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Bilirubin (Total) (SBR)

Clinical Biochemistry

Background Information

Bilirubin is created as part of the red blood cell breakdown process. The liver removes bilirubin from the blood by converting it into a conjugated form (also known as direct bilirubin), which is then secreted into bile and removed from the body in stool.

The total bilirubin test is included in the liver function test profile as a marker of biliary obstruction and also used to assess neonatal hyperbilirubinaemia.

The conjugated bilirubin test may be requested separately.

Patient Preparation

No specific patient preparation is required

Sample Requirements

For adults, blood taken into a 5mL gold top tube (rust top for Acute Unit)

5ml gold tube


For children, blood taken into a 3.5mL rust top tube

3.5ml rust top tube


For neonates, blood taken into a 0.8mL minicollect lithium heparin tube. Please list the tests of particular interest so that some priority can be given to analysis if plasma volumes are small.

Samples from the community should be taken into a 0.8mL minicollect lithium heparin tube and protected from light.

Sample tube: pale green cap


Storage/Transport

Transport to the laboratory the same day at ambient temperature and avoiding exposure to light.

Required Information

Relevant clinical details. Medication or recent exposure to possible hepatotoxic agents. Recent foreign travel or contact with viral hepatitis.

Turnaround Times

The assays are run throughout the day and night. The in-lab turnaround time is less than 24 hours. The test can be ordered as an urgent request.

For neonatal bilirubin results the expected turnaround time is usually less than 3 hours.

Reference Ranges

Please note, there is variability between total bilirubin assays from different manufacturers in reported bilirubin measurement (NICE CG98) and the locally available laboratory assay should be used to guide management.

  • Please refer to GHNHSFT local policy and to current NICE guidelines for up to date information on neonatal jaundice (links below)
    • Please note: if paediatric samples are not protected from light at collection and take longer than 2 hours to reach the laboratory for analysis, the result may be more than 10% lower than the actual value (Rehak et a., 2007).
Age Reference range (µmol/L)
< 1 day <103
1- 2 days <137
2 - 5 days <205
5 - 6 days <190
> 6 days - Adult <21

Babies with prolonged jaundice (jaundice lasting more than 14 days in term or 21 days in pre-term) require a conjugated bilirubin level.

Conjugated bilirubin is assayed, when sample volumes permit, on all neonates with total bilirubin >60 µmol/L at ≥10 days old.

Further information

To learn more about bilirubin, visit Lab Tests Online

NICE CG98 Neonatal Jaundice (2010)

NICE CG98 Neonatal Jaundice Treatment Threshold Graphs

NICE CG98 Neonatal Jaundice: Threshold Table

Trust staff: Please refer to GHNHSFT policy M1091: Jaundice in Term and Preterm infants

References

Rehak NN, Cecco SA, Hortin GL. Photolysis of bilirubin in serum specimens exposed to room lighting. Clin Chim Acta. 2008 Jan;387(1-2):181-3. doi: 10.1016/j.cca.2007.09.019. Epub 2007 Oct 2. PMID: 17967443; PMCID: PMC2131702.

Page last updated: 01/07/2026 | Page last reviewed: 01/07/2026

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