A COMBINATION OF HEPATOCELLULARAND HAEMOLYTIC
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital,
Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai
In private practice, a severe case of falciparum
malaria is a very good example where the patientís blood reports may show evidence
of hepatocellular jaundice in the form of raised bilirubin with raised enzymes
and alkaline phosphatase in addition to haemolytic jaundice where indirect reacting
bilirubin is raised along with anaemia and a high reticulocyte count. There
are three other conditions which are worth remembering where the above combination
of jaundice can take place:
1. In a few patients of viral hepatitis, when the bilirubin is very high, e.g.
40, 50, 60 mg or more, it is worth looking out for additional evidence of haemolytic
jaundice in the form of raised levels of indirect reacting bilirubin, anaemia
and high reticulocyte count as it occurs in patients who have G6PD deficiency.
2. Patients who have alcoholic liver disease, after a heavy alcoholic bout,
can develop haemolysis with high levels of indirect bilirubin, anaemia and high
reticulocyte count in addition to abnormal blood reports of hepatocellular jaundice.
3. Finally, young patients of chronic liver disease or cirrhosis, where no other
common cause is detected and in whom evidence of haemolytic jaundice is detected
should be worked up to exclude Wilsonís disease.