Bilirubin is a yellowish pigment found in bile, a fluid produced by the liver.

This article discusses the laboratory test done to measure bilirubin in the blood. Total and direct bilirubin are usually measured to screen for or to monitor liver or gallbladder problems. Large amounts of bilirubin in the body can lead to jaundice.

A test may also be done to measure bilirubin in a urine sample. For information on that test, see: Bilirubin - urine.

This test is useful in determining if a patient has liver disease or a blocked bile duct.

Bilirubin metabolism begins with the breakdown of red blood cells in many parts of the body. Red blood cells contain hemoglobin, which is broken down to heme and globin. Heme is converted to bilirubin, which is then carried by albumin in the blood to the liver.

In the liver, most of the bilirubin is chemically attached to another molecule before it is released in the bile. This "conjugated" (attached) bilirubin is called direct bilirubin; unconjugated bilirubin is called indirect bilirubin. Total serum bilirubin equals direct bilirubin plus indirect bilirubin.

Conjugated bilirubin is released into the bile by the liver and stored in the gallbladder, or transferred directly to the small intestines. Bilirubin is further broken down by bacteria in the intestines, and those breakdown products contribute to the color of the feces. A small percentage of these breakdown compounds are taken in again by the body, and eventually appear in the urine.

A blood sample is needed. For information on how this is done, see: Venipuncture .

The laboratory specialist spins the blood in a machine called a centrifuge, which separates the liquid part of the blood (serum) from the cells. The bilirubin test is done on the serum.

You should not eat or drink for at least 4 hours before the test. Your health care provider may instruct you to stop taking drugs that affect the test.

Drugs that can increase bilirubin measurements include allopurinol, anabolic steroids, some antibiotics, antimalaria medications, azathioprine, chlorpropamide, cholinergics, codeine, diuretics, epinephrine, meperidine, methotrexate, methyldopa, MAO inhibitors, morphine, nicotinic acid, birth control pills, phenothiazines, quinidine, rifampin, steroids, sulfonamides, and theophylline.

Drugs that can decrease bilirubin measurements include barbiturates, caffeine, penicillin, and high-dose salicylates such as aspirin.