The skin normally becomes yellow once levels reach 2-3 mg/dL. Learn more about what the normal ranges are, the types of bilirubin (direct, indirect and total), as well as what can cause high levels. Blood tests. If a routine urine test detects bilirubin, a doctor will look at blood serum tests to confirm the results and identify any damage to the liver. Meanwhile, direct bilirubin may be too high if the liver is unable to pass on the bilirubin after it has been conjugated. The blood sample for liver function tests is usually taken from a vein in your arm. Normal blood test results for typical liver function tests include: These results are typical for adult men. Jonathan Ritter, PharmD, PhD (Pharmacology), Gilberts syndrome. Here, the enzyme uridine diphosphate-glucuronosyltransferase (UGT1A1) attaches sugar molecules to the unconjugated bilirubin. High bilirubin levels are greater than 2.5 milligrams of bilirubin per deciliter. As stated previously, bilirubin usually exists in two forms in the body. Talk to your provider about the meaning of your specific test results. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. If a person has normal levels of liver enzymes, it may mean that there is another condition contributing to the elevated bilirubin levels besides liver disease. For patient education resources, see. This test is performed routinely in most medical laboratories and can be measured by a variety of methods. Hepatitis doesnt always cause symptoms, but when it does, they can include: Your bile ducts connect your liver to your gallbladder and the opening of your small intestine, called the duodenum. Our goal is to not have a single piece of inaccurate information on this website. Bilirubin Test - Testing.com Normal indirect bilirubin would be under 5.2 mg/dL within the . To measure bilirubin levels, a doctor might order a urine or blood test.. A bilirubin in urine test measures the levels of bilirubin in your urine. [3] In the first step of bilirubin synthesis, the heme molecule is stripped from the hemoglobin molecule. National Heart, Lung, and Blood Institute. Direct and indirect refer solely to how compounds are measured or detected in solution. Hyperbilirubinemia in neonates: Types, causes, clinical examinations, preventive measures and treatments: A narrative review article. There shouldnt be any bilirubin present in urine, so any bilirubin found in a urine sample is an indication of an underlying condition. Your bilirubin test results came back with both a total and direct value. underlying cause of the elevation. Some labs may recommend a 4-hour fasting prior to exam. Learn how jaundice appears in people with darker skin tones and what symptoms to look out for. . (2015). information highlighted below and resubmit the form. After conjugation with glucuronic acid, bilirubin is excreted. She believes that SelfHacked has the best science that is also layperson-friendly on the web. Neonatal Bilirubin, Serum - Mayo Clinic Laboratories | Pediatric Catalog [50][51], Rudolf Virchow in 1847 recognized hematoidin to be identical to bilirubin. Jaundice is a yellow color in the skin, mucus membranes, or eyes. Accessed April 12, 2021. Bhupinder S. Anand, MBBS, MD, DPHIL (OXON), Learn more about the symptoms of jaundice, Bilirubin is a reddish yellow pigment made during the normal breakdown of. In neonates, the liver takes several days to start adequately processing bilirubin. the unsubscribe link in the e-mail. information submitted for this request. Veins vary in size from one person to another and from one side of the body to the other. These two levels typically add up to the total bilirubin level. [50], In the 1930s, significant advances in bilirubin isolation and synthesis were described by Hans Fischer, Plieninger, and others,[50] and pioneering work pertaining to endogenous formation of bilirubin from heme was likewise conducted in the same decade. Bilirubin is then removed from the body through the stool (feces) and gives stool its normal colour. High bilirubin can lead to jaundice. When bilirubin levels rise, a condition known as jaundice may develop. Prolonged jaundice is more common in infants who are breastfeeding. A small amount of older red blood cells are replaced by new blood cells every day. information is beneficial, we may combine your email and website usage information with Typically, bilirubin levels fall somewhere between 0.3 and 1.0 milligrams per deciliter (mg/dL). Jaundice often accompanies the high bilirubin. Some medications, like acetaminophen, antibiotics and anti-inflammatories can also cause high levels,especially when used without a doctors guidance. They are continually monitored by our internal peer-review process and if we see anyone making material science errors, we don't let them write for us again. Bilirubin can be classified as