Davis's Lab & Diagnostic Tests
Bilirubin and Bilirubin Fractions
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Synonym/Acronym:
Conjugated/direct bilirubin, unconjugated/indirect bilirubin, delta bilirubin, TBil.
Rationale
A multipurpose laboratory test that acts as an indicator for various diseases of the liver, for disease that affects the liver, or for conditions associated with red blood cell (RBC) hemolysis.
Patient Preparation
There are no food, fluid, activity, or medication restrictions unless by medical direction.
Normal Findings
(Method: Spectrophotometry) Total bilirubin levels in infants should decrease to adult levels by day 10 as the development of the hepatic circulatory system matures. Values in breastfed infants may take longer to reach normal adult levels. Values in premature infants may initially be higher than in full-term infants and also take longer to decrease to normal levels.
| Age | Conventional Units | SI Units (Conventional Units × 17.1) |
|---|---|---|
| Total bilirubin | ||
| Newborn–1 d | Less than 5.8 mg/dL | Less than 99 micromol/L |
| 1–2 d | Less than 8.2 mg/dL | Less than 140 micromol/L |
| 3–5 d | Less than 11.7 mg/dL | Less than 200 micromol/L |
| 6–7 d | Less than 8.4 mg/dL | Less than 144 micromol/L |
| 8–9 d | Less than 6.5 mg/dL | Less than 111 micromol/L |
| 10–11 d | Less than 4.6 mg/dL | Less than 79 micromol/L |
| 12–13 d | Less than 2.7 mg/dL | Less than 46 micromol/L |
| 14–30 d | Less than 0.8 mg/dL | Less than 14 micromol/L |
| 1 mo–older adult | Less than 1.2 mg/dL | Less than 21 micromol/L |
| Unconjugated bilirubin | Less than 1.1 mg/dL | Less than 19 micromol/L |
| Conjugated bilirubin | ||
| Neonate | Less than 0.6 mg/dL | Less than 10 micromol/L |
| 29 d–older adult | Less than 0.3 mg/dL | Less than 5 micromol/L |
| Delta bilirubin | Less than 0.2 mg/dL | Less than 3 micromol/L |
Critical Findings and Potential Interventions
Adults and Children (TBil)
- Greater than 15 mg/dL (SI: Greater than 257 micromol/L)
Newborns (TBil)
- Greater than 13 mg/dL (SI: Greater than 222 micromol/L)
Timely notification to the requesting health-care provider (HCP) of any critical findings and related symptoms is a role expectation of the professional nurse. A listing of these findings varies among facilities.
Consideration may be given to verification of critical findings before action is taken. Policies vary among facilities and may include requesting recollection and retesting by the laboratory.
Sustained hyperbilirubinemia can result in brain damage. Kernicterus refers to the deposition of bilirubin in the basal ganglia and brainstem nuclei. There is no exact level of bilirubin that puts infants at risk for developing kernicterus. Symptoms of kernicterus in infants include lethargy, poor feeding, upward deviation of the eyes, and seizures. Intervention for infants may include early frequent feedings to stimulate gastrointestinal (GI) motility, phototherapy, and exchange transfusion.
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Synonym/Acronym:
Conjugated/direct bilirubin, unconjugated/indirect bilirubin, delta bilirubin, TBil.
Rationale
A multipurpose laboratory test that acts as an indicator for various diseases of the liver, for disease that affects the liver, or for conditions associated with red blood cell (RBC) hemolysis.
Patient Preparation
There are no food, fluid, activity, or medication restrictions unless by medical direction.
Normal Findings
(Method: Spectrophotometry) Total bilirubin levels in infants should decrease to adult levels by day 10 as the development of the hepatic circulatory system matures. Values in breastfed infants may take longer to reach normal adult levels. Values in premature infants may initially be higher than in full-term infants and also take longer to decrease to normal levels.
| Age | Conventional Units | SI Units (Conventional Units × 17.1) |
|---|---|---|
| Total bilirubin | ||
| Newborn–1 d | Less than 5.8 mg/dL | Less than 99 micromol/L |
| 1–2 d | Less than 8.2 mg/dL | Less than 140 micromol/L |
| 3–5 d | Less than 11.7 mg/dL | Less than 200 micromol/L |
| 6–7 d | Less than 8.4 mg/dL | Less than 144 micromol/L |
| 8–9 d | Less than 6.5 mg/dL | Less than 111 micromol/L |
| 10–11 d | Less than 4.6 mg/dL | Less than 79 micromol/L |
| 12–13 d | Less than 2.7 mg/dL | Less than 46 micromol/L |
| 14–30 d | Less than 0.8 mg/dL | Less than 14 micromol/L |
| 1 mo–older adult | Less than 1.2 mg/dL | Less than 21 micromol/L |
| Unconjugated bilirubin | Less than 1.1 mg/dL | Less than 19 micromol/L |
| Conjugated bilirubin | ||
| Neonate | Less than 0.6 mg/dL | Less than 10 micromol/L |
| 29 d–older adult | Less than 0.3 mg/dL | Less than 5 micromol/L |
| Delta bilirubin | Less than 0.2 mg/dL | Less than 3 micromol/L |
Critical Findings and Potential Interventions
Adults and Children (TBil)
- Greater than 15 mg/dL (SI: Greater than 257 micromol/L)
Newborns (TBil)
- Greater than 13 mg/dL (SI: Greater than 222 micromol/L)
Timely notification to the requesting health-care provider (HCP) of any critical findings and related symptoms is a role expectation of the professional nurse. A listing of these findings varies among facilities.
Consideration may be given to verification of critical findings before action is taken. Policies vary among facilities and may include requesting recollection and retesting by the laboratory.
Sustained hyperbilirubinemia can result in brain damage. Kernicterus refers to the deposition of bilirubin in the basal ganglia and brainstem nuclei. There is no exact level of bilirubin that puts infants at risk for developing kernicterus. Symptoms of kernicterus in infants include lethargy, poor feeding, upward deviation of the eyes, and seizures. Intervention for infants may include early frequent feedings to stimulate gastrointestinal (GI) motility, phototherapy, and exchange transfusion.
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