A bilirubin test plays a crucial role in assessing liver function and detecting certain blood disorders. The test is used to measure the levels of bilirubin—a yellow pigment produced in the body during the normal breakdown of red blood cells. If bilirubin levels are too high or too low, it could indicate a problem with the liver, bile ducts, or red blood cell breakdown. This test is often recommended when a person has symptoms such jaundice, fatigue, or dark urine. That said, sometimes, it is also a part of routine health checks. In this blog, we’ll break down everything you need to know about bilirubin testing and its role in keeping your health in check, followed by some tips that’ll help keep your bilirubin levels in check.

What is Bilirubin?

Bilirubin is a yellow pigment produced when red blood cells break down. This process mainly occurs in the spleen, where old or damaged red blood cells are broken down, releasing haemoglobin. Special cells called macrophages convert haemoglobin into unconjugated (indirect) bilirubin, which then travels to the liver. The liver processes it into conjugated (direct) bilirubin, making it water-soluble so it can be excreted through bile into the intestines. Most bilirubin leaves the body through stool, giving it its brown colour, while a small amount is removed through urine. If bilirubin levels are too high, it may cause jaundice, a yellowing of the skin and eyes, which can signal liver or blood-related issues.

What is a Bilirubin Test?

A bilirubin test checks the levels of bilirubin in the blood to help identify potential liver or blood-related issues. The test is also a routine part of newborn screenings to monitor bilirubin levels, as newborns often take time to process and clear bilirubin efficiently.

When is a Bilirubin Test Recommended?

Doctors usually suggest a bilirubin test when they think there might be a problem with the liver or blood. It’s often done if someone shows signs such as yellowing of the skin or eyes, dark-coloured urine, light-coloured stools, tiredness without a clear cause, nausea, or pain in the abdomen. The test is also used to monitor existing liver conditions such as hepatitis, cirrhosis, or bile duct obstruction.

Newborns often undergo bilirubin testing shortly after birth, as their livers may take time to process bilirubin properly. High bilirubin levels in newborns require monitoring to prevent complications like kernicterus, a rare but serious condition affecting the brain.

Doctors may also recommend this test as part of routine health check-ups, especially for individuals taking medications that affect the liver or those with a history of liver disease, excessive alcohol consumption, or haemolytic disorders.

How is the Bilirubin Test Performed?

A bilirubin test involves taking a small blood sample to measure bilirubin levels. The procedure differs slightly for adults, children, and newborns.

For Adults and Older Children

A healthcare professional cleans the skin, usually on the inner elbow, and ties a tourniquet around the upper arm to make the vein more visible. A clean needle is gently inserted into a vein to draw a small blood sample into a vial. After the sample is taken, the needle is taken out, and slight pressure is applied to prevent bleeding. A bandage is placed over the area, and any mild discomfort or bruising usually fades within a day or two.

For Newborns (Heel Prick Test)

Instead of a vein, newborns have their blood collected from the heel. A small, sterile lancet makes a quick prick, and a few drops of blood are collected on a test strip or in a tube. The baby's heel may be warmed beforehand to improve blood flow. After the sample is taken, the area is cleaned, and light pressure is applied to stop any bleeding. The prick may cause discomfort, but it is momentary.

After the Sample Is Collected

The blood is sent to a laboratory, where bilirubin levels are measured. Results are typically available within a few hours to a day. If bilirubin levels are abnormal, further tests may be needed to determine the cause. Newborns with high bilirubin levels may require monitoring or treatment, such as phototherapy, to prevent complications.

What Do Bilirubin Test Results Mean?

A bilirubin test measures total bilirubin, which includes direct (conjugated) and indirect (unconjugated) bilirubin. Results help assess liver function, bile duct health, and red blood cell breakdown.

Normal Bilirubin Levels

For adults and older children, normal total bilirubin levels typically range between 0.1 to 1.2 mg/dL. However, slight variations may occur depending on the laboratory and testing methods.

High Bilirubin Levels

Elevated bilirubin levels may suggest:

• Liver Disease – Conditions like hepatitis, cirrhosis, or fatty liver disease can impair the liver’s ability to process bilirubin, leading to its buildup in the blood.
• Blocked Bile Ducts – Gallstones, tumours, or bile duct inflammation can prevent bilirubin from being properly excreted, causing jaundice and other symptoms.
• Haemolysis (Excessive Red Blood Cell Breakdown) – Conditions like haemolytic anaemia, sickle cell disease, or certain infections can cause red blood cells to break down too quickly, leading to increased bilirubin production.
• Genetic Disorders – Conditions such as Gilbert’s syndrome, a mild inherited liver disorder, can cause intermittent spikes in bilirubin levels without serious health risks.
• Side Effects of Certain Medications – Some drugs, including antibiotics and medications affecting liver function, can lead to elevated bilirubin levels.

