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Bilirubin meter

Test Overview
A bilirubin test measures the amount of bilirubin in a blood sample. Bilirubin is a brownish
yellow substance found in bile. It is produced when the liver breaks down old red blood cells.
Bilirubin is then removed from the body through the stool (feces) and gives stool its normal
brown color.
Bilirubin circulates in the bloodstream in two forms:
• Indirect (or unconjugated) bilirubin. This form of bilirubin does not
dissolve in water (it is insoluble). Indirect bilirubin travels through the
bloodstream to the liver, where it is changed into a soluble form (direct or
• Direct (or conjugated) bilirubin. Direct bilirubin dissolves in water (it is
soluble) and is made by the liver from indirect bilirubin.
Total bilirubin and direct bilirubin levels are measured directly in the blood, whereas indirect
bilirubin levels are derived from the total and direct bilirubin measurements.
When bilirubin levels are high, the skin and whites of the eyes may appear yellow (jaundice).
Jaundice may be caused by liver disease (hepatitis), blood disorders (hemolytic anemia), or
blockage of the tubes (bile ducts) that allow bile to pass from the liver to the small intestine.
Too much bilirubin (hyperbilirubinemia) in a newborn baby can cause brain damage
(kernicterus), hearing loss, problems with the muscles that move the eye, physical
abnormalities, and even death. Therefore, some babies who develop jaundice may be treated
with special lights (phototherapy ) or a blood transfusion to lower their bilirubin levels.
In a newborn baby, the blood sample is usually taken from the heel (heel stick)
Why It Is Done
The bilirubin test is used to:
• Check liver function and watch for signs of liver disease, such as hepatitis or
cirrhosis, or the effects of medicines that can damage the liver.
• Find out if something is blocking the bile ducts. This may occur if gallstones,
tumors of the pancreas, or other conditions are present.
• Diagnose conditions that cause increased destruction of red blood cells, such as
hemolytic anemia or hemolytic disease of the newborn.
• Help make decisions about whether newborn babies with neonatal jaundice
need treatment. These babies may need treatment with special lights, called
phototherapy. In rare cases, blood transfusions may be needed.

How To Prepare
Adults should not eat or drink for 4 hours before a bilirubin test.
No special preparation is needed for children before having a bilirubin test.
Tell your doctor if you:
• Are taking any medicines.
• Are allergic to any medicines.
• Have had bleeding problems or take blood-thinners, such as aspirin or warfarin
• Are or might be pregnant.
Talk to your health professional about any concerns you have regarding the need for the test,
its risks, how it will be done, or what the results will indicate. To help you understand the
importance of this test, fill out the medical test information form (What is a PDF
document?) .
How It Feels
Blood sample from a heel stick
A brief pain, like a sting or a pinch, is usually felt when the lancet punctures the skin. Your
baby may feel a little discomfort with the skin puncture.
Blood sample from a vein
The blood sample is taken from a vein in your arm. An elastic band is wrapped around your
upper arm. It may feel tight. You may feel nothing at all from the needle, or you may feel a
quick sting or pinch.

How It Is Done
Blood sample from a heel stick
For a heel stick blood sample, several drops of blood are collected from the heel of your baby.
The skin of the heel is first cleaned with alcohol and then punctured with a small sterile
lancet. Several drops of blood are collected in a small tube. When enough blood has been
collected, a gauze pad or cotton ball is placed over the puncture site. Pressure is maintained
on the puncture site briefly, and then a small bandage is usually applied.
Instead of the standard heel stick, some hospitals may use a device called a transcutaneous
bilirubin meter to check a newborn's bilirubin level. This small handheld device measures
bilirubin levels when it is placed gently against the skin. With this device, there may be no
need to puncture the baby's skin. This is a screening test, and a blood sample will be needed if
your baby's bilirubin level is high.
Blood sample from a vein
The health professional taking a sample of your blood will:
• Wrap an elastic band around your upper arm to stop the flow of blood. This
makes the veins below the band larger so it is easier to put a needle into the
• Clean the needle site with alcohol.
• Put the needle into the vein. More than one needle stick may be needed.
• Attach a tube to the needle to fill it with blood.
• Remove the band from your arm when enough blood is collected.
• Put a gauze pad or cotton ball over the needle site as the needle is removed.
• Put pressure on the site and then put on a bandage.
Heel stick
There is very little chance of a problem from a heel stick. A small bruise may develop at the
Blood test
There is very little chance of a problem from having blood sample taken from a vein.
• You may get a small bruise at the site. You can lower the chance of bruising by
keeping pressure on the site for several minutes.
• In rare cases, the vein may become swollen after the blood sample is taken.
This problem is called phlebitis. A warm compress can be used several times a
day to treat this.
• Ongoing bleeding can be a problem for people with bleeding disorders.
Aspirin, warfarin (Coumadin), and other blood-thinning medicines can make
bleeding more likely. If you have bleeding or clotting problems, or if you take
blood-thinning medicine, tell your doctor before your blood sample is taken

