Bilirubin, Direct

CPT: 82248
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Test Details


Evaluate liver and biliary disease. Increased direct bilirubin occurs with biliary diseases, including both intrahepatic and extrahepatic lesions. Hepatocellular causes of elevation include hepatitis, cirrhosis, and advanced neoplastic states. Increased with cholestatic drug reactions, Dubin-Johnson syndrome, and Rotor syndrome. In the latter two syndromes, the level is usually <5 mg/dL.




Measurement of direct bilirubin is usually not necessary when the total bilirubin is <1.2 mg/dL.

Reference Interval

See table.


Range (mg/dL)

0 to 31 d


Children 1 month and older and adults


Additional Information

Theoretically, direct bilirubin should not be increased in hemolytic anemias, in which bilirubin increase should be in the indirect bilirubin fraction in the absence of complications. In practice, some increase in the direct fraction may be encountered in patients with hemolytic anemia in whom complications have not been proven. Some methods have shown the direct bilirubin to be spuriously high. This may be due to different concentrations of sodium nitrite, which may convert some of the unconjugated bilirubin to conjugated bilirubin.1,2 Direct bilirubin is the water soluble fraction. When increased in serum, bilirubin should become positive in the urine. Physiologic jaundice, occurring two to four days after birth, is due to lack of liver glucuronyl transferase.

Specimen Requirements


Serum (preferred) or plasma


1 mL

Minimum Volume

0.5 mL


Red-top tube, gel-barrier tube, or green-top (lithium heparin) tube


Separate serum or plasma from cells within 45 minutes of collection.

Storage Instructions


Stability Requirements



Room temperature

2 days


3 days


14 days

Freeze/thaw cycles

Stable x3

Causes for Rejection

Gross hemolysis; improper labeling; gross lipemia

Clinical Information


1. Chan KM, Scott MG, Wu TW, et al. Inaccurate values for direct bilirubin with some commonly used direct bilirubin procedures. Clin Chem. 1985 Sep; 31(9):1560-1563. 4028405
2. Mair B, Klempner LB. Abnormally high values for direct bilirubin in the serum of newborns as measured with the DuPont aca®. Am J Clin Pathol. 1987 May; 87(5):642-644. 3578139


Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
001222 Bilirubin, Direct 1968-7 001222 Bilirubin, Direct mg/dL 1968-7

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