What is a Total Bilirubin Check?
Total bilirubin test is a test that is done to measure the total amount of bilirubin in the blood. This test aims to evaluate liver function or help diagnose anemia caused by red blood cell damage ( hemolytic anemia ).
Bilirubin is an orange-yellow pigment that forms naturally as a result of the breakdown of old red blood cells. The liver takes bilirubin from the blood and changes its chemical composition. Most of this composition is then excreted through feces and urine.
If bilirubin levels are higher than normal, it means that the red blood cells in your body are breaking down at an unusual rate. It could also mean that your liver is not doing its job of clearing bilirubin from your blood. Another possibility is that there is a problem somewhere along the pathway that removes bilirubin from your liver to your stool.
Why Do a Total Bilirubin Check?
A total bilirubin test is usually done as part of a group of tests to check the health of a person’s liver. A total bilirubin test can be done for the following purposes:
- Investigating the cause of jaundice. Increased bilirubin levels can cause yellowing of the skin and whites of the eyes (jaundice). However, total bilirubin testing for this purpose is usually done in newborns.
- Investigating whether there is a blockage in the liver’s bile duct.
- Helps detect or monitor the development of other liver diseases such as hepatitis.
- Helps monitor the effectiveness of treatment.
- Helps confirm the diagnosis of drug poisoning.
Meanwhile, there are also several other general tests that may be performed along with the bilirubin test, including:
- Liver Function Tests. This is a group of blood tests that measure certain enzymes or proteins in the blood.
- Albumin and Total Protein. Levels of albumin, a protein made by the liver, and total protein show how well the liver is making the proteins the body needs to fight infection and perform other functions.
- Complete Blood Count Check. This test measures several components and features of blood.
- Prothrombin Time. This test measures the clotting time of plasma.
When to Check Total Bilirubin?
A person may be advised to have a total bilirubin test if they experience symptoms such as fatigue, nausea and vomiting, dark urine, abdominal pain, and clay-colored stools.
In addition, the doctor will also recommend a total bilirubin check if:
- Showing signs of jaundice.
- Having anemia.
- May have toxic reactions to medications.
- Has a history of heavy drinking.
- Have been exposed to the hepatitis virus.
- Having cirrhosis.
How to Check Total Bilirubin?
Before taking this test, you should not eat or drink anything other than water for four hours before the test. You can drink as much water as you normally would before going to the lab.
You may also need to stop taking certain medications before the test, but only with your doctor’s advice. Examples of medications that can affect bilirubin levels include antibiotics such as penicillin G, tranquilizers such as phenobarbital, diuretics such as furosemide (Lasix), and asthma medications such as theophylline.
A total bilirubin test uses a blood sample taken from a vein in the arm. Typically, the blood is drawn through a small needle inserted into a vein in the arm. The needle is then attached to a small tube, where the blood is collected.
The patient may feel a quick pain when the needle is inserted into the arm and experience a few moments of discomfort at the injection site after the needle is removed. In infants, the total bilirubin test is usually performed by using a sharp instrument to break the skin on the heel. There may be a slight bruise at the puncture site afterward.
When the blood is collected, you may feel moderate pain or a slight pinching sensation. After the needle is removed, you may feel a throbbing sensation. You will be instructed to apply pressure to the site where the needle entered your skin. A bandage will be placed over the injection site. Keep this bandage on for at least 10 to 20 minutes. You should also avoid using that arm for lifting throughout the day.
The blood sample will then be sent to the laboratory for analysis. After that, you can immediately return to normal activities.
However, there are some very rare risks when someone takes a blood sample, including:
- Dizziness or fainting.
- A hematoma, is a bruise where blood collects under the skin.
- Infection is usually prevented by cleaning the skin before the needle is inserted.
- Excessive bleeding, or bleeding for a long time afterward, may indicate a more serious bleeding condition and should be reported to your doctor.
How to Read Bilirubin Test Results
In older children or adults, the normal value of direct bilirubin is from 0-0.4 milligrams per deciliter (mg/dL). While the normal value of total bilirubin is from 0.3-1.0 mg/dL.
The indirect bilirubin level in the bloodstream is the total bilirubin minus the direct bilirubin level in the bloodstream. Also, normal reference ranges can vary from lab to lab.
In newborns, higher bilirubin is normal due to the stress of birth. Normal indirect bilirubin will be below 5.2 mg/dL in the first 24 hours of birth. However, many newborns have some form of jaundice and bilirubin levels that rise above 5 mg/dL in the first few days after birth.
Your doctor may order further blood tests or an ultrasound if high levels of bilirubin are detected in your blood. In adults, high bilirubin may be due to problems with the liver, bile ducts, or gallbladder. Examples include:
- Liver disease, such as hepatitis.
- Gilbert’s syndrome, a genetic disease.
- Cirrhosis, which is scarring of the liver.
- Biliary stricture, where part of the bile duct is too narrow to allow fluid to pass through.
- Gallbladder or pancreatic cancer.
- Gallstones.
- Drug poisoning.
High bilirubin can also be caused by problems in the blood, not problems with the liver. Blood cells breaking down too quickly can be caused by:
- Hemolytic Anemia: This occurs when too many blood cells are destroyed from autoimmune disease, genetic defects, drug toxicity, or infection, and the liver cannot metabolize the amount of indirect bilirubin in the body.
- Transfusion Reaction: This occurs when the immune system attacks blood given through transfusion.