Jaundice is a medical condition that requires a doctor to be consulted immediately if the patient is an adult, as jaundice in adults is often an indication of a serious condition, such as: pancreatic cancer, hepatitis

1. AL-maaref University College
Department of Medical Laboratory Techniques
Dec 2021
Subject Name : Advanced Clinical Chemistry [Practical]
Topic : Jaundice
4th-Stage
EXECULTED BY
M.Sc. Med. Biochemistry
MOHANAD ALI ABDULHADI

2. • Jaundice refers to the yellow discolouration
of the sclera and skin that is due
to hyperbilirubinaemia, occurring at bilirubin
levels roughly greater than 50 µmol/L

3. Pre-Hepatic Hepatocellular Post-Hepatic
* excessive red cell
breakdown
* unconjugated
hyperbilirubinemia.
•Hemolytic anemia
•Gilbert’s syndrome
•Criggler-Najjar
syndrome
* dysfunction of the
hepatic cells
* unconjugated and
conjugated bilirubin in
the blood
•Alcoholic liver disease
•Viral hepatitis
•Hereditary
hemochromatosis
•Autoimmune hepatitis
•Biliary cirrhosis
•Hepatocellular
carcinoma
* Refers to obstruction
of biliary drainage
* conjugated
hyperbilirubinaemia
•Gallstones
•cholangiocarcinoma
•pancreatic cancer or
abdominal masses (e.g.
lymphomas)
Types of Jaundice

4. Inherited disorders of bilirubin metabolism causing
Unconjugated Hyperbilirubinemia
• Crigler-Najjar syndrome
type 1:
• Crigler-Najjar syndrome
type 2:
• Gilbert syndrome:
Virtually no UGT1A1 activity
UGT1A1 activity below 10%
UGT1A1 activity ~30%
• UDP-glucuronosyltransferases (UGTs)
• UGT’s are a family of enzymes concentrated in the liver.
• One UGT isoform, UGT1A1, conjugates bilirubin and is
essential for its excretion.
• Inherited UGT1A1 deficiency causes jaundice.

5. Inherited disorders of bilirubin metabolism causing
Unconjugated Hyperbilirubinemia
• Crigler-Najjar syndrome
type 1:
• Crigler-Najjar syndrome
type 2:
• Gilbert syndrome:
Serum bilirubin 18-40 mg/dl:
Kernicterus, unless treated
vigorously
Serum bilirubin 8-18 mg/dl:
Kernicterus is rare
Serum bilirubin normal to
5 mg mg/dl
(increases during fasting,
intercurrent illness, etc.
No cerebral toxicity.
Phenobarbital treatment:
little or no effect.
Phenobarbital reduces serum
bilirubin is by >25%

6. Inherited disorders of bilirubin metabolism causing
Conjugated + Unconjugated Hyperbilirubinemia
• Dubin Johnson syndrome
• Rotor syndrome * Hepatic storage disorder
* No pigmentation
•Abnormality of biliary excretion
causes the retention of a pigment
in the liver [organic anions, but
not bile salts ]
•Accumulation of pigments
•serum bilirubin is only mildly
elevated (3-5 mg/dl)