Bilirubin (Total)
Waste product from breakdown of red blood cells
20 of 22 providers
Liver Function
bile duct obstruction
What is Bilirubin (Total)?
Bilirubin is a yellow-orange pigment produced when red blood cells break down at the end of their 120-day lifespan. The spleen and liver process about 250-400 mg of bilirubin daily from old red blood cells. This bilirubin travels to the liver where it is processed (conjugated) and excreted into bile, eventually leaving the body through stool (giving stool its brown color).
Total bilirubin consists of two forms:indirect (unconjugated) bilirubin, which has not yet been processed by the liver, and direct (conjugated) bilirubin, which has been processed and is ready for excretion. When bilirubin accumulates in the blood above 2-3 mg/dL, it causes jaundice—yellowing of the skin and whites of the eyes. The pattern of elevation (direct vs indirect) helps diagnose the underlying cause.
While elevated bilirubin typically indicates liver disease, bile duct obstruction, or excessive red blood cell breakdown, mildly elevated indirect bilirubin can be beneficial. Gilbert's syndrome, a benign genetic condition causing mild bilirubin elevation, is associated with increased longevity and reduced cardiovascular disease, likely due to bilirubin's potent antioxidant properties. However, significantly elevated bilirubin requires medical evaluation.
Why Bilirubin Is Your Liver Excretion and Hemolysis Detector
- Jaundice detection:Bilirubin >2-3 mg/dL causes visible yellowing of skin/eyes, indicating liver dysfunction, bile duct obstruction, or hemolysis
- Differentiates liver disease types:Direct bilirubin elevation indicates cholestasis or hepatocellular damage;indirect elevation suggests hemolysis or Gilbert's syndrome
- Liver function assessment:Unlike ALT/AST which measure damage, bilirubin reflects liver's ability to process and excrete waste—a key synthetic function
- Hemolysis screening:Elevated indirect bilirubin with elevated LDH and low haptoglobin indicates red blood cell breakdown
- Prognostic indicator:In chronic liver disease, rising bilirubin predicts worse outcomes and need for transplant evaluation
- Potential health benefit:Mild elevation (Gilbert's syndrome) associated with lower cardiovascular risk due to antioxidant effects
Optimal vs Standard Ranges
Optimal0.3-1.0 mg/dL▼
- Normal bilirubin metabolism with healthy liver function and normal red blood cell turnover
- Values in this range indicate efficient bilirubin processing and excretion
- Most people fall in this range
Mildly Elevated (Often Gilbert's)1.0-3.0 mg/dL▼
- Often due to Gilbert's syndrome, a benign genetic condition affecting 3-7% of population
- If indirect bilirubin is elevated with normal liver enzymes, no jaundice, and normal hemolysis markers, this is typically Gilbert's and requires no treatment
- May actually be protective
- If direct bilirubin elevated or liver enzymes abnormal, investigate further
Moderately Elevated3.0-10.0 mg/dL▼
- Causes visible jaundice and indicates significant pathology
- Requires urgent investigation
- If direct bilirubin elevated:Evaluate for bile duct obstruction (gallstones, tumor, stricture), cholestatic liver disease, or hepatocellular damage
- Order liver enzymes, imaging (ultrasound/MRCP)
- If indirect bilirubin elevated:Investigate hemolysis (check LDH, haptoglobin, reticulocytes) or liver processing defect
Severely Elevated>10.0 mg/dL▼
- Indicates severe liver dysfunction, complete biliary obstruction, or massive hemolysis
- Requires immediate medical attention
- Levels >15-20 mg/dL suggest acute liver failure, complete bile duct obstruction, or severe hemolytic crisis
- Order urgent comprehensive workup including hepatitis panel, autoimmune markers, toxicology screen, imaging, and consider ICU-level care
- May require ERCP for obstruction or emergency interventions
Scientific Evidence
Gilbert's Syndrome and Cardiovascular Protection
Multiple studies show individuals with Gilbert's syndrome (mild unconjugated hyperbilirubinemia) have 30-50% lower risk of cardiovascular disease and all-cause mortality. Bilirubin acts as a potent antioxidant, reducing LDL oxidation and inflammation. Higher bilirubin within normal range is also associated with reduced CV risk in general population.