Symptoms that may accompany high bilirubin include yellowing of the skin and eyes (jaundice), dark urine, pale stools, fatigue, nausea, and abdominal pain.

Low Bilirubin Levels

Low bilirubin levels are less common and usually not a cause for concern. However, in some cases, they may be linked to:

• Certain Medications – Drugs that affect liver enzyme activity can lower bilirubin levels.
• Cardiovascular Conditions – Some studies suggest a possible link between very low bilirubin levels and an increased risk of heart disease, though this is still being researched.

Since bilirubin levels alone cannot diagnose a specific condition, doctors usually interpret the results alongside liver function tests, blood counts, and clinical symptoms to determine if further testing or treatment is necessary.

What are Normal Bilirubin Levels in Newborns?

Newborns naturally have higher bilirubin levels than adults due to the rapid breakdown of fetal red blood cells after birth. Their livers also take a few days to mature and efficiently process bilirubin.

Typical Bilirubin Levels in Newborns

• At birth: Usually below 5 mg/dL
• First few days (peaks around day 3-5): Can rise to 12 mg/dL in full-term babies and up to 15 mg/dL in premature babies
• After the first week: Levels gradually decrease as the liver becomes more efficient

When is High Bilirubin a Concern?

If bilirubin levels rise too high, it may lead to newborn jaundice, which causes yellowing of the skin and eyes. While mild jaundice is common and resolves on its own, very high levels (above 20 mg/dL) can pose a risk of kernicterus, a rare but serious condition affecting the brain. Doctors monitor bilirubin levels closely in newborns, especially if they are premature, have difficulty feeding, or show signs of severe jaundice. 

What Other Tests May Be Done Alongside a Bilirubin Test?

A bilirubin test is rarely done in isolation. It is often part of a broader diagnostic evaluation to assess liver function, red blood cell health, and bile duct integrity. Several additional tests may be ordered to help determine the underlying cause of abnormal bilirubin levels.

Liver Function Tests (LFTs)

Liver function tests (LFTs) measure different enzymes and proteins produced by the liver. They help evaluate liver health and identify potential diseases affecting liver function.

• Alanine Aminotransferase (ALT) – This enzyme is primarily found in liver cells. When liver cells are damaged due to conditions such as hepatitis, cirrhosis, or fatty liver disease, ALT is released into the bloodstream, leading to elevated levels. Since ALT is specific to the liver, a high ALT level often points to liver disease as the cause of elevated bilirubin.
• Aspartate Aminotransferase (AST) – AST is present in the liver, heart, muscles, and other organs. While elevated AST levels may indicate liver damage, they can also be due to muscle injury, making AST less specific to liver disease than ALT. Comparing AST and ALT levels helps differentiate between liver and non-liver-related causes of bilirubin abnormalities.
• Alkaline Phosphatase (ALP) – ALP is found in the liver, bones, and bile ducts. A high ALP level may indicate bile duct blockages, gallbladder disease, or conditions affecting bone metabolism. If bilirubin is high due to bile duct obstruction (such as gallstones or cholestasis), ALP is often elevated as well.
• Albumin and Total Protein – The liver produces albumin and other proteins essential for maintaining blood volume and carrying substances in the blood. Low albumin levels can indicate chronic liver disease, malnutrition, or kidney disease. Since albumin levels tend to decrease in advanced liver disease, they help assess liver function alongside bilirubin levels.

Complete Blood Count (CBC)

A CBC measures red blood cells (RBCs), white blood cells (WBCs), and platelets, providing insights into overall blood health. A CBC is often performed alongside a bilirubin test to evaluate potential causes of high bilirubin related to red blood cell breakdown (haemolysis).

• Haemoglobin and Haematocrit – These measure the concentration of red blood cells. If haemoglobin is low, it may indicate anaemia due to haemolysis, which can lead to increased bilirubin levels.
• Reticulocyte Count – Reticulocytes are immature red blood cells. A high reticulocyte count suggests that the body is producing more RBCs to compensate for their destruction, which may explain elevated bilirubin levels.
• White Blood Cell (WBC) Count – Elevated WBC levels may indicate infection, inflammation, or an immune response, which can sometimes contribute to liver-related conditions.