indirect (free or unconjugated) while it is circulating and is considered as direct after conjugation in the liver with glucuronic acid. bilirubin = total bilirubin (unconjugated bilirubin + conjugated bilirubin)[16], The half-life of delta bilirubin is equivalent to that of albumin since the former is bound to the latter, yields 23 weeks. A.D.A.M. Accessed April 12, 2021. Total bilirubin is the sum of your direct and indirect bilirubin levels. This is a temporary condition that usually resolves on its own within a few weeks. The fluctuation is rarely enough to cause the skin to yellow, but some people may experience symptoms, such as stomach pain or fatigue. [49] Unconjugated bilirubin is not water-soluble and so is not excreted in the urine. In infants, high levels of bilirubin in the blood can lead to serious complications if left untreated, including kernicterus, a condition that can lead to brain damage, intellectual disabilities, and issues with hearing or vision. [25], In ancient history, Hippocrates discussed bile pigments in two of the four humours in the context of a relationship between yellow and black biles. Frustrated by the lack of good information and tools, Joe decided to embark on a learning journey to decode his DNA and track his biomarkers in search of better health. [4] The production of biliverdin from heme is the first major step in the catabolic pathway, after which the enzyme biliverdin reductase performs the second step, producing bilirubin from biliverdin. PT. mild elevation of either the unconjugated bilirubin or the gamma-glutamyltransferase . Information is shared for educational purposes only. 24th ed. These neonates usually clear jaundice within a week. Align your health hacks with your genes for optimal health & cognitive function. Your doctor will interpret your results, taking into account your medical history, symptoms, and other test results. Medscape. other information we have about you. The tests measure the levels of certain enzymes and proteins in your blood. A level of bilirubin in the blood of 2.0 mg/dL can create jaundice. Normal levels vary slightly from lab to lab; they range from about 0.2 - 1.2 mg/dL. Diagnosing liver disease: Liver biopsy and liver function tests. The age of the infant, as well as whether they were born premature, is also a factor. If jaundice occurs within the first 24 hours after birth, or if bilirubin levels are especially high or dont begin to fall on their own, doctors may intervene with treatments such as: Bilirubin levels are usually tested by taking a blood sample. Bilirubin is a yellow substance that your body makes during the normal process of breaking down red blood cells. The SI units are mol/L. The levels go up and down because Gilberts syndrome slows down the process of removing it from the body. (2021). Last medically reviewed on February 17, 2022. https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/8344. What do high bilirubin levels in a newborn mean? However, very high unconjugated bilirubin levels over time (weeks) can be neurotoxic and can even cause death or lifelong neurological problems (kernicterus) in those who survive. Our website services, content, and products are for informational purposes only. The term "bilirubin" was thought to have become mainstream based on the works of Staedeler in 1864 who crystallized bilirubin from cattle gallstones. Gilberts syndrome is a mild form of high bilirubin. quickly (over a few days); however, the prognosis is not good if the newborn has https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/8362. Smoking cigarettes can affect the liver in several ways. Intrahepatic cholestasis of pregnancy. Total Bilirubin (Blood) - Health Encyclopedia - University of Rochester All rights reserved. Normal results vary from laboratory to laboratory and might be slightly different for women and children. [50] Hippocrates visited Democritus in Abdera who was regarded as the expert in melancholy "black bile". Here's what you can do. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. If you have high bilirubin, your symptoms will depend on the underlying cause. Accessed April 12, 2021. A high level of bilirubin in the blood is known as hyperbilirubinemia. SelfDecode has the strictest sourcing guidelines in the health industry and we almost exclusively link to medically peer-reviewed studies, usually on PubMed. This type of neurological injury is known as kernicterus. Common causes of higher indirect bilirubin include: Hemolytic anemia. 