BOF: 37
A patient presents to you with a history of fever, severe
myalgia and sore throat of 4 days duration. He says he has not appetite and
has only been taking liquids during this period.
Investigations
Hb 14.5 g/dL
MCV 88fl
Reticulocytes 1 %
WBC 5.5 x 109/L
Platelets 280 x 109/L
Bilirubin 60 mmol/L
Alanine aminotransferase 32 U/L
Alkaline phosphatase 100 U/L
Albumin 42 g/L
Urea 6.5 mmol/L
Creatinine 75mmol/L
Which of the following is most likely to account for
these features?
a)
Hereditary spherocytosis
b)
Warm autoimmune haemolytic anaemia
c)
Hepatitis A
d)
Gilbert’s syndrome
e)
Malaria
Answer: d)
Gilbert's syndrome
·
Mild unconjugated non-haemolytic hyperbilirubinaemia
·
Does not lead to hepatic inflammation, fibrosis, chronic liver
disease or liver failure
·
Genetic variant of the human bilirubin UDP-glucuronyltransferase
(UDP=uridine diphosphate glucuronate)
·
Unconjugated bilirubin rises in the absence of haemolysis
·
Reducing calorie intake increases bilirubin levels even in
normal individuals and this is aggravated in those with Gilbert’s syndrome
