Bilirubin: Test Types, Levels and Management

What is Bilirubin?

Bilirubin is a yellowish-orange pigment that forms when the body breaks down old or damaged red blood cells. This process occurs naturally as red blood cells reach the end of their lifespan. 

Bilirubin is then transported through the bloodstream to the liver, where it undergoes further processing. The body uses bilirubin as a way to eliminate waste, making it a crucial part of the detoxification process.

In the liver, bilirubin is combined with bile, a digestive fluid that helps break down fats. This process converts bilirubin into a form that can be excreted from the body. Once conjugated with bile, bilirubin is stored in the gallbladder and eventually released into the intestines. 

Here, it assists in digestion and is excreted from the body through stool. The characteristic color of stool is partly due to the presence of bilirubin. This efficient process ensures that bilirubin levels remain balanced, supporting overall health.

Bilirubin plays a vital role in the body’s waste removal and digestive processes, but when its levels are out of balance, it can signal underlying health issues. This is why bilirubin testing is crucial for monitoring liver function and detecting potential disorders early.

Types of Bilirubin Tests

There are two main ways to measure bilirubin levels: through blood tests and urine tests, each providing important insights into your liver's health.

Blood Tests

• Total Bilirubin: This test measures the total amount of bilirubin in the blood, providing an overview of liver function and overall bilirubin levels. It combines direct (conjugated) and indirect (unconjugated) bilirubin.
• Direct (Conjugated) Bilirubin: This test specifically measures the bilirubin that has been processed by the liver. Elevated levels of direct bilirubin often indicate that the liver is having trouble excreting bile, possibly due to bile duct obstruction or liver disease.
• Indirect (Unconjugated) Bilirubin: This test measures the bilirubin that has not yet been processed by the liver. High indirect bilirubin levels may suggest conditions such as hemolytic anemia, where red blood cells are broken down faster than they can be processed.

Urine Tests

Urine tests for bilirubin are less common but can be useful in routine checkups or when liver function is in question. When bilirubin is detected in urine, it typically indicates that bilirubin levels in the blood are high, often due to liver disease or bile duct blockage. These tests can help in early detection and monitoring of liver-related health issues.

Pre-Test Guidelines

Preparation for a bilirubin test is simple but important to ensure accurate results. Here are some key steps:

• Fasting: Your healthcare provider may ask you to avoid eating or drinking anything other than water for 4 hours before the test. This helps in getting an accurate measurement of your bilirubin levels.
• Medication: Some medications can affect bilirubin levels. Inform your doctor about any prescription or over-the-counter drugs you’re taking. They may advise you to temporarily stop certain medications.
• Avoid Strenuous Activity: Engaging in intense physical activity before the test can temporarily elevate bilirubin levels. It’s best to avoid strenuous exercise before your appointment.

Bilirubin Levels By Age Group

When discussing bilirubin levels, it's important to recognize that these values can serve as key indicators of your liver and overall health. The following ranges, based on guidelines from the Mayo Clinic, provide a standard for what is considered normal bilirubin levels across different age groups:

For Adults

• Total Bilirubin: Up to 1.2 mg/dL.
• Direct Bilirubin: Less than 0.3 mg/dL.
• Indirect Bilirubin: This value is calculated by subtracting direct bilirubin from total bilirubin.

For Children (Under 18)

• Total Bilirubin: Up to 1 mg/dL.
• Direct and Indirect Bilirubin: Less than 0.3 mg/dL.

Note: Results may vary slightly depending on the laboratory performing the test.

For those seeking to understand their levels more clearly, consider using the Docus Lab Test Interpretation Tool for personalized insights and recommendations based on your results. This tool can help you interpret your bilirubin levels and guide you on the next steps to take for your health.

Abnormal Bilirubin Levels

High Bilirubin Levels

High bilirubin levels can be a sign of various underlying health issues. Understanding the causes and associated conditions is key to addressing these abnormalities effectively.

• Liver Dysfunction: Conditions like cirrhosis and hepatitis can impair the liver’s ability to process bilirubin, leading to elevated levels in the blood.
• Bile Duct Blockages: Obstructions in the bile ducts can prevent bilirubin from being excreted properly, causing it to accumulate in the bloodstream.
• Increased Red Blood Cell Breakdown: Disorders such as hemolytic anemia lead to the rapid destruction of red blood cells, resulting in higher bilirubin production.

• Hepatitis: This liver inflammation reduces the liver’s ability to process bilirubin effectively.
• Cirrhosis: Scarring of liver tissue due to chronic damage, which disrupts the liver’s normal function.
• Hemolytic Anemia: A condition where red blood cells are destroyed faster than they are produced, causing an increase in bilirubin.

Low Bilirubin Levels

Low bilirubin levels are generally less alarming but can still provide important insights into your health.

• Medication Use: Certain medications such as barbiturates, caffeine-containing drugs, and high-dose salicylates can lower bilirubin production, leading to reduced levels in the blood.
• Genetic Conditions: Some genetic factors may naturally result in lower bilirubin levels.

While low bilirubin levels are usually not a cause for concern, they can sometimes be linked to underlying issues such as cardiovascular disease. Regular monitoring can help ensure that bilirubin levels remain within a healthy range, contributing to overall well-being.

Symptoms of Abnormal Bilirubin Levels

Symptoms that may prompt a bilirubin test include:

• Jaundice: A yellowing of the skin and eyes, indicating high bilirubin levels.
• Dark Urine: A sign that bilirubin is being excreted through urine due to high levels in the blood.
• Fatigue: Chronic tiredness may be linked to liver dysfunction, affecting bilirubin processing.
• Clay-Colored Stools: A change in stool color can indicate a problem with bilirubin excretion.

These symptoms can be subtle but are important indicators of potential underlying health issues.

Managing and Lowering High Bilirubin Levels

Lifestyle Changes

Managing high bilirubin levels often involves making specific lifestyle adjustments that can support liver health and reduce bilirubin levels. Here are some practical tips:

• Diet: Incorporate liver-friendly foods into your diet, such as leafy greens, beets, and foods rich in antioxidants. Avoid heavy alcohol consumption and limit the intake of processed foods and sugars.
• Hydration: Drink plenty of water to support your body’s natural detoxification processes. Staying hydrated helps the liver function optimally.
• Avoid Toxins: Reduce exposure to environmental toxins and avoid the use of recreational drugs. These can place additional stress on your liver.

Medical Treatments

In some cases, lifestyle changes alone may not be enough to manage high bilirubin levels, and medical treatment may be necessary. Treatments might include:

• Medications: Your doctor may prescribe medications to manage underlying conditions affecting bilirubin levels.
• Phototherapy: For newborns with high bilirubin, phototherapy is often used. This treatment involves exposing the baby to special lights that help break down bilirubin in the skin.
• Surgery: In cases where bile duct obstruction is causing elevated bilirubin, surgical intervention may be required to remove blockages.

Always follow your healthcare provider’s advice and treatment plan to effectively manage bilirubin levels and maintain your health.