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Liver

Total Bilirubin: Normal Values and What a High Level Means

Total bilirubin is a fundamental marker of liver function and red blood cell health. Regular monitoring helps detect potential liver or blood conditions early, supporting informed and proactive health decisions.

Doctor's Assessment Included

Bilirubin is the yellow breakdown product of red blood cells, which the liver processes and removes through the bile. For adults, Star-SHL and Certe use an upper limit of 24 µmol/l for men and 19 for women, Unilabs and Diagnostiek voor U 20 for everyone.

  • Total bilirubin is the sum of an unprocessed (indirect) form and a form processed by the liver (direct); a raised unprocessed form is usually due to red cell breakdown or Gilbert's syndrome, a raised processed form usually to liver disease or blocked bile ducts.
  • For an isolated raised bilirubin, with otherwise normal liver tests, the British Society of Gastroenterology (BSG) advises repeating the liver tests on a fasting sample, with a full blood count and direct and indirect bilirubin; in Gilbert's syndrome, total bilirubin then rises further.
  • A bilirubin result depends strongly on the measuring method, which is why limits differ between laboratories.

Reference Ranges

See the value that applies to you:

Choose male or female — this range differs by sex.

Enter your age — this range changes with age.

This range also depends on context such as cycle phase or sample material; the highlighted rows apply to your group.

Your reference range
umol/l
2 29 umol/l
Reference ranges by group, in umol/l
Male · 1–5 years 2–11 umol/l
2 11
Male · 6–12 years 3–16 umol/l
3 16
Male · 13–18 years 4–29 umol/l
4 29
Male · 19 years and older 4–24 umol/l
4 24
Female · 1–5 years 2–10 umol/l
2 10
Female · 6–12 years 3–16 umol/l
3 16
Female · 13–18 years 3–22 umol/l
3 22
Female · 19 years and older 3–19 umol/l
3 19
2 29 umol/l

Source: NVKC Reference population: Dutch general-practice population (NUMBER, n = 7,574,327)

Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.

Check your own value

Bilirubin (Total): what Dutch laboratories use

Reference ranges by group, in umol/l
Star-shl · Male · 19 years and older 4–24 umol/l
4 24
Star-shl · Female · 19 years and older 3–19 umol/l
3 19
Unilabs · Everyone · 0–115 years 3–20 µmol/l
3 20
Certe · Male · 18 years and older · a limit, not a range < 24 umol/L
24
Certe · Female · 18 years and older · a limit, not a range < 19 umol/L
19
Diagnostiek voor U · Everyone · 0 years and older 3–20 µmol/L
3 20
0 26.4 umol/l

Source: Star-shl

Source: Unilabs

Source: Certe

Source: Diagnostiek voor U

Each value as the laboratory itself publishes it, retrieved in 2026.

Bilirubin (Total): what this test measures

This test measures the total concentration of bilirubin in your blood, which includes both direct (conjugated) and indirect (unconjugated) forms. Bilirubin is produced when haemoglobin from old red blood cells is broken down.

The liver processes indirect bilirubin into direct bilirubin, which is then excreted through bile. Elevated total bilirubin can result from problems at any stage of this process, including excessive red blood cell breakdown, impaired liver function, or blocked bile ducts.

Bilirubin (Total): why this value matters

Total bilirubin is a fundamental marker for assessing liver function and diagnosing the cause of jaundice. By comparing total bilirubin with direct bilirubin, healthcare providers can determine whether elevation is due to liver disease, bile duct obstruction, or haemolysis.

Mild elevations may occur in common and generally harmless conditions such as Gilbert syndrome, which affects approximately 5-10% of the population. However, significant elevations warrant further investigation to rule out serious underlying conditions.

Bilirubin (Total): how the blood test works

Referral
No GP referral needed. After the order we arrange the referral through ZorgDomein, within one business day; orders after 17:00 or at the weekend start on the next business day. ZorgDomein emails a barcode, and that barcode is what the draw site needs.
The draw
A blood draw from a vein in the arm, at a partner laboratory's draw site. No home kit, no finger prick.
Which test
on its own €7,- Complete Metabolic Panel · €149,- · Whoop · €499,- · Whoop Heart Health · €629,- · Whoop Men's Health · €659,-
Where
650+ draw sites run by independent laboratories across the Netherlands. Draw sites

Bilirubin (Total): when is testing worthwhile?

