THE RECOGNITION AND DIFFERENTIAL FEATURES OF INDIRECT REACTING HYPERBILIRUBINEMIA

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Abstract
Not infrequently cases of jaundice are encountered which superficially resemble virus hepatic disease, but which are distinctive from it. This group of patients is comprised of chronic hemolytic anemia, post-hepatitis hyperbilirubinemia and constitutional hepatic dysfunction. The common feature to all of these patients is a waxing and waning elevation of the indirect reacting fraction of the serum bilirubin accompanied usually by an entirely normal liver profile. If such a finding is present, careful study for evidence of hemolysis must be undertaken. If a history of hepatitis is elicited, a liver biopsy should be performed to see if evidence of previous hepatitis can be confirmed. In the absence of hemolysis or evidence of hepatitis a diagnosis of constitutional hepatic dysfunction may be made. In any event, a careful family history may be helpful. Six cases are presented in detail illustrating the differential features of this syndrome. If a diagnosis of chronic hemolytic anemia is made, splenectomy may be curative. In the case of constitutional hepatic dysfunction and post-hepatitis hyperbilirubinemia treatment is entirely unwarranted.