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Bilirubin, Total and Direct

Direct Bilirubin, Bilirubin, Conjugated, Bilirubin Total and Direct

Test Codes

Antrim #17270, EPIC: LAB168, BILTD

Department

Toxicology

Specimen Collection Criteria

FOR EC AND INPATIENT SAMPLE COLLECTION ONLY:

Preferred Sample:  One Light Green (Mint) Top Plasma Separator Tube (PST)(Minimum Whole Blood: 4.0 mL)

Acceptable Sample:  One Gold Top SST (Minimum Whole Blood:  4.0 mL)

FOR PHYSICIAN OFFICE/OUTREACH SAMPLE COLLECTION:

COLLECT:  One Gold Top SST (Minimum Whole Blood:  4.0 mL) 

Contact Laboratory for acceptability of other tube types. 

See Minimum Pediatric Specimen Requirements for Microtainer^® collection.
Protect specimen from prolonged exposure to light. 

Physician Office/Draw Specimen Preparation

Protect specimen from light. Let SST specimens clot 30-60 minutes then immediately centrifuge to separate serum from cells. Refrigerate (2–8°C or 36–46°F) the centrifuged SST tube within two hours of collection. (Minimum: 0.5 mL)

Preparation for Courier Transport

Transport: Centrifuged SST tube, refrigerated (2–8°C or 36–46°F). (Minimum: 0.5 mL)

Rejection Criteria

• Moderate to grossly hemolyzed specimens.
• Red-top tubes with serum not separated from cells within two hours of collection.

In-Lab Processing

Protect specimen from light. Let SST specimens clot 30–60 minutes. Centrifuge SST tubes and Microtainers^® to separate serum from cells. Deliver immediately to the appropriate testing station.

Storage

Specimen Stability for Testing:

Centrifuged SST Tubes and Microtainers^® with Separator Gel
Room Temperature (20–26°C or 68–78.8°F): 2–4 hours
Refrigerated (2–8°C or 36–46°F): 7 days (5 days at Grosse Pointe)
Frozen (-20°C/-4°F or below): Unacceptable

Red-top Tubes and Microtainers^® without Separator Gel
Room Temperature (20–26°C or 68–78.8°F): 2–4 hours
Refrigerated (2–8°C or 36–46°F): Unacceptable
Frozen (-20°C/-4°F or below): Unacceptable

Serum Specimens (Pour-Overs)
Room Temperature (20–26°C or 68–78.8°F): 2–4 hours
Refrigerated (2–8°C or 36–46°F): 7 days (5 days at Grosse Pointe)
Frozen (-20°C/-4°F or below): 7 days

Specimen Storage in Department Prior to Disposal:

Refrigerated (2–8°C or 36–46°F): 7 days

Laboratory

Canton Chemistry Laboratory
Dearborn Chemistry Laboratory
Farmington Hills Chemistry Laboratory 
Grosse Pointe Chemistry Laboratory 
Livonia Main Laboratory
Lenox Main Laboratory
Royal Oak Automated Chemistry Laboratory 
Troy Chemistry Laboratory
Taylor Chemistry Laboratory
Trenton Chemistry Laboratory
Wayne Chemistry Laboratory 

Performed

Sunday – Saturday, 24 hours a day.
STAT results available within 1 hour of receipt in the Laboratory.
Routine results available within 4 hours.

Reference Range

Direct Bilirubin (0-27 days): 0.0 – 1.0 mg/dL.
Direct Bilirubin (28-adult): 0.0 – 0.4 mg/dL.

Total Bilirubin (Age Related):

Age (Days)	Range (mg/dL)
0 – Less than 1 day	0.3–7.9
1 day	0.3–12.0
2–13	0.3–15.0
14–20	0.3–8.0
21–27	0.3–6.0
28 days – Adult	0.3–1.2

Test Methodology

Spectrophotometry.

Interpretation

Increased direct bilirubin occurs with intrahepatic and extrahepatic biliary disease, including hepatitis, cirrhosis, Dubin-Johnson and Rotor syndromes, cholestatic drug reactions and advanced neoplastic disease involving the liver. An increase should not be seen in hemolytic anemia and Gilbert's syndrome. Direct bilirubin is water soluble and when increased in the serum usually results in a positive test for urinary bilirubin.

Clinical Utility

The quantitative determination of direct bilirubin is used in the evaluation of liver and biliary disease.

CPT Codes

82248
LOINC:  59827-6, 5770-3, 1968-7

Contacts

Last Updated

7/21/2024