Prothrombin Time (PT) and International Normalised Ratio (INR)

The liver produces clotting factors, and PT/INR tests measure how long it takes for blood to clot. Prolonged clotting times can indicate liver dysfunction, particularly in cases of severe liver disease where the liver is unable to produce sufficient clotting proteins. When bilirubin is elevated due to liver failure, PT/INR results are often abnormal.

Gamma-Glutamyl Transferase (GGT)

GGT is an enzyme found in the liver and bile ducts. It helps identify bile duct disease, liver damage, and excessive alcohol use. If both GGT and ALP levels are elevated, this suggests bile duct obstruction or cholestasis as the cause of bilirubin abnormalities.

Lactate Dehydrogenase (LDH)

LDH is an enzyme found in almost all tissues, including the liver and red blood cells. Elevated LDH levels often indicate cell damage and may suggest haemolysis, liver disease, or certain cancers. If bilirubin is high due to haemolysis rather than liver dysfunction, LDH levels are typically elevated along with low haptoglobin levels.

Haptoglobin

Haptoglobin binds to free haemoglobin released from red blood cells. In haemolytic anaemia, haptoglobin levels are low, while bilirubin and LDH are high. This test helps distinguish haemolysis-related bilirubin elevation from liver disease.

Hepatitis Panel

Since viral hepatitis (such as hepatitis A, B, or C) can cause liver inflammation and raise bilirubin levels, doctors often order a hepatitis panel to detect viral infection. This includes:

• Hepatitis A IgM antibody (anti-HAV IgM) – Indicates recent or active hepatitis A infection.
• Hepatitis B surface antigen (HBsAg) and antibodies (anti-HBc, anti-HBs) – Helps diagnose hepatitis B infection or immunity.
• Hepatitis C antibody (anti-HCV) and HCV RNA test – Detects hepatitis C infection.

Tips to Keep Your Bilirubin Levels Healthy

1. Eat a Liver-Friendly Diet

A healthy diet plays a major role in bilirubin metabolism. Eating plenty of fruits, vegetables, whole grains, and lean proteins helps support liver function. Reduce processed foods, unhealthy fats, and excess sugar, as they can strain the liver and contribute to bile duct issues.

2. Stay Hydrated

Drinking enough water helps the liver flush out toxins and process bilirubin efficiently. Dehydration can slow down bile production, making it harder for the body to eliminate bilirubin. Aim for at least 8 glasses of water a day.

3. Limit Alcohol Consumption

Excessive alcohol intake can damage liver cells, making it harder for the liver to process bilirubin. If you drink, do so in moderation to reduce the risk of liver disease.

4. Maintain a Healthy Weight

Being overweight increases the risk of fatty liver disease, which can interfere with bilirubin metabolism. Regular physical activity and a balanced diet help prevent liver-related complications.

5. Be Cautious with Medications and Supplements

Certain medications, including some pain relievers, antibiotics, and cholesterol-lowering drugs, can affect liver function. Some herbal supplements may also strain the liver, so it’s best to check with a doctor before using them regularly.

6. Get Vaccinated for Hepatitis

Hepatitis A and B infections can cause liver inflammation and impair bilirubin processing. Vaccination, along with proper hygiene, reduces the risk of infection.

7. Avoid Exposure to Harmful Chemicals

Toxins found in cleaning products, pesticides, and industrial chemicals can harm the liver over time. If you work with chemicals, use protective gear and ensure proper ventilation.

8. Manage Underlying Health Conditions

Conditions like haemolytic anaemia, gallbladder disease, and hepatitis can affect bilirubin metabolism. Regular health check-ups help detect and manage these conditions before they cause complications.

9. Reduce Stress and Get Enough Sleep

Chronic stress and poor sleep can affect liver function. Practicing relaxation techniques, such as deep breathing and meditation, along with maintaining a regular sleep schedule, helps support overall liver health.

10. Exercise Regularly

Physical activity improves blood circulation and supports the liver’s ability to detoxify and process bilirubin. Even moderate exercise, such as walking or yoga, can help maintain a healthy liver.

Making these lifestyle changes can help keep bilirubin levels within a healthy range while supporting overall liver function.

Take Control of Your Liver Health with MaxAtHome

MaxAtHome makes it easy to monitor your liver health from the comfort of your home. If you need a bilirubin test, MaxAtHome offers convenient lab testing services with accurate and reliable results. Our medical professional will come to your location at a time that suits you, ensuring a hassle-free experience.

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Stay on top of your health and monitor your bilirubin levels with MaxAtHome’s trusted lab testing services.