Serum Bilirubin - Total & Direct
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Breakdown product of hemoglobin; elevated in liver disease or hemolysis, causing jaundice.
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🧪 What is Serum Bilirubin – Total and Direct?
Bilirubin is a yellow pigment formed by the breakdown of heme in red blood cells.
- Total bilirubin measures all bilirubin in the blood (both unconjugated and conjugated).
- Direct bilirubin (also called conjugated bilirubin) measures bilirubin that has been processed by the liver and is water-soluble.
- Indirect bilirubin is calculated by subtracting direct bilirubin from total bilirubin and represents unconjugated (not yet processed) bilirubin.
❓ Why is the Test Done?
To:
- Evaluate jaundice or yellowing of the skin and eyes
- Diagnose and differentiate causes of liver dysfunction, hemolysis, and biliary obstruction
- Monitor liver diseases like hepatitis, cirrhosis, and gallstones
- Assess newborn jaundice
📊 Normal Ranges
Bilirubin Type | Normal Range |
|---|---|
Total Bilirubin | 0.3 – 1.2 mg/dL |
Direct (Conjugated) | 0.0 – 0.3 mg/dL |
Indirect (Unconjugated) | Calculated (Total – Direct) |
📈 Interpretation of Results
Pattern | Possible Causes |
|---|---|
Elevated Indirect bilirubin | Hemolytic anemia, Gilbert’s syndrome, ineffective erythropoiesis, Crigler-Najjar syndrome |
Elevated Direct bilirubin | Hepatocellular injury (hepatitis), cholestasis, biliary obstruction, Dubin-Johnson syndrome |
Elevated Both | Mixed hepatocellular and obstructive liver disease |
Normal bilirubin with symptoms | Other causes of jaundice (e.g., breast milk jaundice in neonates) |
🧠 Associated Conditions
Condition | Details |
|---|---|
Hemolytic anemia | Increased breakdown of RBCs leading to indirect hyperbilirubinemia |
Liver diseases | Hepatitis, cirrhosis causing impaired conjugation or excretion |
Biliary obstruction | Gallstones, tumors causing direct hyperbilirubinemia |
Genetic syndromes | Gilbert’s, Crigler-Najjar, Dubin-Johnson syndromes |
🔄 Related / Follow-Up Tests
- Liver function tests (ALT, AST, ALP, GGT)
- Complete blood count (CBC)
- Coagulation profile
- Ultrasound abdomen – to evaluate biliary tract
- Hemolysis workup – LDH, haptoglobin, reticulocyte count
✅ Fasting Required?
Test | Fasting Required |
|---|---|
Serum Bilirubin (Total & Direct) | ❌ No |
📝 Summary Table
Parameter | Details |
|---|---|
What | Measures total and direct bilirubin in blood |
Why | Evaluate jaundice, liver, hemolytic, and biliary diseases |
Normal Range | Total: 0.3–1.2 mg/dL; Direct: 0.0–0.3 mg/dL |
High Indirect Bilirubin | Hemolysis, Gilbert’s syndrome |
High Direct Bilirubin | Hepatitis, cholestasis, obstruction |
Associated Conditions | Liver disease, hemolysis, biliary obstruction |
Follow-up Tests | LFTs, CBC, imaging, hemolysis workup |
Fasting Required | ❌ No |
How our test process works!
