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Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
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.

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