1. Pre-hepatic jaundice
by:Jehad abdullah

2. Pre-hepatic
Due to excess
production of
unconjugated bilirubin
after hemolysis which
exceeds the capacity of
liver to conjugate it
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3.  Characterized by the following
 High levels of
indirect
(unconjugated)
bilirubin in plasma
 Dark urine caused
by high levels of
urobilinogen in
urine
 Dark stool caused
by high levels of
Fecal urobilin
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4. 4

5. Unconjugated bilirubin (Indirect
bilirubin)
A. Main bilirubin present in plasma
normally
B. Water insoluble
C. Transported in blood as Bilirubin-
albumin complex
D. Not excreted in urine
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6. 6

7. Etiology
Increased bilirubin production can result
from the following:
• Hemolysis
- hereditary internal factors
• Defects in cytoskeleton (e.g., hereditary spherocytosis).
• Structurally abnormal hemoglobin (e.g., sickle cell
anemia, thalassemias).
• Enzyme deficiencies (e.g., glucose-6-phosphate
dehydroge- nase [G6PD] deficiency).
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8. - external factors
1- Antibody mediated
2- Drugs e.g. ribavirin
3-Infections ( Malaria - Babesiosis )
4- Any of the causes of hypersplenism (increased activity
of the spleen), such as portal hypertension.
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Etiology

9. Neonatal Jaundice
• is a condition marked by high levels of
bilirubin in the blood.
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10. Special characteristic in
neonates
• 1.More billirubin produced
• Much more Hemolysis
• The life-length of hemolysis(70~80)
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11. 11

12. • 2.The low capability of
albumin on unconjugated
billirubin transportation
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13. 13

14. • 3.The low capability of
heptatocyte
• Less Y protein and Z protein
• The primary development of Hepato-
enzyme system
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16. 16

17. Kernicterus
• Kernicterus is damage to the brain
centers of infants caused by increased
levels of unconjugated-indirect bilirubin
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