's editorial policy editorial process and privacy policy. We do not aim to diagnose, treat, cure or prevent any illness or disease. There are several reasons for a rise in bilirubin levels outside of the newborn period. a device to check bilirubin levels. Bilirubin: Definition, Application, and Significance - Verywell Health Urine bilirubin may also be clinically significant. Bilirubin comes in both direct and indirect form. [10] The naturally occurring isomer is the Z,Z-isomer. Bilirubin builds up when your gallbladder is blocked and cant drain properly. Copyright 1997-2023, A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited without authorization. Urobilin is excreted by the kidneys to give urine its yellow color and stercobilin is excreted in the feces giving stool its characteristic brown color. If you already have liver disease, liver function tests can help determine how your disease is progressing and if you're responding to treatment. Up to 16 % of all people have this syndrome. ALP. It is normal to have some bilirubin in the blood. Indirect bilirubin levels can become high with diseases that destroy red blood cells, like autoimmune hemolytic anemia, thalaessemia or hereditary spherocytosis. blood withdrawal site, and possible bruising at the site. Bilirubin in Urine - Normal Range, Causes, Color, Symptoms Indirect bilirubin is fat-soluble and direct bilirubin is water-soluble.[34]. Conjugated bilirubin is usually not because it can come out of the body, as long as nothing is interfering with its removal. is also a founding member of Hi-Ethics. It is formed during the normal breakdown of red blood cells (hemoglobin) and is excreted in the bile. In adults, normal bilirubin levels are less than one milligram per deciliter. [citation needed], Bilirubin is structurally similar to the pigment phycobilin used by certain algae to capture light energy, and to the pigment phytochrome used by plants to sense light. Much of it goes into the bile and thus out into the small intestine. High levels of bilirubin are often a symptom of another underlying health condition, which can range in terms of severity and prognosis. Bilirubin is a yellowish substance in your blood. Brazil's largest network of private hospitals. Values can vary slightly between labs, but the following ranges are considered normal for adults [2, 11]: Indirect bilirubin is calculated from direct and total figures, where indirect = total minus direct bilirubin. All of our content is written by scientists and people with a strong science background. You can have mildly high bilirubin and have no symptoms at all. In newborns, bilirubin level is higher for the first few days of life. Ansong-Assoku B, et al. Philadelphia, PA: Lippincott Williams & Wilkins. High levels of bilirubin in the blood can cause jaundice, which may cause symptoms, such as: Because an underlying condition, such as liver disease or hemolytic anemia, may cause high bilirubin levels, a person may also experience other symptoms, including: Blood tests can measure bilirubin levels. The ratio between these two types of bilirubin will help narrow down the underlying cause of high bilirubin levels. Accessed April 12, 2021. St Louis, MO: Elsevier Saunders; 2013:196-198. These causes can occur before, during, or after the production of bilirubin. It is produced when the liver breaks down old red blood cells. Your newborn's pediatrician will help manage your newborn's bilirubin levels. Biliverdin is reduced to bilirubin. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Normal values of direct bilirubin range from 0 to 0.4 mg/dL. In preterm infants, the risk of a handicap increases by 30% for each 2.9 mg/dL increase of maximal total bilirubin concentration. For additional information visit Linking to and Using Content from MedlinePlus. Many newborns naturally and temporarily have elevated blood levels of the substance bilirubin. Blood collection tubes containing blood or (especially) serum to be used in bilirubin assays should be protected from illumination. The main risk associated with blood tests is soreness or bruising at the site of the blood draw. Healthy people will generally eliminate excess bilirubin without issue, and levels will maintain themselves at normal ranges. The absence of this gene in Gilberts syndrome means that this enzyme does not work. Your doctor will use these results to help diagnose your condition or determine treatment you might need. Frequently, the medical literature does not distinguish between the two forms, and this can be confusing to the reader. It is carried from the blood to the liver where it is conjugated to its direct form and excreted into the intestines. It seems that bilirubin exhibits protective properties during the islet transplantation process when drugs are delivered throughout the bloodstream. A subset of this test is designed The approximate normal range of bilirubin in the blood is less than 1.0 milligram per deciliter (mg/dL). This gene codes for an enzyme that enables the liver to convert bilirubin to its conjugated form. Jones MW, et al. A.D.A.M., Inc. is accredited by URAC, for Health Content Provider (www.urac.org). Bilirubin is a substance produced by the liver using hemoglobin that is released by destroyed or damagedred blood cells. Bilirubin is normally measured with a blood test. Newborn livers need some time to get up and running when it comes to getting rid of bilirubin. Accessed April 12, 2021. Neonatal Hyperbilirubinemia - Pediatrics - Merck Manuals Professional Your doctor will interpret your results, taking into account your medical history, symptoms, and other test results. Most people don't have serious reactions to having blood drawn. It forms after red blood cells break down, and it travels through your liver, gallbladder, and digestive tract before being excreted. A trace (~1%) of the urobilinogen is reabsorbed into the enterohepatic circulation to be re-excreted in the bile. Diet for Jaundice: Foods to Eat and Foods to Avoid - Healthline However, there is some contradictory evidence. The bilirubin blood test measures the level of bilirubin in the blood. Instead the conjugated bilirubin is converted back into the unconjugated form by the enzyme -glucuronidase (in the gut, this enzyme is located in the brush border of the lining intestinal cells) and a large proportion is reabsorbed through the enterohepatic circulation. Mayo Medical Laboratories. hepatitis A patients recover completely while patients with liver cancer or [18][19], Direct bilirubin = Conjugated bilirubin + delta bilirubin[16], In the liver, bilirubin is conjugated with glucuronic acid by the enzyme glucuronyltransferase, first to bilirubin glucuronide and then to bilirubin diglucuronide, making it soluble in water: the conjugated version is the main form of bilirubin present in the "direct" bilirubin fraction. Bilirubin Blood Test: Procedure, Preparation, and Risks - Healthline Indirect bilirubin is the unconjugated form of bilirubin in the blood. High Bilirubin Levels: Symptoms, Causes, Tests, and Treatments A normal level is: Direct (also called conjugated) bilirubin: less than 0.3 mg/dL (less than 5.1 mol/L) Total bilirubin: 0.1 to 1.2 mg/dL (1.71 to 20.5 mol/L) Normal value ranges may vary slightly among different laboratories. Jaundice is caused by abnormally elevated or high blood levels of bilirubin. Well go over what this could mean and explain why it likely isnt a big deal. Bilirubin levels can peak as high as 18 mg/dL in the fourth or fifth day, and the jaundice typically clears up within 2 weeks as the liver matures. Direct bilirubin is any form of bilirubin which is water-soluble and is available in solution to react with assay reagents; direct bilirubin is often made up largely of conjugated bilirubin, but some unconjugated bilirubin (up to 25%) can still be part of the "direct" bilirubin fraction. [48] Bilirubin is not normally detectable in the urine of healthy people. Liver disease refers to any abnormal process that affects the liver. In the first step of bilirubin synthesis, the heme molecule is stripped from the hemoglobin molecule. Some labs use different measurements or may test different samples. Bilirubin blood test - UCSF Benioff Children's Hospital MedicineNet does not provide medical advice, diagnosis or treatment. Aside from specific chronic medical conditions that may lead to hyperbilirubinemia, neonates in general are at increased risk since they lack the intestinal bacteria that facilitate the breakdown and excretion of conjugated bilirubin in the feces (this is largely why the feces of a neonate are paler than those of an adult). Mayo Clinic College of Medicine and Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Graduate Medical Education, Mayo Clinic School of Continuous Professional Development, Mayo Clinic on Incontinence - Mayo Clinic Press, NEW Mayo Clinic on High Blood Pressure - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Financial Assistance Documents Minnesota, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition, Screen for liver infections, such as hepatitis, Monitor the progression of a disease, such as viral or alcoholic hepatitis, and determine how well a treatment is working, Measure the severity of a disease, particularly scarring of the liver (cirrhosis), Monitor possible side effects of medications. Neonatal jaundice occurs when the liver is not quite ready to process the bilirubin and the accumulation in the blood causes certain tissues to look yellow. Its breakdown products, such as stercobilin, cause the brown color of feces. Indirect Bilirubin - Health Encyclopedia - University of Rochester Your test results will also include reference ranges, the normal range of bilirubin levels. In addition, newborns can be scanned transcutaneously with Heme then passes through various processes of porphyrin catabolism, which varies according to the region of the body in which the breakdown occurs. 