Bilirubin as Prognostic Marker in Cirrhosis
In cirrhotic patients, serum bilirubin is a key component of the MELD score (Model for End-Stage Liver Disease), which predicts mortality and prioritizes liver transplant allocation. Rising bilirubin in cirrhosis indicates worsening hepatic function and warrants transplant evaluation when bilirubin exceeds 3-5 mg/dL persistently.
Direct vs Indirect Bilirubin in Diagnosis
Fractionation of bilirubin into direct and indirect components is diagnostically crucial. Direct bilirubin >50% of total indicates cholestasis or hepatocellular damage. Indirect bilirubin >80% of total suggests hemolysis or Gilbert's syndrome. This simple test directs further workup and differentiates numerous causes of jaundice.
Source:Roche SP, et al. Jaundice in the adult patient. Am Fam Physician. 2004;69(2):299-304.
Drug-Induced Cholestatic Jaundice
Many medications cause cholestatic liver injury with marked elevation of direct bilirubin and ALP. Common culprits include amoxicillin-clavulanate, fluoroquinolones, anabolic steroids, and chlorpromazine. Withdrawal of the offending agent usually leads to improvement within 2-8 weeks, though some cases progress to chronic cholestasis.
Source:Björnsson ES, et al. Drug-induced liver injury:an overview. Clin Liver Dis. 2013;17(4):507-524.
Bilirubin as Antioxidant
Bilirubin is a powerful endogenous antioxidant, comparable to vitamin E in potency. It scavenges peroxyl radicals and inhibits lipid peroxidation. Mildly elevated bilirubin (as in Gilbert's) provides antioxidant protection without toxicity. This explains the cardiovascular and cancer risk reduction seen in Gilbert's syndrome.
Source:Stocker R, et al. Bilirubin is an antioxidant of possible physiological importance. Science. 1987;235(4792):1043-1046.
Which Providers Test Bilirubin (Total)?
Full Provider Comparison
| Provider | Includes | Annual Cost | Biomarkers |
|---|---|---|---|
 Superpower | ✓ | $199 | 100+ (150 with ratios) |
 WHOOP Advanced Labs | ✓ | $349 | 65 |
 Labcorp OnDemand | ✓ | $398 | 30+ |
| ✓ | $486 | 40+ | |
| ✓ | $444 | 288 | |
| ✓ | $349 | 100+ | |
| — | $761 | 54 | |
 Function Health | ✓ | $365 | 160+ |
| ✓ | $250 | 65 | |
| ✓ | $495 | 70+ | |
| ✓ | $895 | 100+ | |
| ✓ | $1950 | 150+ | |
| ✓ | $375 | 80+ | |
| — | $Varies | 75+ | |
| ✓ | $190 | 100+ | |
| ✓ | $99 | 50 | |
| ✓ | $124 | 60 | |
| ✓ | $199 | 50 | |
| ✓ | $499 | 120+ | |
| ✓ | $4188 | 70-80+ | |
| ✓ | $375 | 85 | |
| ✓ | $700 | 128 |
Frequently Asked Questions
What is Bilirubin (Total)?
Waste product from breakdown of red blood cells
What is the optimal range for Bilirubin (Total)?
The standard reference range for Bilirubin (Total) is bile duct obstruction. Optimal ranges may differ based on individual health goals and expert recommendations.
Which blood test providers include Bilirubin (Total)?
20 out of 22 blood testing providers include Bilirubin (Total) in their panels. This biomarker is widely available across major providers.
What category does Bilirubin (Total) fall under?
Bilirubin (Total) is categorized under Liver Function. This category includes biomarkers that help assess related aspects of health and wellness.
Medical Disclaimer
This information is for educational purposes only and is not medical advice. Always consult with a qualified healthcare provider about your specific health needs.
Last reviewed:2026-02-20