Bilirubin, Fractionated
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The following is a list of what is included in the item above. Click the test(s) below to view what biomarkers are measured along with an explanation of what the biomarker is measuring.
Also known as: Bilirubin Fractionated
Bilirubin, Direct
Bilirubin, Indirect
Bilirubin, Total
The Bilirubin, Fractionated test contains 1 test with 3 biomarkers .
Brief Description: The Bilirubin test measures the levels of bilirubin, a yellowish pigment produced during the breakdown of red blood cells, in the blood. Bilirubin is processed by the liver and excreted in bile. The Bilirubin test helps assess liver function and the breakdown of red blood cells, providing valuable information about conditions affecting the liver and bile ducts.
Also Known As: Total Bilirubin Test, TBIL Test, Neonatal Bilirubin Test, Direct Bilirubin Test, Conjugated Bilirubin Test, Indirect Bilirubin Test, Unconjugated Bilirubin Test
Testing Method: Spectrophotometry
Collection Method: Blood Draw 
Specimen: 1 mL Serum 
Test Preparation: No preparation required
When is a Bilirubin, Fractionated test ordered?
A Bilirubin test may be ordered in several situations to assess bilirubin levels:
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Evaluation of Jaundice: Jaundice is a yellowing of the skin and eyes due to an accumulation of bilirubin in the body. The Bilirubin test helps determine the cause of jaundice, whether it is related to liver dysfunction, hemolytic anemia (excessive red blood cell breakdown), or other conditions.
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Monitoring Liver Function: The Bilirubin test is commonly included in liver function panels and is used to monitor liver health, especially in individuals with known liver diseases or conditions that can affect liver function.
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Assessment of Bile Duct Obstruction: Bilirubin levels may be elevated in conditions where the bile ducts are obstructed, such as gallstones or tumors. The Bilirubin test helps evaluate the extent and location of the obstruction.
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Evaluation of Newborn Health: A Bilirubin test is often performed on newborns to screen for conditions such as jaundice and assess the need for further evaluation or treatment.
What does a Bilirubin, Fractionated blood test check for?
Bilirubin is an orange-yellow pigment that is largely formed as a byproduct of heme degradation. Heme is a component of hemoglobin, a red blood cell protein. Bilirubin is eventually digested by the liver, which allows it to be excreted from the body. This test assesses a person's liver function or aids in the diagnosis of anemias caused by RBC destruction by measuring the quantity of bilirubin in their blood.
After roughly 120 days in circulation, RBCs generally disintegrate. Heme is transformed to bilirubin as it is released from hemoglobin. Unconjugated bilirubin is another name for this type of bilirubin. Proteins transport unconjugated bilirubin to the liver, where sugars are linked to bilirubin to produce conjugated bilirubin. Conjugated bilirubin enters the bile and travels from the liver to the small intestines, where bacteria break it down further before it is excreted in the stool. As a result, bilirubin breakdown products give stool its distinctive brown hue.
A normal, healthy human produces a tiny quantity of bilirubin each day. The majority of bilirubin comes from damaged or degraded RBCs, with the rest coming from bone marrow or the liver. Small amounts of unconjugated bilirubin are normally discharged into the bloodstream, but there is almost no conjugated bilirubin. Laboratory tests can measure or estimate both types, and a total bilirubin result can be presented as well.
A person may appear jaundiced, with yellowing of the skin and/or whites of the eyes, if the bilirubin level in their blood rises. The pattern of bilirubin test results can provide information to the health care provider about the ailment that may be present. When there is an exceptional quantity of RBC destruction or when the liver is unable to handle bilirubin, unconjugated bilirubin levels may rise. Conversely, conjugated bilirubin levels can rise when the liver can process bilirubin but not transmit the conjugated bilirubin to the bile for elimination; this is most commonly caused by acute hepatitis or bile duct blockage.
In the first few days after birth, increased total and unconjugated bilirubin levels are fairly common in infants. This condition is known as "physiologic jaundice of the newborn," and it develops when the liver of a newborn is not yet mature enough to handle bilirubin. Physiologic jaundice in newborns usually goes away after a few days. RBCs may be damaged in newborn hemolytic illness due to blood incompatibility between the infant and the mother; in these circumstances, treatment may be necessary since large amounts of unconjugated bilirubin might harm the newborn's brain.