2007 - 2023 Tua Sade. Approximately 50% of full-term infants and 80% of preterm infants have visible jaundice in the first 2 to 4 days after birth if their serum bilirubin levels are at or above 5 mg/dL. https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/8436. A normal level is: Direct (also called conjugated) bilirubin: less than 0.3 mg/dL (less than 5.1 mol/L) Total bilirubin: 0.1 to 1.2 mg/dL (1.71 to 20.5 mol/L) Normal value ranges may vary slightly among different laboratories. A healthcare professional will collect a blood sample from your vein and send it to a lab for analysis. Bilirubin passes through two phases. Prior to being born, the pregnant persons liver helps with this task. This site complies with the HONcode standard for trustworthy health information: verify here. https://liverfoundation.org/for-patients/about-the-liver/diagnosing-liver-disease/#1503683241165-6d0a5a72-83a9. As such, the normal range given for indirect bilirubin is generally the same or very slightly lower than for total bilirubin. Mild rises in bilirubin may be caused by: Moderate[clarification needed] rise in bilirubin may be caused by: Very high[clarification needed] levels of bilirubin may be caused by: Cirrhosis may cause normal, moderately high or high levels of bilirubin, depending on exact features of the cirrhosis. Bilirubin (total, direct [conjugated] and indirect [unconjugated]) - serum. High bilirubin levels usually be notedwithexcessbilirubin production or with difficulties in eliminating it. Learn about the most common liver function tests, why they're used, and more. Our team comprises of trained MDs, PhDs, pharmacists, qualified scientists, and certified health and wellness specialists. When its inflamed, your liver cant easily process bilirubin, leading to a buildup of it in your blood. It is important to report any medications you are on to the blood tech, especially propranolol or rifampin, as these can impact test results. https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/8520. Sample requirement: Urine bilirubin can be measured in a random urine sample, while urobilinogen levels are typically measured in a 24-hour urine sample. This is because it takes some time after birth for an infant to start efficiently metabolizing bilirubin and excreting it in their stool. Our science team must pass long technical science tests, difficult logical reasoning and reading comprehension tests. Gallstones may form if your body is already producing too much bilirubin due to a liver condition or if your liver is creating too much cholesterol. Jaundice (hyperbilirubinemia) in cancer. Over time, when red blood cells need to be replenished, the hemoglobin is broken down in the spleen; it breaks down into two parts: heme group consisting of iron and bile and protein fraction. Learn about the impact smoking has on the liver and other organs. The blood sample for liver function tests is usually drawn through a small needle inserted into a vein in the bend of your arm. A small amount of bilirubin in your blood is normal, but a high level may be a sign of liver disease. Bilirubin is a substance produced by the liver using hemoglobin that is released by destroyed or damaged red blood cells. A plus sign next to the number [1+, 2+, etc] means that the information is found within the full scientific study rather than the abstract. Pratt DS. This type of jaundice is usually not harmful but requires close monitoring. (2016). [52] It is not always distinguished from hematoidin, which one modern dictionary defines as synonymous with it[53] but another defines as "apparently chemically identical with bilirubin but with a different site of origin, formed locally in the tissues from hemoglobin, particularly under conditions of reduced oxygen tension. In general, though, adults with elevated bilirubin levels are urged not to drink alcohol, and to avoid any compounds that may harm or stress the liver's function. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Infant jaundice is fairly common in premature babies, causing their skin and the whites of their eyes to turn yellow. Masters in Applied Microbiology, and skilled in clinical analysis. If bilirubin in urine is found, the patient will have to undergo blood tests to check their level and liver function. Friedman LS. The neonatal doctor might recommend seeing a lactation consultant among other treatments if they give a jaundice diagnosis. Other causes may include inflammation or cancer of the gallbladder, which produces bile, or pancreatitis. Newborns produce more bilirubin than adults do because of greater production and faster breakdown of red blood cells in the first few days of life. The condition of having high bilirubin levels is called hyperbilirubinemia. Normal Range. You prepare for a bilirubin test by refraining from eating for a few hours and avoiding certain compounds