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Liver

Direct bilirubin: liver disease, hepatitis and the value

According to the Cleveland Clinic, red blood cells at the end of their life are broken down, and the yellow waste product released, bilirubin, is processed in the liver. What the liver has already processed is called direct bilirubin.

According to MedlinePlus, liver damage or blocked bile ducts can let bilirubin escape from the liver into the blood. According to the Cleveland Clinic, high bilirubin cannot always be seen from the outside, so only a blood test gives the value.

Certe uses less than 5 µmol/l for direct bilirubin above the age of 14 days.

Doctor's Assessment Included

Direct bilirubin is the bilirubin the liver has already processed and readied for the bile. According to the Cleveland Clinic, a rise might indicate gallstones or a biliary disease.

  • For direct bilirubin, Star-SHL uses 0 to 5 µmol/l, Unilabs 0 to 4 µmol/l, Certe less than 5 µmol/l above the age of 14 days and Diagnostiek voor U less than 3.4 µmol/l.
  • According to the Cleveland Clinic, conditions that affect processing in the liver raise both direct and indirect bilirubin.
  • According to the Cleveland Clinic, high bilirubin can exist without visible jaundice.

Reference Ranges

Male
umol/l
Normal < 5 High

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 (Direct): what Dutch laboratories use

The upper limit runs from 3.4 umol/l at Diagnostiek voor U to 5 umol/l at Star-shl.

Reference ranges by group, in umol/l
Star-shl · Everyone 0–5 umol/l
0 5
Unilabs · Everyone 0–4 µmol/l
0 4
Certe · Everyone · 0 years and older · a limit, not a range < 5 umol/L
5
Diagnostiek voor U · Everyone · a limit, not a range < 3.4 µmol/L
3.4
0 5.5 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 (Direct): what this test measures

A direct bilirubin test measures in µmol/l the bilirubin the liver has processed; Certe names the reference work Tietz as its source for adults.

Bilirubin (Direct): why this value matters

According to MedlinePlus, a provider may order a bilirubin test to monitor an existing liver disease, and direct bilirubin is the part of that bilirubin the liver has already processed.

Bilirubin (Direct): 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
Complete Metabolic Panel · €149,-
Where
650+ draw sites run by independent laboratories across the Netherlands. Draw sites

Bilirubin (Direct): when is testing worthwhile?

According to MedlinePlus, jaundice, which could indicate hepatitis, cirrhosis or another liver disease, is a reason a provider may order a bilirubin test.

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

Low Levels

The sources read give no meaning of their own for a low direct bilirubin; according to the Cleveland Clinic, some medicines, including antibiotics and seizure medications, can lower bilirubin in general.

High Levels

Viral hepatitis, cirrhosis and chronic liver failure are among the Cleveland Clinic's causes of high bilirubin, and according to that source conditions that affect processing in the liver raise both forms, including the direct one.

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

What raises the value

  • Gallstones

    Higher direct bilirubin can mean the body is having trouble clearing it, which might indicate gallstones.

  • Inflammation of the gallbladder (cholecystitis)

    Higher direct bilirubin might indicate a biliary disease, such as an inflamed gallbladder.

  • Inflammation of the bile ducts (cholangitis)

    Higher direct bilirubin might indicate a biliary disease, such as inflamed bile ducts.

  • Liver conditions that affect the processing of bilirubin

    Conditions that affect the liver's ability to process bilirubin cause high levels of both types, the direct one included.

Bilirubin (Direct): lifestyle and this value

Have your GP look at a raised direct bilirubin; according to the Cleveland Clinic, avoiding alcohol and drugs and eating a healthy diet can in general reduce the stress on the liver.

Bilirubin (Direct): frequently asked questions

Does a high direct bilirubin point to liver disease?

According to the Cleveland Clinic, a high direct bilirubin can fit a liver condition that hinders the processing of bilirubin, but also gallstones or an inflammation of the bile ducts.

Bilirubin (Direct): sources

  1. Star-shl, Labbepalingen (referentiewaarden per bepaling), star-shl.nl, geraadpleegd 2026-10-01 (retrieved 2026) star-shl.nl
  2. Unilabs, Bepalingenklapper (referentiewaarden per bepaling), bepalingenklapper.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenklapper.nl
  3. Certe, Bepalingenwijzer (referentiewaarden per bepaling), bepalingenwijzer.certe.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenwijzer.certe.nl
  4. Diagnostiek voor U, eLabgids (Referentiewaarden DvU), diagnostiek.getincontrol.eu, geraadpleegd 2026-10-01 (retrieved 2026) diagnostiek.getincontrol.eu
  5. Cleveland Clinic Health Library, Bilirubin Test, my.clevelandclinic.org, geraadpleegd 2026-10-18 (retrieved 2026) my.clevelandclinic.org

Test Products

This marker is included in the following test panels.

Heart and blood vessels

Complete Metabolic Panel

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

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

Medical reviewer

Medical standards

Dr. Naimi oversees the medical standards behind our content and assessments.

Medical policy
CIBG Ministerie van Volksgezondheid,
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Bilirubin (Direct)

€10,-