Author
Bowtie Team
Updated on
2026-01-08
Disclaimer: This article is translated with the assistance of AI.
Bilirubin is a metabolite of red blood cells that reflects liver function and indicates blood problems. Bowtie details normal total bilirubin values, how to interpret them, and lists related test costs at private hospitals and clinics.
What is Bilirubin?
Total bilirubin 2 is a type of bile pigment, a metabolite from the breakdown of red blood cells, formed by direct bilirubin (conjugated bilirubin) and indirect bilirubin (unconjugated bilirubin). Bilirubin is the main pigment in bile, appearing orange-yellow in color. The liver absorbs bilirubin from the blood and breaks it down, with most bilirubin eventually excreted in the form of bile through feces.
What are Direct and Indirect Bilirubin?
Direct bilirubin is a product formed when bilirubin undergoes chemical processes in the liver, which is then excreted through the intestines and out of the body via feces; indirect bilirubin reaches the liver through the blood and is produced from the breakdown of red blood cells 2 .
Direct bilirubin and indirect bilirubin make up approximately 20% and more than 75% of total bilirubin, respectively. The normal values for direct and indirect bilirubin in adults or children are as follows 1 :
| Bilirubin | Normal Values |
| Direct Bilirubin | 0.1-0.3 mg/dL or 1.7-5.1 μmol/L (SI units) |
| Indirect Bilirubin | 0.2-0.8 mg/dL or 3.4-12.0 μmol/L (SI units) |
What is the Role of Total Bilirubin?
Total bilirubin is a waste product generated when the liver absorbs bilirubin from the blood and breaks it down chemically, making it an indicator of liver function to check for any damage. Abnormal bilirubin levels indicate that the liver cannot properly break down waste or remove bilirubin from the blood.
What is the Normal Value of Total Bilirubin?
The normal value of total bilirubin differs between newborns and adults or children 1 :
| Normal Total Bilirubin Values | |
| Adults/Children | 0.3-1.0 mg/dL or 5.1-17 μmol/L (SI units) |
| Newborns | 1.0-12.0 mg/dL or 17.1-205 μmol/L (SI units) |
What Symptoms Occur When Total Bilirubin is Too High?
Abnormal bilirubin levels indicate not only liver dysfunction that prevents proper waste breakdown and removal of bilirubin from the blood, but also issues with red blood cell breakdown at an abnormal rate and problems in the bile ducts 3 .
Symptoms of excessively high total bilirubin levels include 4 :
- Jaundice (skin and whites of the eyes turn yellow)
- Darker urine color
- Lighter or grayish-black stool color
- Itchy skin
What Diseases Can High Total Bilirubin Lead To?
High total bilirubin can lead to the following diseases 4 :
- Hemolysis
- Sickle cell disease
- Liver cirrhosis
- Hepatitis
- Liver cancer
- Gallbladder or bile duct obstruction
- Bile duct stones , tumors, or cholangitis
What Are the Effects of Low Total Bilirubin on the Body?
Low total bilirubin levels may indicate the following issues in the body 2 :
- Certain medications (penicillins, non-steroidal anti-inflammatory drugs – NSAIDs) or caffeine influence
- Autoimmune diseases, such as rheumatoid arthritis, lupus, polymyositis, primary Sjögren’s syndrome (dry syndrome)
- Cardiovascular diseases
What Diseases Can Low Total Bilirubin Lead To?
Low total bilirubin generally does not cause serious negative effects on the body, but studies show low total bilirubin is associated with the following diseases 5 :
- Cardiovascular diseases
- Stroke
- Fatty liver
- Obesity
- Type 2 diabetes
How to Check if Total Bilirubin is Normal?
Total bilirubin can be measured through urine or blood tests. Doctors generally opt for blood tests to check total bilirubin. Since bilirubin is one of the indicators in liver function tests, a comprehensive liver function check can examine various indicators, including bilirubin , to determine if liver function is at normal levels 3 .