that influence bilirubin levels before the test. Bilirubin (bil-ih-ROO-bin) is an orange-yellow substance made during the normal breakdown of red blood cells. Bilirubin. Before joining SelfHacked, she was a research scientist with extensive field and laboratory experience. The normal range for aminotransferase levels is slightly higher in males, nonwhites and obese persons. The bilirubin test can chemically determine the total and if needed, the conjugated and unconjugated levels of bilirubin in the blood. Newborns with high levels of bilirubin have a condition that doctors call neonatal hyperbilirubinemia or jaundice in neonates. conjugated bilirubin. Generally, for older children and adults, the following ranges are considered normal: Total bilirubin: 0.3 to 1 milligrams per deciliter (mg/dL) Direct (conjugated) bilirubin: 0.1 to 0.3 mg/dL; In newborns, a normal value would be an indirect (unconjugated) bilirubin of below 8.7 mg/dL within the first 48 hours of birth. ghr.nlm.nih.gov/condition/gilbert-syndrome, nhlbi.nih.gov/health-topics/hemolytic-anemia, ghr.nlm.nih.gov/condition/intrahepatic-cholestasis-of-pregnancy, jamanetwork.com/journals/jamaoncology/fullarticle/2533531, yael-stiftung.de/en/informations-for-patients-and-physicians/general-informations/three-different-autoimmune-liver-diseases, ncbi.nlm.nih.gov/pmc/articles/PMC4935699/, jamanetwork.com/journals/jama/article-abstract/2107769, The Liver and Cholesterol: What You Should Know, Liver Function Tests: Purpose and Procedure. MNT is the registered trade mark of Healthline Media. [55] 14C labeled protoporphyrin biotransformation to bilirubin evidence emerged in 1966 by Cecil Watson. [citation needed]. American Liver Foundation. Abnormal liver function test results don't always indicate liver disease. Three different autoimmune liver disease. For adults over 18, normal total bilirubin can be up to 1.2 milligrams per deciliter (mg/dl) of blood. Bilirubin levels may spike when exposed to stress [, Strenuous exercise. Bilirubin Test: Understanding High vs. Low Levels & Its Causes This research indicates that bilirubin acts as a powerful antioxidant and anti-inflammatory agent that may protect us from conditions such as heart disease, diabetes, cancer, and neurodegenerative diseases [3, 4, 5, 6, 7, 8, 9, 10]. Years of alcohol abuse cause the liver to become inflamed and swollen. Bilirubin is a reddish yellow pigment made during the normal breakdown of red blood cells. This is the pre-hepatic or the pre-liver phase. In general, newborns have a good outcome if the bilirubin levels decrease "Overview of Hemolytic Anemia Hematology and Oncology", "Animal pigment bilirubin discovered in plants", "Biliverdin reductase: a major physiologic cytoprotectant", "Bilirubin and glutathione have complementary antioxidant and cytoprotective roles", "Bilirubin Links Heme Metabolism to Neuroprotection by Scavenging Superoxide", "Unconjugated Hyperbilirubinemia: Practice Essentials, Background, Pathophysiology", "Bilirubin: Reference Range, Interpretation, Collection and Panels", "Liver Disease Associated with Systemic Disorders", "Unbound bilirubin measurements in term and late-preterm infants", "High levels of serum triglyceride, low-density lipoprotein cholesterol, total bile acid, and total bilirubin are risk factors for gallstones", "Gilbert syndrome, UGT1A1*28 allele, and cardiovascular disease risk: possible protective effects and therapeutic applications of bilirubin", "Protective effects and mechanisms of bilirubin nanomedicine against acute pancreatitis", "Polylysine-bilirubin conjugates maintain functional islets and promote M2 macrophage polarization", "Bilirubin: The Test | Bilirubin Test: Total bilirubin; TBIL; Neonatal bilirubin; Direct bilirubin; Conjugated bilirubin; Indirect bilirubin; Unconjugated bilirubin | Lab Tests Online", "A study of six representative methods of plasma bilirubin analysis", "Total bilirubin measurement by photometry on a blood gas analyzer: potential for use in neonatal testing at the point of care", "Digestive Disorders Health Center: Bilirubin", "Sulfonamides: Bacteria and Antibacterial Drugs: Merck Manual Professional", "Urinalysis: three types of examinations", "Historical Review of Bilirubin Chemistry", "CHOLESCINTIGRAPHY the clinical application of 99m Technetium-diethyl-IDA to the investigation of the liver and biliary tract", "A brief history of carbon monoxide and its therapeutic origins", https://en.wikipedia.org/w/index.php?title=Bilirubin&oldid=1152369954, Reacts quickly when dyes (diazo reagent) are added to the blood specimen to produce, Reacts more slowly, still produces azobilirubin, Ethanol makes all bilirubin react promptly, then: indirect bilirubin = total bilirubin direct bilirubin, 00.3mg/dl Direct (conjugated) bilirubin level, 0.11.2mg/dl Total serum bilirubin level.