Bilirubin metabolism begins with the breakdown of red blood cells in many parts of the body. Heme is converted to bilirubin, which is then carried by albumin in the blood to the liver, where it gets chemically attached to uridine diphosphoglucuronic acid forming conjugated bilirubin (direct bilirubin). Direct bilirubin eventually gets secreted actively into the bile ducts. The main physiologic role of bilirubin is to act as a cellular antioxidant. This test is used to diagnose and/or monitor liver disease, such as cirrhosis, hepatitis, or gallstones. INCREASED direct bilirubin may indicate bile duct obstruction, cirrhosis, Dubin-Johnson syndrome, hepatitis, intrahepatic cholestasis, or long-term alcohol abuse. See also Bilirubin, Total, Serum
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