Liver Test

Bilirubin Test

Name: Bilirubin Test: Normal Range & High Bilirubin | HealthReview
Creator: Suman Konda
Published: 2026-07-05

Bilirubin is a yellow pigment made when red blood cells break down. High bilirubin causes jaundice: yellow skin and eyes. Here's what your bilirubin report means.

Written and clinically reviewed by Suman Konda, PharmD, Clinical Pharmacist · Based on peer-reviewed sources · Editorial policy · Not medical advice

Last reviewed and updated: 01 August 2026 · How we check our content

What is bilirubin?

When red blood cells reach the end of their 120-day lifespan, they are broken down in the spleen. The haemoglobin releases a yellow pigment called bilirubin. This travels to the liver, gets processed (conjugated), and is excreted in bile into the gut, giving stools their brown colour and contributing to the yellow colour of urine. When this pathway is disrupted at any point, bilirubin builds up in the blood, causing jaundice.

Types of bilirubin in your report

Test	Normal Range (mg/dL)	What it measures
Total Bilirubin	0.2 – 1.2	All bilirubin combined
Direct (Conjugated)	0.0 – 0.3	Processed by liver: bile duct problem if high
Indirect (Unconjugated)	0.2 – 0.9	Pre-liver: haemolysis or Gilbert's if high

What does HIGH total bilirubin mean?

HIGH Total bilirubin above 1.2 mg/dL

Jaundice (yellow skin/eyes) becomes visible when total bilirubin exceeds 2.5–3 mg/dL. Causes depend on WHICH type is elevated:

High INDIRECT bilirubin: pre-liver causes

High indirect bilirubin

Gilbert's Syndrome (most common: affects 5–10% of people, harmless): mildly elevated indirect bilirubin that fluctuates with fasting, stress or illness. No treatment needed. Haemolytic anaemia: red blood cells being destroyed faster than the liver can process bilirubin. Causes: sickle cell disease, thalassaemia, G6PD deficiency, autoimmune haemolysis. Neonatal jaundice: very common in newborns, immature liver can't process bilirubin fast enough.

High DIRECT bilirubin: liver/bile duct causes

High direct bilirubin

High direct (conjugated) bilirubin means the liver has processed it but can't excrete it: a bile duct blockage or liver cell damage. Causes: gallstones blocking the bile duct (most common surgical cause), viral hepatitis (A, B, E), alcoholic hepatitis, cholestasis of pregnancy, pancreatic cancer compressing the bile duct (painless jaundice in elderly = investigate urgently), primary biliary cholangitis.

Questions to ask your doctor

Is my bilirubin rise direct or indirect, and what does that narrow it down to?
Do I need a liver ultrasound to check for gallstones or bile duct dilation?
Could this be Gilbert's syndrome, a harmless condition?
Should I test for Hepatitis A, B and E?

Frequently asked questions

Should a borderline Bilirubin result be repeated?

Usually. A value just outside the interval is common in people who are entirely well, since about one in twenty healthy results falls outside any 95% reference range by construction. A borderline Bilirubin is normally rechecked rather than acted on.

Do Bilirubin results from two different laboratories compare directly?

Not reliably. Methods differ, so a change between labs can reflect the assay rather than a change in you. Where Bilirubin is being tracked over time, staying with one laboratory makes the comparison meaningful.

Does Bilirubin need to be measured fasting?

That depends on the rest of the panel. Samples are usually drawn together and the fasting rule is set by the strictest test included, not by Bilirubin alone. Follow whatever instruction you were given when the test was arranged.

References

The clinical information on this page is drawn from peer-reviewed sources indexed by the US National Library of Medicine. Links go to the source so you can read it yourself.

Liver Function Tests. In: StatPearls. Treasure Island (FL): StatPearls Publishing. NCBI Bookshelf NBK482489