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Chapter 043. Jaundice (Part 3)

Evaluation of the patient with jaundice. MRCP, magnetic resonance cholangiopancreatography; ALT, alanine aminotransferase; AST, aspartate aminotransferase; SMA, smooth-muscle antibody; AMA, antimitochondrial antibody; LKM, liver-kidney microsomal antibody; SPEP, serum protein electrophoresis; CMV, cytomegalovirus; EBV, Epstein-Barr virus. Isolated Elevation of Serum Bilirubin Unconjugated Hyperbilirubinemia The differential diagnosis of an isolated unconjugated hyperbilirubinemia is limited (Table 43-1). The critical determination is whether the patient is suffering from a hemolytic process resulting in an overproduction of bilirubin (hemolytic disorders and ineffective erythropoiesis) or from impaired hepatic uptake/conjugation of bilirubin (drug effect or genetic disorders). Table 43-1 Causes of Isolated Hyperbilirubinemia I. Indirect hyperbilirubinemia . | Chapter 043. Jaundice Part 3 Evaluation of the patient with jaundice. MRCP magnetic resonance cholangiopancreatography ALT alanine aminotransferase AST aspartate aminotransferase SMA smooth-muscle antibody AMA antimitochondrial antibody LKM liver-kidney microsomal antibody SPEP serum protein electrophoresis CMV cytomegalovirus EBV Epstein-Barr virus. Isolated Elevation of Serum Bilirubin Unconjugated Hyperbilirubinemia The differential diagnosis of an isolated unconjugated hyperbilirubinemia is limited Table 43-1 . The critical determination is whether the patient is suffering from a hemolytic process resulting in an overproduction of bilirubin hemolytic disorders and ineffective erythropoiesis or from impaired hepatic uptake conjugation of bilirubin drug effect or genetic disorders . Table 43-1 Causes of Isolated Hyperbilirubinemia I. Indirect hyperbilirubinemia A. Hemolytic disorders 1. Inherited a. Spherocytosis elliptocytosis Glucose-6-phosphate dehydrogenase and pyruvate kinase deficiencies b. Sickle cell anemia 2. Acquired a. Microangiopathic hemolytic anemias b. Paroxysmal nocturnal hemoglobinuria c. Spur cell anemia d. Immune hemolysis B. Ineffective erythropoiesis 1. Cobalamin folate thalassemia and severe iron .