Jaundice & Anaemia

Question 1

Heme excretion

Answer 1

Haem to Biliverdin to Bilirubin

Bilirubin-Albumin to liver

Conjugation in Liver

Conjugated BR to Intestines - Converted to Stercobillin [Brown] by bacteria

Conjugated BR to Kidney - Converted to Urobillinogen then Urobillin [Yellow]

Question 2

Prehepatic Jaundice

Serum changes and Presentation

Answer 2

Unconjugated BR INCREASE
Conjugated BR - SAME
Down stream stuff increases

Presentation:
- black/coffee urine due to haemoglobin

Question 3

Hepatic Jaundice [Defect]

Answer 3

UCBR increases
CBR decreases
Downstream stuff decreases

Presentation
- Pale Stools

Question 4

Hepatic Jaundice [Dysfunctions - Early + Late]

Late same as Obstructive Jaundice

Answer 4

Early: reabsorption issue

• Urobilliogen increases

Late: Excretion issue

CBR increases - excretes in urine
Stercobillin decreases, Urobilliogen decreases

Presentation
- Tea colored urine, Pale stools

Question 5

Defining serum test

Answer 5

Conjugated BR

• if same - must be Pre-hepatic Jaundice
• if increase - Obstructive-Hepatic /Post-hepatic Jaundice
• if decrease - Hepatic Jaundice - Conjugation problem

Question 6

Anemia

3 general types

Answer 6

Macrocytic, Megaloblasts,
- DNA synthesis problem - B12, Folate deficiency

Microcytic, Hypochromic
- HB maturation problem - Iron deficiency, Thalassemia

Normocytic

• Production
• Loss
• Dilutional - pregnancy

Question 7

Hemolysis Tests [4]

Answer 7

LDH - tissue/RBC death
Bilirubin
Haptoglobin (binds hemoglobin)

Direct Combs Test DCT - autoAB against RBC

Question 8

Anemia of chronic diseases causes

Answer 8

Alterations in the metabolism of iron via the molecule hepcidin and ferritin - Anemia
- low reticulocyte count; WBC driven up, EPO decrease, Hepcidin increase

-CKD - EPO decrease

Question 9

Thalassemia
Whats HbA
Whats HbD
HbA2
HbF

Answer 9

AR

HbA is normal 2a 2b
HbD is 4 of the same
HbA2 is 2a 2Delta
HbF is 2a 2Gamma