Jaundice

Keywords: Neonatal jaundice, Hyperbilirubinaemia

 

Causes

Appropriate Tests

 

Bilirubin, Aspartate aminotransferase, Alanine aminotransferase, Alkaline phosphatase, Gamma glutamyltransferase, Lactate dehydrogenase; Full blood count, Blood film; Protein, Albumin.

Carotene if bilirubin normal.

Coagulation profile, Urea, Electrolytes, Glucose, Liver function tests. Consider Phosphate, Calcium, Albumin, Full blood count, MTU and MCS if positive, consider serology investigations relevant to history.

See Guideline on Pathology testing in the Emergency department: Appendix 2.

Neonatal

Bilirubin (total, conjugated), Albumin; Full blood count, Blood film; Direct antiglobulin test.

Unconjugated hyperbilirubinaemia

 

Physiological

 

Haemolysis

See Haemolysis (neonatal).

Drugs

 

Hypothyroidism

 

Haematoma resorption

 

Breast milk jaundice

 

Crigler-Najjar syndrome

 

Conjugated hyperbilirubinaemia

 

Neonatal Hepatitis, especially

 

  • Alpha-1-antitrypsin deficiency

See Alpha-1-antitrypsin faeces and Alpha-1-antitrypsin.

  • Toxoplasmosis

See Toxoplasma Ab.

  • Syphilis

See Syphilis serology (serum or CSF).

  • Cytomegalovirus infection

See Cytomegalovirus detection.

  • Herpes simplex virus infection

See Herpes simplex Ab (serum, CSF).

Neonatal sepsis

 

Biliary atresia

See Cholestasis.

Galactosaemia

 

Adult

 

Hepatocellular disease, especially

 

Hepatitis

 

Hepatic failure

 

Increased bilirubin production

 

Cholestasis

 

Haemolysis

 

Ineffective erythropoiesis

See Megaloblastic anaemia.

Haematoma resorption

 

Impaired bilirubin uptake or conjugation

 

Gilbert syndrome

 

Crigler-Najjar syndrome