Testing is recommended when jaundice is observed, as part of a routine liver function panel, or when monitoring known liver or blood disorders.

Total bilirubin testing may also be appropriate when experiencing symptoms such as unexplained fatigue, abdominal pain, dark urine, or pale stools, or when evaluating the potential side effects of certain medications.

Bilirubin (Total): symptoms of a high or low value

Low Levels

Low total bilirubin levels are generally not clinically significant and typically reflect normal red blood cell turnover and liver function.

High Levels

Jaundice (yellowing of skin or eyes)
Fatigue and weakness
Abdominal pain or discomfort
Nausea or loss of appetite
Dark urine and pale stools

Bilirubin (Total): causes of a low or high value

What raises the value

  • Gilbert's syndrome

    The most common cause of an isolated raised bilirubin is Gilbert's syndrome, an inherited trait that 5 to 8 percent of people have and that is not linked to liver disease.

  • Breakdown of red blood cells

    A slightly raised bilirubin is found when red blood cells break down, as in haemolytic anaemia, and with large bruises.

  • Liver disease

    Hepatitis, damage to the liver tissue, long-term alcohol use or poisoning by medicines can raise bilirubin.

  • Blocked bile ducts

    Gallstones, a tumour of the bile ducts or pancreatic cancer that blocks the flow of bile can raise bilirubin.

  • Strenuous exercise

    Bilirubin can rise after strenuous exercise.

Bilirubin (Total): lifestyle and this value

Moderate your alcohol intake, as excessive consumption is a leading cause of liver damage and elevated bilirubin. Eat a balanced diet with adequate fibre to support healthy bile production and excretion.

Stay well hydrated and maintain a healthy weight to reduce the risk of fatty liver disease. If you have Gilbert syndrome, be aware that fasting, stress, and illness can temporarily raise bilirubin levels. Always discuss medications and supplements with your healthcare provider.

Bilirubin (Total): frequently asked questions

What does elevated total bilirubin mean?

Elevated total bilirubin can indicate liver disease, bile duct obstruction, or increased breakdown of red blood cells. It may also be caused by Gilbert syndrome, a common and generally harmless genetic condition. Consult your healthcare provider for proper evaluation.

What is Gilbert syndrome?

Gilbert syndrome is a common, inherited condition where the liver processes bilirubin more slowly than usual. It typically causes mildly elevated bilirubin levels and occasional jaundice, particularly during fasting, stress, or illness, but generally does not require treatment.

Should I fast before a bilirubin test?

Fasting requirements may vary depending on your healthcare provider's instructions and whether additional tests are being performed. Fasting can raise bilirubin levels in people with Gilbert syndrome, so inform your provider if you have this condition.

Bilirubin (Total): sources

  1. den Elzen WPJ, Brouwer N, Thelen MH, Le Cessie S, Haagen I-A, Cobbaert CM. NUMBER: standardized reference intervals in the Netherlands using a 'big data' approach. Clin Chem Lab Med 2018;57(1):42-56. (retrieved 2026) doi.org
  2. Star-shl, Labbepalingen (referentiewaarden per bepaling), star-shl.nl, geraadpleegd 2026-10-01 (retrieved 2026) star-shl.nl
  3. Unilabs, Bepalingenklapper (referentiewaarden per bepaling), bepalingenklapper.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenklapper.nl
  4. Certe, Bepalingenwijzer (referentiewaarden per bepaling), bepalingenwijzer.certe.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenwijzer.certe.nl
  5. Diagnostiek voor U, eLabgids (Referentiewaarden DvU), diagnostiek.getincontrol.eu, geraadpleegd 2026-10-01 (retrieved 2026) diagnostiek.getincontrol.eu
  6. Newsome PN, et al. Guidelines on the management of abnormal liver blood tests. Gut 2018;67(1):6-19. (retrieved 2026) pmc.ncbi.nlm.nih.gov
  7. NVKC, Alles over testen: Bilirubine, allesovertesten.nl, geraadpleegd 2026-10-06 (retrieved 2026) allesovertesten.nl

Test Products

This marker is included in the following test panels.

Health Checkups

Complete Metabolic Panel

Comprehensive metabolic panel: electrolytes, kidney, liver, glucose, HbA1c, and protein.

