Bilirubin (Indirect)

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Indirect (unconjugated) bilirubin is the form of bilirubin circulating in the blood before the liver has processed it. It is bound to albumin for transport and is not water-soluble. This is the form that accumulates in Gilbert syndrome and hemolytic conditions.

Why it matters: Elevated indirect bilirubin usually points to either increased red blood cell breakdown (hemolysis) or impaired liver uptake/conjugation. Gilbert syndrome, the most common cause, is benign and affects up to 10% of the population. Less commonly, elevated indirect bilirubin can indicate hemolytic anemia or ineffective red blood cell production.

Reference Range
< 19.0umol/L
19NormalHigh
Symptoms of Low Bilirubin (Indirect)
Not a concern
Symptoms of High Bilirubin (Indirect)
Mild yellowing of skin (often comes and goes)
Fatigue during episodes
May worsen with fasting or stress
What Moves It

May increase with:

Hemolytic anemia
Gilberts syndrome
Ineffective erythropoiesis

May decrease with:

Rare
Associated Conditions
Hemolytic anemiaGilberts syndromeNeonatal jaundice
Related Markers
Bilirubin (Total)Bilirubin (Direct)reticulocytes
Common questions

What is Bilirubin (Indirect)?

Indirect (unconjugated) bilirubin is the form of bilirubin circulating in the blood before the liver has processed it. It is bound to albumin for transport and is not water-soluble. This is the form that accumulates in Gilbert syndrome and hemolytic conditions.

What might a high or low Bilirubin (Indirect) mean?

Elevated indirect bilirubin usually points to either increased red blood cell breakdown (hemolysis) or impaired liver uptake/conjugation. Gilbert syndrome, the most common cause, is benign and affects up to 10% of the population. Less commonly, elevated indirect bilirubin can indicate hemolytic anemia or ineffective red blood cell production.

What is the typical reference range for Bilirubin (Indirect)?

The general-population reference range shown here is < 19 umol/L. Reference ranges describe the general population and are not a personal target — discuss your results with your physician.

What can affect Bilirubin (Indirect)?

It may be higher with: Hemolytic anemia, Gilberts syndrome, Ineffective erythropoiesis. It may be lower with: Rare.

More in Liver
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