Total Bilirubin Related Test Costs
Private Hospitals
The following table lists the fees for liver function tests or total bilirubin related examinations at various private hospitals:
| Private Hospital | Examination Item | Fees |
| Hong Kong Sanatorium & Hospital | Total and Direct Bilirubin | HK$260 – HK$950 |
| Canossa Hospital | Liver Function Tests | HK$1030 – HK$1,745 |
| Gleneagles Hong Kong Hospital | Liver Function Tests | HK$730 – HK$1820 |
| Hong Kong Adventist Hospital | Liver Function Tests | HK$575 – HK$1,765 |
| St. Paul’s Hospital | Liver Function Tests | HK$640 – HK$925 |
| Evangel Hospital | Liver Function Tests | HK$625 – HK$1,050 |
| Hong Kong Baptist Hospital | Total Bilirubin | HK$210 – HK$336 |
| Caritas Medical Centre | Liver Function Tests | HK$590 – HK$885 |
| St. Teresa’s Hospital | Liver Function Tests | HK$470 – HK1,040 |
| Union Hospital | Liver Function Tests | HK$750 |
| Hong Kong Adventist Hospital – Tsuen Wan | Liver Function Tests | HK$705 – HK$1,558 |
| The Chinese University of Hong Kong Medical Centre | Liver Function Tests | HK$630 – HK$790 |
Private Clinics
The following table lists the fees for liver function tests at various private clinics:
| Private Clinic | Examination Item | Fees |
| Bowtie & JP Health | Liver Function Tests | HK$220 |
| APROMED Endoscopy Centre | Liver Function Tests | HK$200 |
| Hong Kong Federation of Trade Unions Workers’ Medical Clinics | Liver Function Tests | HK$540 (Non-members) |
| Silver Cross Medical Group | Liver Function Tests | HK$400 |
| Hong Kong International Professional Health Check Association (HKIPHC) | Liver Function Tests | HK$400 |
| Precision Medical & Health Check Centre | Liver Function Tests | HK$160 |
Book Liver Function Check Service Now!
Bowtie & JP Health Health Center provides comprehensive medical services, including physical examinations and liver function checks. If you plan to book a physical examination or liver function check at Bowtie & JP Health Health Center , you can call 3169 2269, or Book Clinic Services !
How to Lower Total Bilirubin?
We can lower total bilirubin 6 by improving daily life and dietary habits:
- Drink enough water
- Eat a variety of vegetables and fruits
- Eat high-fiber foods, such as oatmeal, broccoli, chickpeas, berries, and almonds
- Avoid high-fat proteins; opt for skinless chicken breast, fish, or eggs instead
- Quit alcohol
- Reduce sugar intake
- Avoid high-salt foods to reduce sodium intake
Total Bilirubin Related Common Questions
Does elevated total bilirubin always mean there’s a liver problem?
Elevated total bilirubin levels do not necessarily mean there’s a liver problem; it could indicate hemolytic disorders, sickle cell disease, or medication effects.
How to interpret the ratio of direct and indirect bilirubin?
An elevated ratio of direct to indirect bilirubin indicates different issues; a high direct bilirubin ratio suggests the liver is not clearing bilirubin properly, implying liver damage or disease, while a high indirect bilirubin ratio may indicate other problems, such as hemolytic disorders or anemia .
Sources
- 1 Wehbi, Mohammad , et al. “Bilirubin.” Medscape, 18 Nov. 2019
- 2 Sheikh, Zilpah . “Bilirubin Test: What You Need to Know.” WedMD, 26 Sept. 2023,
- 3 Pruthi, Sandhya . “Bilirubin Test.” Mayoclinic
- 4 “Bilirubin Test.” Cleveland clinic, 1 Sept. 2023
- 5 Giorgi , Anna . “I Have Low Bilirubin: What Does This Mean?” Verywellhealth, 18 Dec. 2023
- 6 Dylan, Bailey. “Diet for Jaundice: What Should I Add or Remove?” Healthline, 14 Nov. 2023
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