Bilirubin Direct
- C1045
Rs 170
Tests Detail
| Observations Included |
| Bilirubin Direct * |
| The Test marked with (*) are in our NABL Scope. |
Sample Report
- Also Known As:
Bilirubin - Formal Name:
otal Bilirubin TBIL Neonatal Bilirubin Direct Bilirubin Conjugated Bilirubin Indirect Bilirubin Unco - Sample Instructions:
When you have signs or symptoms of liver damage, liver disease, bile duct blockage, hemolytic anemia, or a liver-related metabolic problem, or if a newborn has jaundice - Test Preparation Needed?
In adults, a blood sample drawn from a vein in the arm; in newborns, a blood sample from a heelstick; non-invasive technology is available in some healthcare facilities that will measure bilirubin by using an instrument placed on the skin (transcutaneous bilirubin meter) - What Is Being Tested?
You may need to fast (nothing but water) for several hours before the test; fasting requirements vary by laboratory; ask your lab or healthcare provider for instructions. - How Is It Used?
Bilirubin is an orange-yellow pigment, a waste product primarily produced by the normal breakdown of heme. Heme is a component of hemoglobin, which is found in red blood cells (RBCs). Bilirubin is ultimately processed by the liver to allow its elimination from the body. This test measures the amount of bilirubin in the blood to evaluate a person's liver function or to help diagnose anemias caused by RBC destruction (hemolytic anemia). RBCs normally degrade after about 120 days in circulation. As heme is released from hemoglobin, it is converted to bilirubin. This form of bilirubin is also called unconjugated bilirubin. Unconjugated bilirubin is carried by proteins to the liver; there, sugars are attached (conjugated) to bilirubin to form conjugated bilirubin. Conjugated bilirubin enters the bile and passes from the liver to the small intestines; there, it is further broken down by bacteria and eventually eliminated in the stool. Thus, the breakdown products of bilirubin give stool its characteristic brown color. A small amount (approximately 250 to 350 milligrams) of bilirubin is produced daily in a normal, healthy adult. Most (85%) of bilirubin is derived from damaged or degraded RBCs, with the remaining amount derived from the bone marrow or liver. Normally, small amounts of unconjugated bilirubin are released into the blood, but virtually no conjugated bilirubin is present. Both forms can be measured or estimated by laboratory tests, and a total bilirubin result (a sum of these) may also be reported. If the bilirubin level increases in the blood, a person may appear jaundiced, with a yellowing of the skin and/or whites of the eyes. The pattern of bilirubin test results can give the health practitioner information regarding the condition that may be present. For example, unconjugated bilirubin may be increased when there is an unusual amount of RBC destruction (hemolysis) or when the liver is unable to process bilirubin (i.e., with liver diseases such as cirrho - When Is It Ordered
A bilirubin test is used to detect an increased level in the blood. It may be used to help determine the cause of jaundice and/or help diagnose conditions such as liver disease, hemolytic anemia, and blockage of the bile ducts. Bilirubin is an orange-yellow pigment, a waste product primarily produced by the normal breakdown of heme. Heme is a component of hemoglobin, which is found in red blood cells (RBCs). Bilirubin is ultimately processed by the liver to allow its elimination from the body. Any condition that accelerates the breakdown of RBCs or affects the processing and elimination of bilirubin may cause an elevated blood level. Two forms of bilirubin can be measured or estimated by laboratory tests: Unconjugated bilirubin—when heme is released from hemoglobin, it is converted to unconjugated bilirubin. It is carried by proteins to the liver. Small amounts may be present in the blood. Conjugated bilirubin—formed in the liver when sugars are attached (conjugated) to bilirubin. It enters the bile and passes from the liver to the small intestines and is eventually eliminated in the stool. Normally, no conjugated bilirubin is present in the blood. Usually, a chemical test is used to first measure the total bilirubin level (unconjugated plus conjugated bilirubin). If the total bilirubin level is increased, the laboratory can use a second chemical test to detect water-soluble forms of bilirubin, called "direct" bilirubin. The direct bilirubin test provides an estimate of the amount of conjugated bilirubin present. Subtracting direct bilirubin level from the total bilirubin level helps estimate the "indirect" level of unconjugated bilirubin. The pattern of bilirubin test results can give the healthcare provider information regarding the condition that may be present. In adults and older children, bilirubin is measured to: Diagnose and/or monitor diseases of the liver and bile duct (e.g., cirrhosis, hepatitis, or gallstones) Evaluate people with s - What Does The Test Result Mean?
A health practitioner usually orders a bilirubin test in conjunction with other laboratory tests (alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase) when someone shows signs of abnormal liver function. A bilirubin level may be ordered when a person: Shows evidence of jaundice Has a history of drinking excessive amounts of alcohol Has suspected drug toxicity Has been exposed to hepatitis-causing viruses Other symptoms that may be present include: Dark, amber-colored urine Nausea/vomiting Abdominal pain and/or swelling Fatigue and general malaise that often accompany chronic liver disease Measuring and monitoring bilirubin in newborns with jaundice is considered standard medical care. Tests for bilirubin may also be ordered when someone is suspected of having (or known to have) hemolytic anemia as a cause of anemia. In this case, it is often ordered along with other tests used to evaluate hemolysis, such as complete blood count, reticulocyte count, haptoglobin, and LDH. - Is There Anything Else I Should Known?
Adults and children Increased total bilirubin that is mainly unconjugated (indirect) bilirubin may be a result of: Hemolytic or pernicious anemia Transfusion reaction Cirrhosis A relatively common inherited condition called Gilbert syndrome, due to low levels of the enzyme that produces conjugated bilirubin If conjugated (direct) bilirubin is elevated more than unconjugated (indirect) bilirubin, there typically is a problem associated with decreased elimination of bilirubin by the liver cells. Some conditions that may cause this include: Viral hepatitis Drug reactions Alcoholic liver disease Conjugated (direct) bilirubin is also elevated more than unconjugated (indirect) bilirubin when there is blockage of the bile ducts. This may occur, for example, with: Gallstones present in the bile ducts Tumors Scarring of the bile ducts Rare inherited disorders that cause abnormal bilirubin metabolism such as Rotor, Dubin-Johnson, and Crigler-Najjar syndromes, may also cause increased levels of bilirubin. Low levels of bilirubin are generally not concerning and are not monitored. Newborns An elevated bilirubin level in a newborn may be temporary and resolve itself within a few days to two weeks. However, if the bilirubin level is above a critical threshold or increases rapidly, an investigation of the cause is needed so appropriate treatment can be initiated. Increased bilirubin concentrations may result from the accelerated breakdown of red blood cells due to: Blood type incompatibility between the mother and her newborn Certain congenital infections Lack of oxygen (hypoxia) Diseases that can affect the liver In most of these conditions, only unconjugated (indirect) bilirubin is increased. An elevated conjugated (direct) bilirubin is seen in the rare conditions of biliary atresia and neonatal hepatitis. Biliary atresia requires surgical intervention to prevent liver damage.
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