Unconjugated hyperbilirubinemia in a newborn can be caused by all the following EXCEPT:
Correct Answer: Dubin Johnson syndrome
Description: Ans. a (Dubin Johnson syndrome). (Ref. Harrison's Principles of Internal Medicine 16th ed., 240)Rotor syndrome and Dubin Johnson syndrome cause conjugated hyperbilirubinemia, due to impaired hepatic excretion (lntrahepatic defect).Causes of unconjugated hyperbilirubinemia1. Defective Hepatic uptake:Eg. Flavospidic acid and Novobiocin2. Over production:a. Hemolysis (Intra and extra vascular)b. Ineffective erythropioesis3. Decreased hepatic uptake:a. Prolonged fastingb. Sepsis4. Decreased bilirubin conjugation: (i.e., decreased hepatic glucuronosyl transferase activity)a. Gilbert's syndromeb. Crigler - Najjar type II (moderate) and type I (Severe)c. Neonatal jaundiced. Acquired transferase deficiency:i) Drugs chloramphenicol and pregnanediolii) Breast milk jaundice due to pregnanediol and fatty acid in breast milkiii) Hepatitis, Cirrhosise. SepsisRotor syndrome is a benign condition with deficiency of hepatic storage of conjugated bilirubin, resulting in its leakage in plasma. LFTs are normal and Rx is unneccersary.
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