Increased total and conjugated bilirubin levels in infants can be caused by biliary atresia, an uncommon but life-threatening congenital disease. To avoid catastrophic liver damage that may necessitate liver transplantation during the first few years of life, this problem must be rapidly recognized and treated, usually with surgery. Despite early surgical therapy, some children may require liver transplants.
Lab tests often ordered with a Bilirubin, Fractionated test:
When a bilirubin test is ordered, several other tests are often ordered alongside it to provide more comprehensive information about liver health and the underlying causes of bilirubin abnormalities:
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Hepatic Function Panel (Liver Panel):
- Purpose: To assess overall liver function including enzymes like ALT, AST, ALP, as well as albumin and total protein levels.
- Why Is It Ordered: A liver panel can help pinpoint the cause of abnormal bilirubin levels, indicating whether the issue is related to liver cell damage, bile duct obstruction, or other liver dysfunctions.
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- Purpose: To evaluate the levels of different blood cells, including red blood cells, white blood cells, and platelets.
- Why Is It Ordered: To check for conditions like hemolysis (breakdown of red blood cells), which can cause elevated indirect bilirubin levels.
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- Purpose: To measure the number of young red blood cells in the blood, providing an indication of bone marrow function.
- Why Is It Ordered: An increased reticulocyte count can be a sign of hemolytic anemia, which could explain a rise in indirect bilirubin.
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- Purpose: Haptoglobin binds free hemoglobin released from erythrocytes, and low levels can indicate hemolysis.
- Why Is It Ordered: To further investigate the cause of hemolysis as a reason for elevated indirect bilirubin.
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- Purpose: To detect antibodies that may be bound to red blood cells, causing them to be destroyed prematurely.
- Why Is It Ordered: To identify immune-mediated hemolytic anemia, which can cause increased indirect bilirubin levels.
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- Purpose: To test for the presence of viral hepatitis infections, such as hepatitis A, B, and C.
- Why Is It Ordered: Viral hepatitis can cause liver inflammation leading to bilirubin metabolism disturbances.
These additional tests are important for determining the etiology of bilirubin metabolism issues and guiding the appropriate treatment. The physician will consider the patient’s medical history, symptoms, and physical examination findings when deciding which tests to order.
Conditions where a Bilirubin, Fractionated test is recommended:
A Bilirubin test is commonly ordered for:
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Liver Diseases: The test helps diagnose and monitor liver diseases such as hepatitis, cirrhosis, or liver cancer, which can affect bilirubin metabolism and excretion.
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Jaundice: Elevated bilirubin levels cause jaundice. The Bilirubin test helps determine the underlying cause of jaundice, whether it is related to liver dysfunction, excessive red blood cell breakdown, or other conditions.
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Bile Duct Obstruction: Conditions such as gallstones, tumors, or strictures can obstruct the bile ducts, leading to elevated bilirubin levels. The Bilirubin test aids in evaluating the extent and location of the obstruction.
How does my healthcare provider use a Bilirubin, Fractionated test?
Healthcare providers use the results of a Bilirubin test to:
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Assess Liver Function: Bilirubin levels provide valuable information about liver function and can indicate the presence of liver diseases or conditions affecting liver metabolism.
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Diagnose and Monitor Liver Diseases: Abnormal bilirubin levels help healthcare providers diagnose liver diseases, monitor disease progression, and evaluate treatment effectiveness.
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Evaluate Jaundice: Bilirubin levels aid in identifying the underlying cause of jaundice, guiding further investigations and appropriate treatment interventions.
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Assess Bile Duct Obstruction: Elevated bilirubin levels in the presence of bile duct obstruction can help healthcare providers evaluate the extent and location of the obstruction and plan appropriate interventions.
By effectively utilizing the results of a Bilirubin test, healthcare providers can assess liver function, diagnose and monitor liver diseases, evaluate jaundice, identify bile duct obstructions, and make informed decisions regarding patient care and treatment interventions.
What do my bilirubin test results mean?
