Test Catalog

Test Id : BFBL

Bilirubin, Body Fluid

Useful For
Suggests clinical disorders or settings where the test may be helpful

Evaluating peritoneal fluid or abdominal drain fluid as a screening test for bile leakage


May aid in the distinction between a transudative and an exudative pleural effusion

Method Name
A short description of the method used to perform the test

Photometric, Diazonium Salt

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.


Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Bilirubin, BF

Specimen Type
Describes the specimen type validated for testing

Body Fluid

Ordering Guidance

For bilirubin testing on urine specimens, order BILUR / Bilirubin, Random, Urine. Testing will be changed to UBILU if this test is ordered on urine specimens.

Shipping Instructions

Ship specimen in amber vial to protect from light.

Necessary Information

1. Date and time of collection are required.

2. Specimen source is required.


Question ID Description Answers
FLD14 Fluid Type:

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Supplies: Amber Frosted Tube, 5 mL (T915)

Preferred Source:

-Peritoneal fluid (peritoneal, abdominal, ascites, paracentesis)

-Pleural fluid (pleural, chest, thoracentesis)

-Drain fluid (drainage, Jackson Pratt [JP] drain)

-Pericardial fluid

Acceptable Source: Write in source name with source location (if appropriate)

Collection Container/Tube: Sterile container

Submission Container/Tube: Opaque, amber vial

Specimen Volume: 1 mL

Collection Instructions:

1. Centrifuge to remove any cellular material and transfer into an amber vial to protect from light.

2. Indicate the specimen source and source location on label.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

0.5 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis Reject
Gross lipemia Reject
Gross icterus OK
Anticoagulant or additive
Amniotic fluid
Breast milk
Cerebrospinal fluid
Bronchoalveolar lavage (BAL)
Bronchial washings
Gastric secretions
Nasal secretions
Vitreous fluid
Synovial fluid

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Body Fluid Frozen (preferred) 70 days LIGHT PROTECTED
Refrigerated 14 days LIGHT PROTECTED

Useful For
Suggests clinical disorders or settings where the test may be helpful

Evaluating peritoneal fluid or abdominal drain fluid as a screening test for bile leakage


May aid in the distinction between a transudative and an exudative pleural effusion

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Peritoneal fluid:

Bilirubin is typically measured in peritoneal fluid of patients with suspected bile duct leak or gallbladder perforation as a screening test prior to imaging or cholescintigraphy. If the value is higher than that of serum and is greater than 6 mg/dL, and the ascitic fluid amylase is not elevated (indicating upper intestinal perforation), it can be assumed that the gallbladder has perforated into the peritoneum (choleperitoneum) or either bowel or biliary perforation has occurred.(1) Furthermore, biliary leakage after laparoscopic cholecystectomy is the most common post-operative complication.(2) While endoscopy is a beneficial first-line treatment for the management of bile leaks there often are logistical issues which hinder the procedure from being performed rapidly. Post-cholecystectomy patients generally have a drain in place (particularly a Jackson Pratt [JP] drain) and may undergo bilirubin testing on the drain fluid as an objective assessment of a bile leak. A body fluid/serum bilirubin ratio of greater than 5 in a JP drain fluid is highly sensitive and specific for bile leak.(3)


Pleural fluid:

Measurement of bilirubin in pleural fluid has been investigated to aid in the differentiation of transudative and exudative effusions in pursuit of more specific biomarkers than traditional light criteria measuring total protein and lactate dehydrogenase. Bilirubin values tend to be higher in exudates than in transudates, although there is some overlap between groups which limits the usefulness of its measure.(4)


Other fluids:

Determination of body fluid bilirubin concentration can aid in the distinction between a transudative and an exudative fluid or identify the presence of bile in other fluid compartments.

Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

An interpretive report will be provided.

Provides information to assist in interpretation of the test results

Bilirubin may be measured in other fluids although the decision limits are not well defined in fluids other than pleural fluid. Fluid to serum bilirubin ratios are expected to be less than or equal to 1.0 and should be interpreted in conjunction with other clinical findings.

Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Bilirubin is photosensitive. Failure to protect from light may cause decreased results.


In very rare cases, gammopathy, in particular type IgM (Waldenstrom macroglobulinemia), may cause unreliable results.


Cyanokit (Hydroxocobalamin) may cause false low results.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Runyon BA: Ascitic fluid bilirubin concentration as a key to choleperitoneum. J Clin Gastroenterol. 1987 Oct;9(5):543-545

2. Koch M, Garden OJ, Padbury R, et al: Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 2011. May;149(5):680-688. doi: 10.1016/j.surg.2010.12.002

3. Darwin P, Goldberg E, Uradomo L: Jackson Pratt drain fluid-to-serum bilirubin concentration ratio for the diagnosis of bile leaks. Gastrointest Endosc. 2010 Jan;71(1):99-104. doi: 10.1016/j.gie.2009.08.015

4. Metintas M, Alatas O, Alatas F, Colak O, Ozdemir N, Erginel S: Comparative analysis of biochemical parameters for differentiation of pleural exudates from transudates Light's criteria, cholesterol, bilirubin, albumin gradient, alkaline phosphatase, creatine kinase, and uric acid. Clin Chim Acta. 1997 Aug 29;264(2):149-162. doi: 10.1016/s0009-8981(97)00091-0

Method Description
Describes how the test is performed and provides a method-specific reference

Total bilirubin, in the presence of a suitable solubilizing agent, is coupled with 3,5-dichlorophenyl diazonium in a strongly acidic medium to produce azobilirubin. The intensity of the color of the azobilirubin produced is proportional to the total bilirubin concentration and is measured at 546/600 nm.(Package insert: Bilirubin Total Gen. 3. Roche Diagnostics; V9.0. 01/2020)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information


Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Sunday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

Same day/1 to 2 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

1 week

Performing Laboratory Location
Indicates the location of the laboratory that performs the test


Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their account representative. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test has been modified from the manufacturer's instructions. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.


LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
BFBL Bilirubin, BF 1974-5
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
FLD14 Fluid Type: 14725-6
BRNBF Bilirubin (BF) 1974-5

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | PHP Pdf | CMS Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports