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Liver

Total bilirubin in men older than 18: 24 µmol/l at Star-SHL and Certe, and what a rise means

Bilirubin is a substance that according to the NVKC, the Dutch society of clinical chemists, is formed when red blood cells are broken down. According to the NVKC, the liver converts bilirubin into a conjugated form, which leaves the body through the gut and the stools. Without that conversion, the body cannot get rid of bilirubin, according to MedlinePlus Genetics.

According to the NVKC, an inflammation of the liver, damage to the liver tissue, long-term alcohol use or a blocked bile duct can give a raised bilirubin. Too much bilirubin can cause jaundice, yellow skin or yellow whites of the eyes. Only a blood test shows whether bilirubin is raised.

Certe uses an upper limit of 24 µmol/l for men older than 18, against 19 µmol/l for women older than 18. The NVKC notes that men have slightly higher bilirubin than women.

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
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
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
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

According to the NVKC, a bilirubin test determines the total amount of bilirubin in the blood, expressed in micromoles per litre (µmol/l). According to the NVKC, that result depends strongly on the measuring method, which is why reference values vary between laboratories: Certe and Star-SHL give 24 µmol/l as the upper limit for men older than 18, Unilabs 20 µmol/l for everyone from one month to 115 years and Diagnostiek voor U 20 µmol/l for everyone older than 5 days.

Certe names the NUMBER study in Clin Chem Lab Med from 2019 as the source of its adult values, and Star-SHL refers to the same journal article.

Bilirubin (Total): why this value matters

According to the BSG, total bilirubin is one of the tests of liver function, alongside albumin among others. According to the BSG, liver disease develops silently, and there may be no symptoms until complications develop; at that late stage, the tests of liver function may be abnormal, according to the BSG.

According to the NVKC, bilirubin is also requested when a doctor suspects liver problems from heavy alcohol use. According to the NVKC, long-term alcohol use is on the list of causes of a raised bilirubin in adults.

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

Bilirubin (Total): when is testing worthwhile?

For the first tests for a possible liver disease, the BSG advises measuring bilirubin together with albumin, ALT, alkaline phosphatase and GGT. According to the NVKC, a doctor usually requests bilirubin for signs of liver problems, such as yellow skin or yellow whites of the eyes, or when liver damage from alcohol is suspected.

According to MedlinePlus, fasting, not eating or drinking for several hours, can be a condition the doctor sets for the bilirubin test.

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

Low Levels

According to MedlinePlus, a low bilirubin level is usually not a cause for concern; MedlinePlus names medicines such as antibiotics, sleeping pills and medicines for seizures as a possible cause. Star-SHL uses a lower limit of 4 µmol/l for men older than 18, and Certe gives only an upper limit.

High Levels

According to the NVKC, a raised bilirubin in adults fits among other things an inflammation of the liver, liver cancer, damage to the liver tissue, gallstones or bile duct tumours, pancreatic cancer, breakdown of red blood cells, long-term alcohol use and poisoning by medicines. According to the NVKC, Gilbert's syndrome also gives raised levels.

According to the NVKC, yellow skin or yellow whites of the eyes point to jaundice, which comes from an increased amount of bilirubin due to abnormalities in the liver or the bile drainage.

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

What lowers the value

  • Certain medicines

    A low bilirubin is usually not a cause for concern, but may be due to medicines such as antibiotics, birth control pills, sleeping pills and medicines for seizures.

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

With a raised bilirubin level, the GP is the first step. When liver disease or a red blood cell disorder is suspected, more tests may be needed according to MedlinePlus, including an ultrasound or a liver biopsy, the examination of a piece of liver tissue under a microscope.

Bilirubin (Total): frequently asked questions

Is bilirubin higher in men than in women?

Yes, according to the NVKC bilirubin is slightly higher in men than in women. Star-SHL and Certe use an upper limit of 24 µmol/l for men older than 18 and 19 µmol/l for women older than 18.

Can alcohol raise bilirubin?

Yes, according to the NVKC long-term alcohol use is on the list of causes of a raised bilirubin in children and adults. According to the NVKC, a doctor also requests the bilirubin test when liver problems from heavy alcohol use are suspected.

Does liver disease always give a raised bilirubin?

Not always: according to the BSG, liver disease develops silently, possibly without symptoms until complications develop, and at that late stage the tests of liver function, including bilirubin, may be abnormal.

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. MedlinePlus, Bilirubin Blood Test, U.S. National Library of Medicine, geraadpleegd 2026-10-13 (retrieved 2026) medlineplus.gov
  7. 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
  8. NVKC, Alles over testen: Bilirubine, allesovertesten.nl, geraadpleegd 2026-10-13 (retrieved 2026) allesovertesten.nl

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)
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Bilirubin (Total)

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