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Test ID: BFBL Bilirubin, Body Fluid

Reporting Name

Bilirubin, BF

Useful For

Evaluation of 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

Specimen Type

Body Fluid

Advisory Information

For bilirubin testing on amniotic fluid specimens, order AFBIL / Bilirubin, Amniotic Fluid. Testing will be changed to AFBIL if this test is ordered on amniotic fluid specimens.


For bilirubin testing on urine specimens, order UBILU / 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.

Specimen Required

Supplies: Amber Frosted Tube, 5 mL (T192)

Preferred Source:

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

-Pleural fluid (pleural, chest, thoracentesis)

-Drain fluid (drainage, 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

0.5 mL

Specimen Stability Information

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

Reference Values

An interpretive report will be provided.

Day(s) and Time(s) Performed

Monday through Sunday; Continuously

Test Classification

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 U.S. Food and Drug Administration.

CPT Code Information


LOINC Code Information

Test ID Test Order Name Order LOINC Value
BFBL Bilirubin, BF 1974-5


Result ID Test Result Name Result LOINC Value
BRNBF Bilirubin (BF) 1974-5
FLD14 Fluid Type: 14725-6

Clinical Information

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) and/or 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 or 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.


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.

Clinical Reference

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

Analytic Time

Same day/1 day

Method Name

Photometric, Diazonium Salt

Mayo Clinic Laboratories | Gastroenterology Catalog Additional Information: