancreatitis, pancreatic pseudocyst
- Potential Complications: Severe jaundice, encephalopathy, hepatic failure, secondary biliary cirrhosis, portal hypertension, varices, ascites, hepatorenal syndrome
Follow-up Tests
- Immediate Additional Tests: Total bilirubin, indirect (unconjugated) bilirubin, alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), transaminases (AST/ALT), albumin, prothrombin time (PT/INR)
- Imaging Studies: Ultrasound of abdomen/liver, CT scan, MRI, MRCP (magnetic resonance cholangiopancreatography), ERCP (endoscopic retrograde cholangiopancreatography) if obstruction suspected
- Viral Serology: Hepatitis A, B, C antibodies and antigens if hepatitis suspected
- Autoimmune Markers: ANA, anti-smooth muscle antibody, anti-LKM antibody if autoimmune hepatitis suspected
- Liver Biopsy: May be indicated to assess severity of liver disease, stage cirrhosis, or diagnose specific liver conditions
- Monitoring Schedule: For chronic liver disease: every 3-6 months; for acute conditions: serial measurements daily to weekly; for post-treatment: baseline then as clinically indicated
- Related Complementary Tests: 5-nucleotidase, 5'-NT, lipase, amylase, ceruloplasmin (for Wilson's disease), ferritin (for hemochromatosis)
Fasting Required?
- Fasting Required: NO
- Special Instructions: Direct bilirubin test can be performed on random blood samples at any time of day. No overnight fasting is necessary.
- Medications: Continue all regular medications unless otherwise directed by physician. Do NOT stop medications without consulting your healthcare provider.
- Sample Collection: Simple blood draw (venipuncture). Sample collected in standard serum separator tube or EDTA tube depending on laboratory protocol.
- Pre-Test Preparation: Wear comfortable, loose-fitting clothing with accessible sleeves. Bring insurance card and photo ID. Inform phlebotomist of any bleeding disorders or medications.
- Timing Considerations: Results typically available within 24 hours. For acute conditions, stat processing may be available. Light exposure should be minimized as bilirubin is photosensitive.

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