A 30 year old male patient with cholelithiasis is found to have serum bilirubin 2.5, Hb 6 and urine test positive for urobilinogen. What is the most likely diagnosis?
Correct Answer: Hemolytic jaundice
Description: In hemolytic disorders the serum bilirubin rarely exceeds 86 mol/L (5 mg/dL). Hemolysis regularly produces in the serum an increase in unconjugated bilirubin and aspaate transaminase (AST), urobilinogen will be increased in both urine and stool. So the most likely diagnosis in this patient is hemolytic jaundice. In Hemolytic Anemia the main clinical sign is jaundice. The spleen is enlarged because it is a preferential site of hemolysis. The laboratory features of HA are related to hemolysis and the erythropoietic response of the bone marrow. Hemolysis produces an increase in unconjugated bilirubin and aspaate transaminase (AST); urobilinogen will be increased in both urine and stool. The main sign of the erythropoietic response by the bone marrow is an increase in reticulocytes. The increased number of reticulocytes is associated with an increased mean corpuscular volume (MCV) in the blood count. On the blood smear, this is reflected in the presence of macrocytes.A bone marrow aspirate will show erythroid hyperplasia. Cholelithiasis is a complication of hemolytic anemia. Obstructive jaundice is unlikely in this case as the patient has anemia and a positive urine urobilinogen test. Reference: Harrison's Internal Medicine, 18th Edition, Page 326, 872-875, 3179-3180
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