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Laboratory: Clinical Biochemistry  (AUTOMATED)
Test Name:
Test Code: BILA
Clinical Information:
Alternate name: Bile Salts, Total
Description: Bile acids are formed in the liver from cholesterol and secreted into the intestines after the ingestion of a meal. Normal, healthy individuals efficiently clear bile acids from the liver, resulting in low fasting levels. Marked elevations in serum bile acids indicates impaired clearance due to liver dysfunction. Total bile acid testing does not assist in determining the etiology of liver disease.
Significant increases in total bile acids in pregnant individuals can aid in the diagnosis and management of Intrahepatic Cholestasis of Pregnancy (ICP). Results should be interpreted alongside serum transaminases (ALT and AST).
In neonates, very low or undetectable serum bile acids in the context of low-GGT cholestasis may indicate the presence of Bile Acid Synthesis Defects (BASD).
The send-out version of the test (ICL) was replaced by an in-house assay at HSC effective Jan 23, 2023. Results from the in-house assay are approximately 5% lower when comparing results to those produced by the previous assay.
Test Indications:
To aid in the diagnosis and management of Intrahepatic Cholestasis of Pregnancy
- To aid in the evaluation of neonatal cholestasis


Patient preparation instructions: This test is NOT recommended for monitoring of total bile acid levels post ursodiol treatment. This assay overestimates total bile acids post ursodiol treatment due to structural similarity of Ursodeoxycholic acid (Ursodiol) to primary bile acids. If levels of bile acids post ursodiol treatment is required please refer to: Bile Acid Profile, Serum 

Collection Devices:
Specimen Required:

Serum: 0.5 mL
Pediatric Serum: 0.3 mL

Collection Information: Please document if patient is fasting
Specimen Stability:
Ambient: 24 hours
Refrigerated: 7 days
Frozen: 3 months
Serum: 0.5 mL
Pediatric Serum: 0.3 mL

Shipping & Storage: Samples must be transferred to an aliquot tube and stored frozen if analysis will not be complete within 48 hours (#110-10-05 Serum / Plasma Separation Procedure & Transport). Ship samples to MS5 Biochemistry at HSC.
Testing Laboratory (MB): HSC
Reference Values:
Reference Intervals: 2 -10 μmol/L (This reference range is for fasting patient.)
Diagnostic threshold for intrahepatic Cholestasis of Pregnancy is 19 μmol/L or more (Random and nan-fasting sample).
19-39 μmol/LMild ICP
40-99 μmol/LModerate ICP
>100 μmol/LSevere ICP

Method of Analysis: 5th Generation Enzymatic Colorimetric (Randox)

See Also:
More Information: