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  #1  
Old 05-31-2012
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Liver Incidental Hyperbilirubinemia!

A 30-year-old woman is evaluated because of an abnormal serum total bilirubin level detected when she had a life insurance examination. Medical history is unremarkable. Her only medication is an oral contraceptive agent. Physical examination is normal.

Hemoglobin 13.9 g/dL (139 g/L)
Mean corpuscular volume 88 fL
Red cell distribution width 10.8%
Serum total bilirubin 2.4 mg/dL (41.0 μmol/L)
Serum direct bilirubin 0.2 mg/dL (3.4 μmol/L)
Serum aspartate aminotransferase 23 U/L
Serum alanine aminotransferase 22 U/L
Serum alkaline phosphatase 82 U/L

Which of the following is the most appropriate management at this time?

(A) Discontinue the oral contraceptive agent
(B) No further intervention required
(C) Obtain a reticulocyte count and haptoglobin level
(D) Repeat the liver chemistry tests in 3 months
(E) Schedule abdominal ultrasonography
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-the direct blirubin is normal,so the problem is in indirect =hemolysis may be=(C).
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C, rule out hemolysis as first
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C.......indirect bilrubin is increased....
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check for hemolysis?
so C?
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(C) Obtain a reticulocyte count and haptoglobin level

Quote:
When there is an increased production of red blood cells to overcome chronic or severe loss of mature red blood cells, such as in a haemolytic anaemia, people often have a markedly high number and percentage of reticulocytes. A very high number of reticulocytes in the blood can be described as reticulocytosis.
Quote:
A decrease in haptoglobin can support a diagnosis of hemolytic anemia, especially when correlated with a decreased RBC count, Hemoglobin, and Hematocrit, and also an increased reticulocyte count.
If the reticulocyte count is increased, but the haptoglobin level is normal, this may indicate that cellular destruction is occurring in the spleen and liver, which may indicate a drug-induced hemolysis, or a red cell dysplasia. The spleen and liver recognize an error in the red cells (either Drug coating the red cell membrane or a dysfunctional red cell membrane), and destroy the cell. This type of destruction does not release hemoglobin into the peripheral blood, so the haptoglobin cannot bind to it. Thus, the haptoglobin will stay normal if the hemolysis is not severe. In severe extra-vascular hemolysis, haptoglobin levels can also be low, when large amount of hemoglobin in the reticuloendothelial system leads to transfer of free hemoglobin into plasma.
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Quote:
Originally Posted by Novobiocin View Post
(C) Obtain a reticulocyte count and haptoglobin level
this is awesome q
ans is gilberts syndrome and reassurance is needed!!!!

they say in routine lab elevation of indirect brb....suspect gilberts only and nothing else when total brb < 3 and direct <.3 because prevalence of gilberts in community is high.
make sense?

i did stop ocp. :-(...lolz...it causes obstructive type picture.

and haptoglobin workup not needed....

love this q.
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Quote:
Originally Posted by tyagee View Post
ans is gilberts syndrome and reassurance is needed!!!!
But that's not among the answer choices?
Reassurance is considered an intervention
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Quote:
Originally Posted by Novobiocin View Post
But that's not among the answer choices?
Reassurance is considered an intervention
Ans is b
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