In adults and children, increased total bilirubin, primarily unconjugated bilirubin, could be caused by:
- Hemolytic or pernicious anemia are two types of anemia.
- Reaction to a transfusion
- Cirrhosis
- Gilbert syndrome
When conjugated bilirubin levels are higher than unconjugated bilirubin levels, there is usually a problem with bilirubin removal by the liver cells. This can be caused by a variety of factors, including:
- Hepatitis caused by a virus
- Reactions to drugs
- Alcoholic hepatitis
When the bile ducts are blocked, conjugated bilirubin is raised more than unconjugated bilirubin. This can happen, for example, when:
- In the bile ducts, there are gallstones.
- Damaging of the bile ducts due to tumors
Increased bilirubin levels can also be caused by rare hereditary illnesses that involve aberrant bilirubin metabolism, such as Rotor, Dubin-Johnson, and Crigler-Najjar syndromes.
Low bilirubin levels are usually not a cause for worry and are not monitored.
A newborn's high bilirubin level may be transient and diminish within a few days to two weeks. However, if the bilirubin level exceeds a crucial threshold or rises rapidly, the cause must be investigated so that appropriate treatment can be started. Increased bilirubin levels can be caused by the rapid breakdown of red blood cells as a result of:
- Incompatibility of the mother's blood type with that of her child
- Infections that are present at birth
- oxygen deficiency
- Liver disease
Only unconjugated bilirubin is elevated in most of these disorders. In the rare disorders of biliary atresia and newborn hepatitis, increased conjugated bilirubin is found. To avoid liver damage, biliary atresia necessitates surgical surgery.
Most Common Questions about the Bilirubin Fractionated test:
Understanding the Test
What is the Bilirubin Fractionated test?
The Bilirubin Fractionated test is a blood test that measures the amount of bilirubin in the blood. Bilirubin is a yellow pigment that is produced by the normal breakdown of red blood cells. The test typically measures both direct (conjugated) and indirect (unconjugated) bilirubin.
What is the difference between direct and indirect bilirubin?
Direct (or conjugated) bilirubin is bilirubin that has been processed by the liver and is excreted in bile. Indirect (or unconjugated) bilirubin is bilirubin that has not yet been processed by the liver. The Bilirubin Fractionated test measures both types to help determine the cause of jaundice or other liver problems.
Conditions Associated with Bilirubin Levels
What is jaundice and how is it related to the Bilirubin Fractionated test?
Jaundice is a condition characterized by yellowing of the skin and eyes due to increased bilirubin levels in the blood. The Bilirubin Fractionated test is used to diagnose and monitor jaundice.
What conditions can the Bilirubin Fractionated test help diagnose?
The Bilirubin Fractionated test can help diagnose a variety of conditions, including liver diseases (such as cirrhosis, hepatitis, or liver cancer), gallbladder diseases (such as gallstones or cholecystitis), and hemolytic anemias (conditions where red blood cells are broken down too quickly).
Can the Bilirubin Fractionated test diagnose newborn jaundice?
Yes, the Bilirubin Fractionated test can be used to diagnose and monitor newborn jaundice. Newborns often have elevated bilirubin levels due to the immaturity of their liver.
Understanding Test Results
What do elevated bilirubin levels indicate in the Bilirubin Fractionated test?
Elevated levels of total bilirubin can indicate a problem with the liver's ability to process bilirubin, a blockage in the bile ducts, or an increased breakdown of red blood cells. If direct bilirubin is elevated, it suggests a blockage in the bile ducts or liver disease. If indirect bilirubin is elevated, it suggests an increased breakdown of red blood cells or a problem with the liver's ability to process bilirubin.
What do low bilirubin levels indicate in the Bilirubin Fractionated test?
Low bilirubin levels are usually not a concern and can be seen in people who consume a low-fat diet or in certain medical conditions like Gilbert's syndrome.
What does it mean if my direct bilirubin is high but my indirect bilirubin is normal in the Bilirubin Fractionated test?
High direct bilirubin with normal indirect bilirubin often suggests a problem with the liver's ability to excrete bilirubin into the bile, or a blockage that is preventing the bile (which contains direct bilirubin) from leaving the liver.
