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Haem catabolism ppt BIIOCHEMISTRY vkunder637@gmail.com

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Jaundice hyperbilirubinemia

Jaundice hyperbilirubinemia

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  • Under physiologic conditions in the human adult, 1–2× 108 erythrocytes are destroyed per hour. Thus, in 1day, a 70-kg human turns over approximately 6 g of hemoglobin.When hemoglobin is destroyed in the body,globin is degraded to its constituent amino acids,which are reused, and the iron of heme enters the ironpool, also for reuse. The iron-free porphyrin portion ofheme is also degraded, mainly in the reticuloendothelialcells of the liver, spleen, and bone marrow.
  • The catabolism of heme from all of the heme proteinsappears to be carried out in the microsomal fractionsof cells by a complex enzyme system called hemeoxygenase.
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    • 1. Dr. Vijay Marakala, MBBS, MD. Assistant professor BIOCHEMISTRY SIMS & RC
    • 2. NADPH + H+ NADP+ O2 Fe+3 NADPH + H+ NADP+ Haem degradation Haem oxygenase Bilirubin reductase
    • 3. FATE OF BILIRUBIN ?
    • 4. Fate of bilirubin • Further metabolism and excretion of bilirubin occurs in the liver and intestine Uptake of bilirubin by liver Conjugation of bilirubin in liver Secretion of conjugated bilirubin into bile Excretion of bilirubin through faeces and urine
    • 5. BLOOD CELLS LIVER Bilirubin diglucuronide (water-soluble) 2 UDP-glucuronic acid via bile duct to intestines Urobilinogen formed by bacteria KIDNEY CO Biliverdin Heme oxygenase O2 Bilirubin (water-insoluble) NADP+ NADPH Biliverdin reductase Heme Globin Hemoglobin reabsorbed into blood Bilirubin (water-insoluble)via blood to the liver INTESTINE
    • 6. Disorder of Hb catabolism • Disease or conditions that interfere with bilirubin metabolism may cause a rise in its serum concentration of bilirubin Total bilirubin 0.1 to 1mg/dl Conjugated 0.1 to 0.4mg/dl Unconjugated 0.2 to 0.7mg/dl NORMAL LEVELS
    • 7. Hyperbilirubinaemia • When serum bilirubin exceeds 1mg/dl – HYPERBILIRUBINAEMIA • >2.2 to 5mg/dl - JAUNDICE Yellowish discoloration of skin and sclera due to deposition of bilirubin in the tissues. The condition is called jaundice or icterus
    • 8. INCREASED HAEMOLYSIS ↑breakdown of Hb JAUNDICE LIVER DAMAGE ↓Excretion of bilirubin JAUNDICE BILE DUCT OBSTRUCTION ↓Excretion of bilirubin JAUNDICE CAUSES OF JAUNDICE
    • 9. Jaundice Classification Prehepatic Hepatic Posthepatic
    • 10. Prehepatic or Haemolytic Jaundice • Increased breakdown of haemoglobin to bilirubin. Excess haemolysis may be due to Sickle haemoglobin Deficiency of G- 6PD enzyme Incompatible blood transfusion
    • 11. Hepatic/hepatocellular/intrahepatic • Disorder of the liver cells or the bile passages within the liver. Viral hepatitis Toxic chemicals Drugs Cirrhosis
    • 12. Posthepatic or Obstructive Jaundice • Obstruction in the passage of conjugated bilirubin from liver to intestine. Gallstones Ca of head of pancreas Ca of common bile duct
    • 13. Lab findings in three types of jaundice
    • 14. Neonatal or physiological Jaundice • Mild jaundice in the first few days after birth is common. • Results from an accelerated haemolysis and immature liver enzyme system • Deficiency of UDP-glucuronyl transferase
    • 15. Congenital Hyperbilirubinemia Crigler-Najjar syndrome Gilbert’s disease Dubin-Johnson syndrome Rotor syndrome
    • 16. Crigler-Najjar syndrome • Deficiency of • Type I & II • Type I is Fatal • Unconjugated bilirubin increases more than 20mg/dl • Children die because of • Type II is milder form
    • 17. Gilbert’s disease • Partial conjugation defect • Reduced activity of • Asymptomatic and mild • Unconjugated bilirubin increases - 3mg/dl
    • 18. Dubin-Johnson syndrome • Mutation in the responsible for transport of conjugated bilirubin into bile • Black liver jaundice
    • 19. Rotor syndrome • Similar to Dubin-Johnson syndrome • • Exact defect is not identified • No staining of liver