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

Normal values may vary slightly from laboratory to laboratory.

What abnormal results mean:

Jaundice is a yellowing of the skin and the white part of the eye, which occurs when bilirubin builds up in the blood at a level greater than approximately 2.5 mg/dL. Jaundice occurs because red blood cells are being broken down too fast for the liver to process. This might happen due to liver disease or bile duct blockage.

If the bile ducts are blocked, direct bilirubin will build up, 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 be a sign of:

• Crigler-Najjar syndrome
• Erythroblastosis fetalis
• Gilbert's disease
• Healing of a large hematoma (bruise or bleeding under the skin)
• Hemolytic anemia
• Hemolytic disease of the newborn
• Hepatitis
• Physiological jaundice (normal in newborns)
• Sickle cell anemia
• Transfusion reaction
• Pernicious anemia

Increased direct bilirubin may indicate:

• Bile duct obstruction
• Cirrhosis
• Dubin-Johnson syndrome (very rare)
• Hepatitis
• Intrahepatic cholestasis (buildup of bile in the liver) due to any cause

Additional conditions under which the test may be performed:

• Biliary stricture
• Cholangiocarcinoma
• Cholangitis
• Choledocholithiasis
• Hemolytic anemia due to G6PD deficiency
• Hepatic encephalopathy
• Idiopathic aplastic anemia
• Idiopathic autoimmune hemolytic anemia
• Immune hemolytic anemia (including drug-induced immune hemolytic anemia)
• Secondary aplastic anemia
• Thrombotic thrombocytopenic purpura
• Wilson's disease