What does it mean if my indirect bilirubin is high but my direct bilirubin is normal in the Bilirubin Fractionated test?
High indirect bilirubin with normal direct bilirubin often suggests an increased breakdown ofred blood cells or a problem with the liver's ability to convert indirect bilirubin into direct bilirubin.
Preparing for the Test
Do I need to fast before a Bilirubin Fractionated test?
No, you typically do not need to fast before a Bilirubin Fractionated test. However, you should always follow your healthcare provider's instructions.
Are there any medications that can affect the Bilirubin Fractionated test results?
Yes, certain medications can increase bilirubin levels, including some antibiotics, anti-cancer drugs, anti-inflammatory drugs, and certain cardiovascular drugs. If you're taking any medication, it's important to inform your healthcare provider.
Can alcohol consumption affect the Bilirubin Fractionated test results?
Yes, heavy alcohol consumption can damage the liver and increase bilirubin levels.
Interpreting Results
How are the results of the Bilirubin Fractionated test reported?
The results of the Bilirubin Fractionated test are reported in milligrams per deciliter (mg/dL). Your healthcare provider will interpret your results based on your health history and other test results.
What are the normal ranges for the Bilirubin Fractionated test?
Normal ranges can vary slightly depending on the laboratory that analyzes the blood sample. Generally, total bilirubin levels should be under 1.2 mg/dL. Direct bilirubin should be under 0.3 mg/dL and indirect bilirubin should be under 0.8 mg/dL.
Follow-up and Treatment
If my Bilirubin Fractionated test results are abnormal, what is the next step?
If your bilirubin levels are high, your healthcare provider may order additional tests to determine the cause. These could include other liver function tests, imaging studies like ultrasound or CT scan, or liver biopsy.
How is high bilirubin treated?
Treatment for high bilirubin depends on the cause. It may involve treating the underlying disease causing the increased bilirubin, like liver disease or a blood disorder. In newborns with jaundice, treatment might include phototherapy.
Comparisons with Other Tests
What is the difference between the Bilirubin Fractionated test and other liver function tests?
While the Bilirubin Fractionated test specifically measures levels of bilirubin in the blood, other liver function tests measure different substances produced or processed by the liver. These might include enzymes like ALT and AST, or proteins like albumin.
What is the role of the Bilirubin Fractionated test in a liver panel?
In a liver panel, the Bilirubin Fractionated test is one of several tests used to assess liver function. It helps identify problems with bile flow or the liver's ability to process bilirubin.
Additional Information
What is Gilbert's syndrome and how is it related to the Bilirubin Fractionated test?
Gilbert's syndrome is a benign genetic condition that can cause slightly elevated levels of indirect bilirubin. The Bilirubin Fractionated test can be used to help diagnose this syndrome.
Does the Bilirubin Fractionated test involve any radiation exposure?
No, the Bilirubin Fractionated test is a blood test and does not involve any radiation exposure.
Does the Bilirubin Fractionated test need to be repeated over time?
If you have been diagnosed with a condition that affects bilirubin levels, your healthcare provider may recommend repeat testing to monitor yourcondition. However, if your test results are normal and you don't have any symptoms, repeat testing is typically not necessary.
Effect of Lifestyle Choices
Can lifestyle choices impact the results of the Bilirubin Fractionated test?
Yes, lifestyle choices such as alcohol consumption, diet, and medication use can impact bilirubin levels and therefore the results of the Bilirubin Fractionated test.
Does smoking affect the Bilirubin Fractionated test?
While smoking can cause a variety of health problems, it does not typically have a direct impact on the level of bilirubin in your blood.
Medical Consultation
What kind of doctor interprets the results of the Bilirubin Fractionated test?
Usually, the healthcare provider who ordered the test - which could be a general practitioner, internist, or specialist such as a gastroenterologist or hematologist - will interpret the results.
Can the Bilirubin Fractionated test be used to monitor the effectiveness of treatment for liver disease?
Yes, the Bilirubin Fractionated test can be used to monitor the effectiveness of treatment for liver disease. If bilirubin levels decrease over time with treatment, it typically indicates that the treatment is working.
We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.