Lab results explained
High bilirubin: what your result means
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Short answer: Total bilirubin above 1.2 mg/dL (about 21 µmol/L) is high. A mild rise in indirect bilirubin with normal liver enzymes is often Gilbert syndrome, which is harmless. A raised direct bilirubin points more to the liver or bile ducts. Yellow eyes, dark urine or pale stools need prompt medical review.
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Typical adult range
Your lab may print a slightly different range. Use the one on your report when there is one.
| Test | Men | Women |
|---|---|---|
| Total bilirubin | 0.1–1.2 mg/dL1.71–20.5 µmol/L | |
| Direct bilirubin | 0–0.3 mg/dL0–5.13 µmol/L | |
| Indirect bilirubin | 0.2–0.9 mg/dL3.42–15.4 µmol/L | |
| ALT (SGPT) | 7–55 U/L | 7–45 U/L |
What bilirubin is
Bilirubin is a yellow substance made when old red blood cells break down. The liver changes it into a form that can leave the body in bile and stool. Reports often list S. bilirubin as total, direct (conjugated) and indirect (unconjugated). Direct bilirubin is the form the liver has already processed, and indirect is the form it has not. The usual range is up to 1.2 mg/dL for total, up to 0.3 mg/dL for direct and 0.2 to 0.9 mg/dL for indirect. To get µmol/L, multiply mg/dL by about 17.1.
Common causes of high bilirubin
Which part is raised helps narrow down the cause. A high indirect level usually means the liver is receiving more bilirubin than it can handle, or is slow to process it. A high direct level usually means the liver is damaged or bile cannot drain properly. Your liver enzymes and a blood count help your doctor tell these apart quickly.
- Gilbert syndrome, a common harmless inherited condition (indirect)
- Breakdown of red cells, called haemolysis (indirect)
- Hepatitis from viruses such as hepatitis A, B or E, alcohol or medicines (direct)
- Gallstones or other blockage of the bile ducts (direct)
- Fatty liver disease and cirrhosis
Symptoms and the pattern with liver enzymes
Jaundice, a yellow tint to the skin and the whites of the eyes, usually shows once bilirubin is well above the normal range. A blocked bile flow can also cause dark urine, pale stools and itching. ALT (SGPT) helps sort out the cause. A high bilirubin with a much higher ALT suggests inflammation of the liver itself, such as hepatitis. Gilbert syndrome typically shows a mild indirect rise, often worse when fasting or ill, with normal ALT and a normal blood count. This page is about adults; jaundice in newborns is assessed differently.
What usually happens next
If you feel well and only indirect bilirubin is slightly high, your doctor may repeat it with other liver tests and a blood count to check for Gilbert syndrome or haemolysis. If direct bilirubin or liver enzymes are raised, your doctor may order tests for hepatitis viruses, an ultrasound of the liver and gallbladder, and a review of your alcohol use and medicines. Do not stop prescribed medicines on your own, but tell your doctor about everything you take, including herbal and home remedies.
When to get help the same day
Get same-day medical care if you have yellow eyes or skin with fever, shivering or pain in the upper right belly, if you are pregnant and develop jaundice, or if bilirubin is 15 mg/dL or higher. Call your local emergency number for confusion or unusual drowsiness, vomiting blood, black stools or severe belly pain.
Questions to ask your doctor
- Is my raised bilirubin mostly direct or indirect, and what does that suggest?
- Could this be Gilbert syndrome, and do I need other tests to confirm it?
- Do I need tests for hepatitis or an ultrasound?
- Could any of my medicines or supplements be affecting my liver?
- When should my liver tests be repeated?
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Frequently asked questions
Is a bilirubin of 1.5 mg/dL dangerous?
A total bilirubin of 1.5 mg/dL is mildly high. If the rise is mainly indirect and your other liver tests are normal, it is often Gilbert syndrome. Your doctor will look at the full liver panel and your symptoms.
What is Gilbert syndrome?
It is a common inherited condition in which the liver processes bilirubin a little slowly. It causes mild rises in indirect bilirubin, especially when fasting, ill or stressed. It does not damage the liver and usually needs no treatment.
What causes high direct bilirubin?
High direct bilirubin usually means liver inflammation, such as hepatitis, or a blockage in the bile ducts, such as gallstones. It needs a doctor's review, often with an ultrasound and more blood tests.
At what bilirubin level does jaundice show?
Yellowing of the eyes usually becomes visible once total bilirubin is roughly twice the upper limit of normal or more. It can be hard to see in some skin tones and in poor light, so the whites of the eyes are the best place to look.
Sources
This page explains what results usually mean. It isn't a diagnosis or medical advice; your doctor interprets results with your symptoms, history and medicines. Medical disclaimer
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