A child presents with complaints of oliguria, abdominal distension and diarrhoea. On examination there is deep jaundice. Hepatomegaly was present measuring 4 era below the costal margin. Conjugated bilirubin in blood was 38 mg/dL, and there was urine urobilinogen and bile pigments. Hemoglobin was 4 mg/dL and serum creatinine was 3 mg/dL. Which of the following tests is of least impoance to diagnose this case?
Correct Answer: Serum ceruloplasmin
Description: Severe anemia, jaundice, hepatomegaly are strongly suggestive of this child is suffering with severe hemolysis. Oliguria and elevated creatinine levels are pointing out to acute renal failure due to hemolysis. Hence the investigations should be towards the etiology of hemolysis. Serum ceruloplasmin determination is for finding out Wilson's disease. The above clinical picture does not correlate with Wilson's disease. Findings of Wilson's disease may include jaundice, hepatomegaly early in childhood, splenomegaly, and Kayser-Fleischer rings. Hepatic involvement may present as ALF, acute hepatitis, chronic liver disease, cholelithiasis, or as cirrhosis with poal hypeension. Serum ceruloplasmin levels (measured by the oxidase method) are usually less than 20 mg/dL. (Normal values are 23-43 mg/dL.) Ref: Sokol R.J., Narkewicz M.R. (2012). Chapter 22. Liver & Pancreas. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.
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