• Results
• A bilirubin test measures the amount of bilirubin in a blood sample.
The results are usually available in 1 to 2 hours.
• Normal adult values
• Normal values may vary from lab to lab.

Reserch 2

Most of the time no medical treatment is needed for jaundice in a newborn

(hyperbilirubinemia). But watch for increasing intensity of the yellow tint in the skin and eyes
or any change in your baby's behavior.
Babies who have bilirubin in their blood at a level that could be harmful need treatment.
Whatever the cause, if the condition is not treated, excessive amounts of bilirubin in the blood
may lead to brain damage ( kernicterus), which could result in hearing loss, mental
retardation, and behavior problems.
The most common treatment for hyperbilirubinemia is phototherapy, which uses fluorescent
light to help transform bilirubin into a form the body can more quickly eliminate. Standard
phototherapy is usually done in a hospital. But babies with jaundice who are otherwise
healthy may be treated at home with a type of phototherapy that uses a fiber-optic wrap,
usually a blanket or a band. These wraps usually reduce blood bilirubin levels more slowly
than standard phototherapy, so generally they are used only for mild jaundice. Sometimes
standard therapy and fiber-optic wrap therapy are used together. 2
If your newborn is receiving phototherapy for jaundice in the hospital, you can help by:
• Asking whether you can stay in the hospital overnight so you can continue to care for
your baby. If you are not able to stay, visit frequently.
• Touching your baby often during phototherapy sessions in the enclosed plastic crib
(incubator). You can reach into the incubator through specially made armholes on both
sides of the incubator.
• Talking or singing to your baby, because babies can hear through the incubator.
• Holding your baby during the short periods when he or she is taken out from under the
The fluorescent lights used in phototherapy for babies with jaundice are not harmful if
precautions are taken. Eye shields are placed over the baby's eyes to protect them while under
the light. The shields are removed during feedings. Babies are accustomed to being in the dark
after months in the womb, so the shields should not bother your baby.
If your baby is being treated at home for jaundice, it is important that you understand how to
use all of the equipment. Ask your baby's doctor for help if you have questions or concerns.
You may need to take your baby to a lab each day to get his or her bilirubin checked. A home
health nurse may visit to make sure all is going well.
If the baby's jaundice is being caused by an underlying condition, other treatments may be
needed. For example, if severe jaundice is caused by the baby's body destroying red blood
cells (blood type incompatibility), the baby may need immunoglobulin (IG). If that doesn't
help, the baby may need to be admitted to a hospital and given a blood transfusion.

The Test Sample
What is being tested?
Bilirubin is an orange-yellow pigment found in bile. Red blood cells (RBCs)
normally degrade after 120 days in the circulation. At this time, a component of
the RBCs, hemoglobin (the red-colored pigment of red blood cells that carries
oxygen to tissues), breaks down into unconjugated bilirubin. Approximately 250
to 350 mg of bilirubin is produced daily in a normal, healthy adult, of which 85%
is derived from damaged or old red cells that have died, with the remaining
amount from the bone marrow or liver.

Unconjugated bilirubin is carried to the liver, where sugars are attached to it to make it water
soluble, producing conjugated bilirubin. This conjugated bilirubin is passed to the bile by the
liver and is further broken down by bacteria in the small intestines and eventually excreted in
the feces. The breakdown products of bilirubin give feces its characteristic brown color. If
bilirubin levels increase in the blood, the appearance of jaundice becomes more evident.
Normally, almost all bilirubin in the blood is unconjugated.
How is the sample collected for testing?
In newborns, blood is often collected from a heelstick, a technique that uses a
small, sharp blade to cut the skin on the infant’s heel and collect a few drops of
blood into a small tube. For adults, blood is typically collected by needle from a
vein. Non-invasive technology is available in some health care facilities that will
measure bilirubin by using an instrument placed on the skin (transcutaneous
bilirubin meter).