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Liver

Direct bilirubin: bile ducts, dark urine and pale stool

According to MedlinePlus, a healthy liver removes most of the bilirubin through the bile ducts, the tubes that carry bile from the liver. Bilirubin is a yellow waste product of broken-down old red blood cells, and the part the liver has already processed is called direct bilirubin.

According to MedlinePlus, if the bile ducts are blocked, bilirubin can leak out of the liver into the blood, and according to the Cleveland Clinic direct bilirubin can rise when the body cannot clear the processed bilirubin. A blood test is the only way to know the value.

Star-SHL uses 0 to 5 µmol/l for direct bilirubin, with the package insert of the Siemens Atellica CH system as its source.

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

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.

Male Your group
umol/l
Normal < 5 High
Female Your group
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

Direct bilirubin counts only the processed bilirubin, in µmol/l, while total bilirubin counts the direct and the indirect form together.

Bilirubin (Direct): why this value matters

Direct bilirubin matters because, according to MedlinePlus, the bilirubin test can help find a blockage in the bile ducts.

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
GLP-1 Baseline Panel · €214,-
Where
650+ draw sites run by independent laboratories across the Netherlands. Draw sites

Bilirubin (Direct): when is testing worthwhile?

According to MedlinePlus, dark urine and clay-coloured stool are symptoms for which a bilirubin test may be ordered, as are jaundice and stomach pain.

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

Low Levels

A direct bilirubin that is too low goes undiscussed by the Cleveland Clinic and MedlinePlus; both cover a low bilirubin only in general. According to the Cleveland Clinic, sleeping pills and other medicines can lower bilirubin as a whole, and according to that source this is usually not a cause for concern.

High Levels

According to the Cleveland Clinic, cholangitis, an inflammation of the bile ducts, is one of the biliary diseases that a raised direct bilirubin might point to, alongside gallstones and an inflamed gallbladder (cholecystitis). According to that source, high bilirubin in the blood can leak into the urine and make it darker, and if less bilirubin reaches the stool than it should, the stool might turn lighter or clay-coloured.

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

A raised direct bilirubin is a reason to talk to your GP; according to the Cleveland Clinic, treating the cause effectively brings bilirubin down.

Bilirubin (Direct): frequently asked questions

Why can urine turn dark with high bilirubin?

Urine can turn dark because, according to the Cleveland Clinic, high bilirubin in the blood can leak into the urine.

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.

GLP-1

GLP-1 Baseline Panel

Your starting point before the first injection: blood sugar, cholesterol, pancreas, liver, kidneys, thyroid and nutrients in one measurement.

Insulin (Fasting) ALT (Alanine Aminotransferase) TSH (Thyroid Stimulating Hormone) AST (Aspartate Aminotransferase) HDL Cholesterol HbA1c (Glycated Hemoglobin) Bilirubin (Total) ApoB (Apolipoprotein B) Vitamin B12 Ferritin Potassium Sodium Glucose (Fasting) Total Cholesterol Albumin Lipase Creatinine Vitamin D (25-OH) Triglycerides Bilirubin (Direct) Bilirubin (Indirect) HOMA-IR eGFR (Estimated Glomerular Filtration Rate) LDL Cholesterol Cholesterol/HDL Ratio Non-HDL Cholesterol LDL/HDL Ratio
€214,-

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,-