Indirect-to-Direct Bilirubin Ratio (I/D)

Clinicians consider this ratio when bilirubin is elevated or borderline to clarify the pattern. It helps suggest whether the change occurs before or after the liver processes bilirubin. This context can guide next steps, like checking liver enzymes, hemolysis markers, or imaging if needed. You can test this marker with Aniva across Germany and Finland.

Clinicians consider this ratio when bilirubin is elevated or borderline to clarify the pattern. It helps suggest whether the change occurs before or after the liver processes bilirubin. This context can guide next steps, like checking liver enzymes, hemolysis markers, or imaging if needed. You can test this marker with Aniva across Germany and Finland.

High: Proportionally more indirect bilirubin. May be seen with fasting, hemolysis, or slower conjugation (such as Gilbert syndrome).
Low: Proportionally more direct bilirubin. May accompany cholestasis, bile duct blockage, or some liver cell injury. Review trends with other liver tests to narrow the cause. This ratio is not guideline-endorsed; no standardized cutoffs.

Common factors such as recent fasting, dehydration, strenuous exercise, alcohol, and acute illness can shift the ratio. Some medicines (for example, rifampin, atazanavir, probenecid, and hormonal contraceptives) may change bilirubin handling. Sample handling matters: bright light can lower measured bilirubin, and hemolysis can affect results. Testing at a consistent time of day helps reduce normal variation.

Special situations (when to confirm or adjust): pregnancy, suspected Gilbert syndrome, or testing soon after an illness or new medication may warrant repeat testing or tailored interpretation.