Test Detail
Interpreting Results
Tests Included

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Written by
Dr. Betina Chandolia
BDS, MDS - Oral Pathology and Microbiology
Reviewed by
Dr. Ashish Ranjan
MBBS, MD (Pharmacology)
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Bilirubin (Total, Direct and Indirect)

Bilirubin (Total, Direct and Indirect) Test Includes 3 testsView All
You need to provide
This test is for
Male, Female
Test Preparation
  1. No special preparation required


What is Bilirubin (Total, Direct and Indirect)?

A kidney, ureter, and bladder (KUB) X-ray helps to visualize the organs of urinary and gastrointestinal systems. It is performed to determine an intestinal blockage, foreign objects in the stomach, tumors, kidney stones and gallstones. It can also provide information regarding the size, shape, and position of the kidneys, ureters, and bladder. This X-ray is advised to people complaining of persistent or acute abdominal pain.

A KUB X-ray is primary evaluation of the urinary tract before performing any other diagnostic procedures.

Why is Bilirubin (Total, Direct and Indirect) done?

The Bilirubin (Total, Direct and Indirect) test is done in case of signs and symptoms of:

  • Liver damage

  • Liver disease

  • Bile duct blockage

  • Hemolytic anemia

  • Liver-related metabolic problems

  • Jaundice in newborns

What does Bilirubin (Total, Direct and Indirect) Measure?

The Bilirubin (Total, Direct and Indirect) measures the amount of bilirubin present in the blood of a person. Bilirubin is an orange-yellow waste pigment produced by the normal breakdown of heme. The heme is a component of hemoglobin and is found in red blood cells. The liver processes the bilirubin and eliminates it from the body. 

The life span of red blood cells is about 120 days. The heme which is released from the hemoglobin is converted into bilirubin which is called unconjugated bilirubin. It is then carried to the liver by proteins, where it gets attached to sugars and becomes conjugated bilirubin. The conjugated bilirubin enters the bile from the liver and passes to the small intestine where it is broken down by the bacteria and further eliminated in the stool. These breakdown products of bilirubin are responsible for giving the characteristic brown color to the stool.

A healthy adult body produces approximately 250 - 350 mg of bilirubin daily. About 85% of bilirubin comes from damaged or degraded RBCs while the remaining amount comes from the bone marrow or liver. The small amount of unconjugated bilirubin is released in the blood normally, but conjugated bilirubin is not present in the blood. 

Both these forms of bilirubin can be measured or estimated and total bilirubin (sum of direct and indirect bilirubin) may be reported. In case there is an increase in levels of bilirubin, there will be yellowing of the skin and white of the eyes, giving the appearance of jaundice.  

Interpreting Bilirubin (Total, Direct and Indirect) results


The normal values of total bilirubin may range from 0.30 mg/dL to 1.20 mg.dL.

Reference range may vary from lab to lab*

  • Increased total bilirubin which is mainly unconjugated may be due to hemolytic anemia, transfusion reactions 
  • Increased total bilirubin which is mainly conjugated may be due to viral hepatitis, drug reactions, alcoholic liver disease, gall stones or any obstruction in the bile ducts 
  • Low levels of bilirubin are usually not a cause for concern and therefore not monitored 

Answers to Patient Concerns & Frequently Asked Questions (FAQs) about Bilirubin (Total, Direct and Indirect)

Frequently Asked Questions about Bilirubin (Total, Direct and Indirect)

Q. How is the blood sample taken?
The healthcare provider takes a blood sample from the arm. The site from where the blood is to be withdrawn is cleaned with a swab of rubbing alcohol. This is then followed by inserting a small needle which has a tube attached to it for collecting blood. Once the sufficient blood for analysis is withdrawn, the needle is removed. The site is then covered with a gauze pad.
Q. Is there any risk associated with the withdrawal of blood sample procedure?
As such there is no risk but in few cases, bruising, bleeding, and infection at the puncture site can be seen. In very few cases, there can be swelling of the vein after the blood is withdrawn.
Q. What does Bilirubin (Total, Direct and Indirect) Test aid in diagnosing?
In case of adults and older children, Bilirubin (Total, Direct and Indirect) Test aids to diagnose and monitor diseases of the liver and bile duct. These diseases may include cirrhosis, gallstones or hepatitis. This test also helps to evaluate the progress people with sickle cell disease or other causes of hemolytic anemia. In case of newborns with jaundice, this test is done to distinguish the causes of jaundice.
Q. What other tests are advised along with Bilirubin (Total, Direct and Indirect) Test?
Other tests which are advised along with Bilirubin (Total, Direct and Indirect) test include alkaline phosphatase, aspartate aminotransferase and alanine aminotransferase tests. In case, hemolytic anemia is suspected, the other tests which are advised include complete blood count, reticulocyte count, haptoglobin and LDH.
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Tests Included (3 tests)

  • Bilirubin Total
  • Bilirubin Direct
  • Bilirubin Indirect


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