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Unconjugated bilirubin
This test measures the amount of bilirubin in your blood. Your body makes bilirubin when it breaks down hemoglobin. Hemoglobin is a protein in red blood cells. The breakdown of hemoglobin is called hemolysis.
Your liver removes bilirubin from your body. So measuring bilirubin is a way to check how well your liver is working.
You may need this test if the results of a total bilirubin blood test are abnormal.
Your total bilirubin may be tested if your healthcare provider suspects you have certain health conditions. These include transfusion reaction, Gilbert syndrome, Dubin-Johnson syndrome, Rotor syndrome, or Crigler-Najjar syndrome. It may also be done as part of routine blood testing to screen for liver problems or damage, such as cirrhosis. Or it may be done to screen for a blood disease, such as hemolytic anemia or pernicious anemia. You may also have bilirubin testing to track a disease you have or are being treated for.
Your healthcare provider may order many other tests along with direct, indirect, and total bilirubin that assess your liver health. These tests are called liver function tests and may include:
Serum aminotransferases, such as aspartate and alanine
Alkaline phosphatase
Albumin
Prothrombin time. This is a clotting test.
Test results may vary depending on your age, gender, health history, and other things. Your test results may be different depending on the lab used. They may not mean you have a problem. Ask your healthcare provider what your test results mean for you.
Indirect and direct bilirubin make up your total bilirubin. When total bilirubin is abnormal, it is important to measure direct and indirect bilirubin levels. Bilirubin is measured in milligrams per deciliter (mg/dL). An example of normal values for adults is:
Total bilirubin: 0.3 to 1.0 mg/dL
Direct (conjugated) bilirubin: 0.0 to 0.3 mg/dL
Indirect (unconjugated) bilirubin: 0.2 to 0.8 mg/dL
Indirect bilirubin is the difference between total and direct bilirubin.
Common causes of higher indirect bilirubin include:
Hemolytic anemia. This means your body is getting rid of too many red blood cells.
Bleeding into the skin caused by injury
Bleeding in the lung caused by a blood clot
A genetic condition that causes slightly higher indirect bilirubin levels without other symptoms of disease
The test is done with a blood sample. A needle is used to draw blood from a vein in your arm or hand.
Having a blood test with a needle carries some risks. These include bleeding, infection, bruising, and feeling lightheaded. When the needle pricks your arm or hand, you may feel a slight sting or pain. Afterward, the site may be sore.
Different things may affect bilirubin levels. Vigorous exercise can raise bilirubin levels. So can the HIV medicine atazanavir.
Caffeine can lower total bilirubin. So can certain medicines. These include:
Barbiturates
Penicillin
High doses of salicylates
You may need to fast several hours before this test. Ask your healthcare provider how you should prepare for the test. Directions can vary.
Several types of medicine may change the bilirubin level in your blood. Be sure your healthcare provider knows about all medicines, herbs, vitamins, and supplements you are taking. This includes medicines that don't need a prescription and any illicit drugs you may use.