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Bilirubin Metabolism - Pathophysiology • Conjugated Bilirubin • Unconjugated Bilirubin By Dr. Khushboo Gala @LouLectures #Bilirubin #Metabolism #Pathophysiology
Bilirubin Metabolism ... • Conjugated Bilirubin ... • Unconjugated Bilirubin ... LouLectures #Bilirubin ... Pathophysiology #hepatology
Macrophage Activation Syndrome (MAS) Classified among the secondary or acquired forms of haemophagocytic lymphohistiocytosis (sHLH) What? A subset of
fever syndromes Clinical ... Fever is the main clinical ... ↑ AST ↑ ALT ↑ bilirubin ... Diagnosis #Management #Hematology ... #Rheumatology
Biochemistry and Metabolism of Bilirubin Hemolysis → Hemoglobin → Heme → Biliverdin → Unconjugated Bilirubin (a.k.a. "indirect
Metabolism of Bilirubin ... → Unconjugated Bilirubin ... "indirect bilirubin ... interchangeably for routine clinical ... pathophysiology #hepatology
Laboratory Testing in Hemolytic Anemia Intravascular vs Extravascular Hemolysis Reticulocytes Unconjugated bilirubin LDH Peripheral smear Haptoglobin Urine hemosiderin Urine hemoglobin Carboxyhemoglobin #Hemolytic #Anemia #Laboratory #Testing #workup
Unconjugated bilirubin ... workup #diagnosis #hematology
Inherited Non-hemolytic Disorders of Hyperbilirubinemia == Disorders of Conjugation == Gilbert Syndrome: • 5-10% of the population
as jaundice on clinical ... birth with serum bilirubin ... associated with bilirubin ... in conjugated bilirubin ... #hepatology #diagnosis
Bilirubin Crystals on Urine Microscopy Dr. Telma Lemos @TELMALEMOS10 #Bilirubin #Crystals #crystalluria #Urine #Microscopy #trichomoniasis #clinical
Bilirubin Crystals ... TELMALEMOS10 #Bilirubin ... trichomoniasis #clinical
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 Liver Chemistry Tests - AST, ALT, Alkaline Phosphatase and Bilirubin Metabolism AST and ALT: • AST: liver
Phosphatase and Bilirubin ... initial insult Bilirubin ... transports conjugated bilirubin ... ASTALT #AlkPhos #Bilirubin ... #Hepatology #Pathophysiology
Hemolysis - Diagnostic Algorithm and Causes Increased red cell production: • Increased Reticulocytosis/polychromasia • Erythroid
Increased Serum bilirubin ... Causes #Workup #Hematology
Liver Disease in Pregnancy Intrahepatic Cholestasis of Pregnancy (ICP) • Onset/Trimester: 25-32 weeks • Typical clinical features:
weeks • Typical clinical ... fold elevation, Bilirubin ... fold elevation, Bilirubin ... but variable ++, Bilirubin ... Disease #Pregnancy #hepatology
Hemolytic Anemias - Differential Diagnosis Algorithm Signs of anemia and hemolysis: • ↓ Haptoglobin • ↑ LDH
/ unconjugated bilirubin ... Diagnosis #Algorithm #hematology
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