Bicarbonate Calcium Chloride Potassium Sodium Glucose (Fasting) HbA1c (Glycated Hemoglobin) Albumin ALP (Alkaline Phosphatase) ALT (Alanine Aminotransferase) AST (Aspartate Aminotransferase) Bilirubin (Total) Urea (BUN) Creatinine eGFR (Estimated Glomerular Filtration Rate) Total Protein Bilirubin (Direct) Bilirubin (Indirect)
€149,-
Whoop

Whoop

A 45-biomarker comprehensive health panel inspired by WHOOP Advanced Labs — a deep look at metabolism, cardiovascular risk, hormones, liver, kidney and inflammation.

SHBG (Sex Hormone Binding Globulin) TSH (Thyroid Stimulating Hormone) ALT (Alanine Aminotransferase) LDL Cholesterol Cortisol DHEA-S Estradiol (E2) Free Testosterone FSH (Follicle Stimulating Hormone) LH (Luteinizing Hormone) Total Testosterone Bicarbonate Calcium Chloride Ferritin Iron (Serum) Magnesium Potassium Sodium Transferrin CRP (C-Reactive Protein) Homocysteine Glucose (Fasting) HbA1c (Glycated Hemoglobin) ApoB (Apolipoprotein B) HDL Cholesterol Total Cholesterol Albumin HOMA-IR ALP (Alkaline Phosphatase) AST (Aspartate Aminotransferase) Bilirubin (Total) Total Protein Urea (BUN) Creatinine Vitamin D (25-OH) eGFR (Estimated Glomerular Filtration Rate) Insulin (Fasting) Leukocyte Differential Transferrin Saturation Lipoprotein(a) Triglycerides Basic Blood Count Bilirubin (Direct) Bilirubin (Indirect) Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€499,-
Whoop

Whoop Heart Health

A 46-biomarker heart health panel inspired by the WHOOP Heart Health Panel — an advanced look at cholesterol, lipoproteins, inflammation and kidney function.

Complete Blood Count (CBC) ALP (Alkaline Phosphatase) ALT (Alanine Aminotransferase) AST (Aspartate Aminotransferase) Albumin Total Protein Bilirubin (Total) ApoB (Apolipoprotein B) Total Cholesterol LDL Cholesterol HDL Cholesterol Triglycerides Lipoprotein(a) Urea (BUN) Creatinine eGFR (Estimated Glomerular Filtration Rate) Calcium Bicarbonate Chloride Sodium Potassium Magnesium Cortisol DHEA-S Estradiol (E2) FSH (Follicle Stimulating Hormone) LH (Luteinizing Hormone) SHBG (Sex Hormone Binding Globulin) Total Testosterone Free Testosterone TSH (Thyroid Stimulating Hormone) Glucose (Fasting) HbA1c (Glycated Hemoglobin) Insulin (Fasting) HOMA-IR CRP (C-Reactive Protein) Homocysteine Ferritin Iron (Serum) Transferrin Transferrin Saturation Vitamin D (25-OH) Cystatin C Uric Acid Bilirubin (Direct) Bilirubin (Indirect) Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€629,-
Whoop

Whoop Men's Health

A 49-biomarker men's health panel inspired by the WHOOP Men's Health Panel — testosterone, PSA and prostate health plus a complete metabolic and hormone base.

Complete Blood Count (CBC) ALP (Alkaline Phosphatase) ALT (Alanine Aminotransferase) AST (Aspartate Aminotransferase) Albumin Total Protein Bilirubin (Total) ApoB (Apolipoprotein B) Total Cholesterol LDL Cholesterol HDL Cholesterol Triglycerides Lipoprotein(a) Urea (BUN) Creatinine eGFR (Estimated Glomerular Filtration Rate) Calcium Bicarbonate Chloride Sodium Potassium Magnesium Cortisol DHEA-S Estradiol (E2) FSH (Follicle Stimulating Hormone) LH (Luteinizing Hormone) SHBG (Sex Hormone Binding Globulin) Total Testosterone Free Testosterone TSH (Thyroid Stimulating Hormone) Glucose (Fasting) HbA1c (Glycated Hemoglobin) Insulin (Fasting) HOMA-IR CRP (C-Reactive Protein) Homocysteine Ferritin Iron (Serum) Transferrin Transferrin Saturation Vitamin D (25-OH) PSA (Prostate-Specific Antigen) Prolactin Leptin Uric Acid Zinc Bilirubin (Direct) Bilirubin (Indirect) Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€659,-

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Medical standards

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Medical policy
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Bilirubin (Total)

€7,-