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Bilirubin (total)

Blood Sciences Test





Reference Range

  • 14d – 16y: <21 umol/L
  • Adult: <21 umol/L

Test Usage

1. Hyperbilirubinaemia with raised enzymes see Liver enzymes

2. Hyperbiliruinaemia with normal enzymes

Disorders of hepatic excretion

Gilbert’s syndrome, a common incidental finding, is an unconjugated¬†hyperbilirubinaemia

Dubin Johnson and Rotor syndromes, much less common but also found incidentally, are conjugated hyperbilirubinaemias

Crigler-Najjar syndrome is a rare severe unconjugated hyperbilirubinaemia.

Haemolytic anaemias

  • uncommon but important. Check blood count, film, reticulocytes


  • thyroid disease, iron overload, drug reaction, resolving hepatitis

Clinical. How should I investigate an isolated case of slightly raised bilirubin in an asymptomatic adult?

Answer: We recommend:

  • Values up to 20% above ULN are likely to be statistical rather than clinically abnormal.
  • If the subject is unwell, repeat when fully recovered.
  • Values <1.5 times ULN: interval retest in 1-3 months unless clinical suspicion of disease.
  • Values > 1.5 ULN: confirm proportion of indirect (unconjugated) bilirubin.
  • If > 70% unconjugated, probable Gilbert syndrome: no further testing needed if non-progressive on interval retesting, unless haemolysis is clinically suspected. If rising on retesting, consider haemolysis and test haptogloblin, lactate dehydrogenase and blood film with reticulocyte count.
  • Values >3 times ULN: clinical disease probable, further investigation required.


Local test

Turnaround Time

1 day

Can be added on to an existing request up to 1 days following sample receipt

Specimen Labelling Procedure
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