The article is professionally consulted by Master, Doctor Nguyen Thi Ngoc – General Internal Medicine – Endocrinology – Department of Examination & Internal Medicine – Vinmec Central Park International General Hospital. Doctor has more than 10 years of studying, researching and working in the field of endocrinology.

Viewing: What is Bilirubin

Bilirubin is the main bile pigment formed from the degradation of heme in red blood cells. Bilirubin blood test is a special test necessary to assess the health status of people, helping doctors to diagnose and treat diseases effectively.

Total Bilirubin

Over 1 month of age with a bilirubin index: 0.3 – 1.2 mg/dl or 5.1 – 20.5 μmol/L. Adults have a bilirubin index: 0.2 – 1.0 mg/dL or 3.4 – 17.1 μmol/L.

Direct bilirubin

Normal: 0 – 0.4 mg/dl or 0 – 7 μmol/L

Indirect Bilirubin

Normal: 0.1 -1.0 mg/dL or 1 – 17 μmol/L

Direct Bilirubin/Total Bilirubin Ratio


Results will vary slightly depending on the lab and adult men. In the case of women and children, results may be slightly different because results are affected by certain foods or by taking medications or exercising.

Medications that can also lower bilirubin levels include: barbiturates, caffeine, penicillin, high-dose salicylate, atazanavir (HIV antivirals can increase indirect bilirubin levels), citrates, corticosteroids , ethanol, penicillin, protein, salicylate, urea…

Medicines that increase bilirubin levels such as: antibiotics, some birth control pills, diazepam (Valium), flurazepam, indomethacin (Indocin), and phenytoin (Dilantin), adrenaline, allopurinol, antimalarials, vitamins C, azathioprine, chlorpropamide, cholinergics, codeine, dextran, diuretics, isoproterenol, levodopa, MAO inhibitors, meperidine, methyldopa, methotrexate, morphine, oral contraceptives, phenazopyridine, phenothiazines, quinidine, rifampin , streptomycin, theophylline, tyrosine, vitamin A…

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Elevated bilirubin levels

3. What is the effect of high bilirubin? Usually a high bilirubin level indicates an increasing rate of red blood cell damage.

For infants, rapid determination of bilirubin blood levels is also an important method. Timely testing before the excess indirect bilirubin causes damage to the brain cells of the child. Consequences of injury will slow down children’s intellectual development, reduce learning and development ability. In addition, it also causes children to have hearing loss, eye movement disorders or worse, death …

4. What disease is high bilirubin

?Increased total bilirubin concentration in the case of:

Pregnancy Newborns and premature infants Vigorous physical activity Causes of unconjugated hyperbilirubinemia. Causes of conjugated hyperbilirubinemia Hypothyroidism.

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Increased levels of unconjugated bilirubin (indirect bilirubin) in cases of:

Increased destruction of red blood cells Hemolysis: malaria, neonatal Rh incompatibility disease, hemoglobin disease, deficiency of red blood cell enzymes, disseminated intravascular coagulation, autoimmune hemolysis. ineffective: Biermer anemia.Heavy blood transfusion.Splenomegaly.Large hematoma.Decreased bilirubin conjugation in the liver.Decompensated heart failure.Drugs: Rifampicin…

Increased concentration of conjugated bilirubin (direct bilirubin) in cases of:

Hepatocellular diseases: viral hepatitis, drug-induced hepatitis (INH, Rifampicin, Halothan, Methyldopa, Chlorpromazine, Paracetamol, Salicylate…, toxic hepatitis; decompensated heart failure. Cirrhosis, primary biliary cirrhosis, sclerosing cholangitis, liver infection or lesions (eg, tumor pathology, liver metastases, Wilson’s disease, granulomatosis, etc.). Congenital disorders: Dubin-Johnson disease (disorder of bilirubin excretion), Rotor syndrome. Drugs: Chlorpromazine, barbituric, oral contraceptives, testosterone, erythromycin. Gallstones, acute or chronic pancreatitis, pancreatic pseudocyst in acute pancreatitis, pancreatic cancer. Balloon cancer of Vater, carcinoma carcinoma) of the biliary tree, stricture or obstruction (atresie) of the biliary tree.

5. Bilirubin helps in differential diagnosis of jaundice

High levels of bilirubin in the blood will enter the tissues, causing jaundice

High levels of bilirubin in the blood will enter the tissues, causing jaundice. Test for total bilirubin, direct bilirubin is important in the differential diagnosis of some jaundice. When the total Bilirubin index increases more than 2 times above the normal level (> 42.75 mol/l) causes jaundice.

5.1 For obstructive jaundice

The direct bilirubin index is very high in the blood, the total bilirubin is also increased, there is bilirubinuria. Plasma alkaline phosphatase is the best standard to evaluate biliary obstruction, if increased more than 5 times above normal, it indicates biliary obstruction. Jaundice due to biliary obstruction is common in bile duct obstruction due to stones, pancreatic head tumors, due to worms entering the bile ducts.

In In extrahepatic biliary obstruction, bilirubin may gradually increase to 513 – 684 mol/l. In intrahepatic biliary obstruction or metabolic disease or infiltrative liver disease: plasma bilirubin is normal but Alkaline phosphatase is elevated.

5.2 Jaundice due to hemolysis (hemolysis)

In hemolysis, plasma total bilirubin is rarely increased more than 5 times the normal, unless associated with liver disease. When there is liver disease, indirect bilirubin increases very high in the blood, total bilirubin increases sometimes up to 30-40 times, even up to 80 times higher than normal. Bilirubinuria is negative (with urobilinogenuria). The direct bilirubin/total bilirubin ratio can be used to differentiate:

Proportion Rate 20 – 40%: show more intrahepatic disease than extrahepatic biliary obstruction. Rate 40 – 60%: disease occurs in both intrahepatic and extrahepatic. Prevalence > 50%: The obstruction is more external to the liver than to the intrahepatic disease.

Hemolytic jaundice is common in neonatal hemolytic jaundice (physiological jaundice), malignant malaria, venomous snakebite (cobra)…

5.3 Jaundice due to liver damage

In the case of acute viral hepatitis (infectious hepatitis), bilirubin levels rise early and appear in the urine before symptoms of jaundice, urobilinogenuria are present. When the liver is damaged, it will reduce the conversion of total bilirubin into direct bilirubin, so total bilirubin will increase in the blood but direct bilirubin will decrease.

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In liver failure, severe cirrhosis, direct bilirubin decreases due to reduced liver function, reduces the conjugation process with glucuronic acid. In liver cancer, serum total bilirubin is very high, can increase 10-20 times than normal (171-342 mol/l).