Pre-hepatic (haemolytic) jaundice

Haemolytic jaundice:

Leads to an unconjugated hyperbilirubinaemia

The increased breakdown of RBCs leads to an increase in the production of bilirubin

The resulting jaundice is usually mild (serum bilirubin of 68-102mmol/L) as normal liver function can easily handle the increased bilirubin derived from excess haemolysis

Causes of haemolytic jaundice:

Inherited:

Red cell membrane defect (hereditary spherocytosis/elliptocytosis)

Hb abnormalities (Thalassaemia, sickle cell disease)

Metabolic defects (G6PDH deficiency, pyruvate kinase deficiency)

Acquired:

Autoimmune

Alloimmune (haemolytic transfusion reactions, haemolytic disease of the newborn)

Drug induced

Mechanical (microangiopathic haemolytic anaemia, valve prosthesis)

Renal/liver failure

Malaria

Hypersplenism

Burns

Evidence for haemolysis:

Elevated serum bilirubin (unconjugated)

Raised LDH

Reticulocytosis

NORMAL serum ALP, transferases and albumin