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Liver

Direct bilirubin: the gallbladder, gallstones and what the value says

According to the Cleveland Clinic, bile is the fluid in which the liver gets rid of bilirubin, a yellow waste product of the breakdown of old red blood cells; bilirubin gives bile its yellow colour and also colours the stool. The bilirubin the liver has already processed and readied for the bile is called direct bilirubin.

According to the Cleveland Clinic, when the outflow of bile stalls, for example from gallstones or an inflamed gallbladder, direct bilirubin can rise. According to the Cleveland Clinic, high bilirubin is not always visible, so the value only shows in a blood test.

Star-SHL uses 0 to 5 µmol/l for direct bilirubin.

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

Female
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 measurement gives in µmol/l the amount of bilirubin the liver has already processed; Star-SHL measures it in serum under the code DBIL.

Bilirubin (Direct): why this value matters

According to the Cleveland Clinic, direct bilirubin can be higher when the body has trouble clearing the processed bilirubin, which is why it matters with complaints of the gallbladder and 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
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, a bilirubin test may be done to find a blockage of the bile ducts, and with stomach pain, dark urine or clay-coloured stool.

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

Low Levels

The sources read do not name a low direct bilirubin; according to the Cleveland Clinic, birth control pills can lower bilirubin in general, and according to that source low levels are usually not a cause for concern.

High Levels

According to the Cleveland Clinic, gallstones, an inflamed gallbladder (cholecystitis) and inflamed bile ducts (cholangitis) are conditions a high direct bilirubin might indicate. According to the Cleveland Clinic, when bilirubin does not reach the stool properly, the stool can become 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

With a raised direct bilirubin, see your GP; the Cleveland Clinic says the value falls once the cause is effectively treated.

Bilirubin (Direct): frequently asked questions

Can gallstones raise direct bilirubin?

According to the Cleveland Clinic, gallstones can raise direct bilirubin, because the body then has trouble clearing the processed bilirubin.

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

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Test Products

This marker is included in the following test panels.

Metabolism

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 (Direct)

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