Term
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Definition
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Term
| aHemoglobin gets broken down into ___ and then into __ in RES. In circulation, bilirubin is ___ and bound to __. It is transferred to __ and __ by __ __. It is then excreted via the __ __ into the __ __. |
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Definition
- biliverdin
- bilirubin
- unconjugated and bound to albumin
- hepatocytes and conjugated by glucuronyl transferase
- bile duct into the small intestine |
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Term
| Gut flora metabolize __ bilirubin into __ that are excreted in the stools. |
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Definition
| - conjugated bilirubin into stercobilins that are excreted in the stools |
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Term
| With limited gut flora and slow motility, bilirubin is converted back to the ___ form and reabsorbed. |
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Definition
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Term
| Newborns have higher levels of bilirubin than adults b/c? |
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Definition
ILIDS:
- Immature liver (decreased glucuronyl transferase)
- Large RBC load (so higher Hct 60-65)
- Increased enterohepatic circulation
- Degradation of extra hematopoietic tissue
- Shortened RBC lifespan (90 instead of 120) |
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Term
| Normal total serum bilirubin: |
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Definition
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Term
| Indirect hyperbilirubinemia: |
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Definition
| total bilirubin > 2.5 with direct < 15% |
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Term
| Direct hyperbilirubinemia: |
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Definition
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Term
| __ hyperbilirubinema is lipid soluble and may enter brain. |
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Definition
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Term
| ___ hyperbilirubinemia is water soluble. Suspect this if there is bilirubin in the urine. |
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Definition
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Term
| Bilirubin in the urine, suspect ___ hyperbilirubinemia. |
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Definition
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Term
| 2 types of indirect hyperbilirubinemia: |
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Definition
1. Physiologic Jaundice (MC jaundice in newborns)
2. Pathologic Jaundice |
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Term
| Indirect Physiologic Jaundice: |
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Definition
FORP
- Full term infant < or equal to 15
- Occurs >24 hours after birth
- Resolves by 1 week in full term infants or 2 weeks in preterm infants
- Peaks at 3 -5 days |
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Term
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Definition
BMCVT
- Bilirubin increase > 5 mg/dl/day or > 0.5 mg/dl/hr
- May appear in first 24 hours
- Conjuated bili > or equal to 2.0
- Visible jaundice on DOL 1 or after 2 weeks
- Total bilirubin > 5 on DOL 1, or total bilirubin > 15 after DOL 1 |
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Term
| 2 main causes of pathologic indirect hyperbili: |
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Definition
- Increased production
- Decreased clearance |
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Term
| causes of increased production leading to pathologic indirect hyperbilirubinemia: |
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Definition
- Antibody mediated hemolysis (Coomb's test positive)
- Non-antibody mediated hemolysis (Coombs test negative)
- Extravascular hemolysis
- Increased enterohepatic circulation |
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Term
| When is rhogam given to Rh- mom: |
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Definition
- 28 weeks
- delivery
- any invasive procedure where blood transfer occurs |
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Term
| what is Rh isoimmunization: |
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Definition
| mom is RH-, baby RH+, so mom's blood forms antibodies to baby |
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Term
| complications of Rh isoimmunization: |
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Definition
- hydrops in utero
- severe anemia
- hyperbilirubinemia |
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Term
| Examples of antibody mediated hemolysis (increased production) resulting in pathologic indirect hyperbilirubinemia: |
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Definition
- ABO mismatch
- Rh isoimmunization |
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Term
| Examples of non-antibody mediated hemolysis leading to pathologic indirect hyperbilirubinemia: |
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Definition
- Structural (MC Spherocytosis)
- Enzyme deficiencies (MC G6PD deficiency) |
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Term
| With spherocytosis RBCs collect in the __ and cause __. These pts tend to have a family history of __, __, and __. |
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Definition
- spleen
- splenomegaly
- gallstones
- anemia
- jaundice |
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Term
| G6PD deficiency is __ linked and occurs in __ of __, __, or __ descent. |
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Definition
- x-linked
- males
- African
- Mediterrranean
- Asian |
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Term
| Non-hemolytic causes of increased bilirubin production: |
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Definition
- Hematoma or bruising (cephalohematoma)
- Hemorrhage (IVH or abdominal)
- Excess RBC production (polycythemia, RBC > 60) |
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Term
| Increased enterohepatic circulation can cause pathologic indirect hyperbilirubinemia, causes of this include: |
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Definition
- decreased motility
- decreased stooling (meconium plug, bowel obstruction) |
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Term
| Causes of decreased clearance leading to pathologic indirect hyperbilirubinemia: |
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Definition
- Prematurity: decreased conjugation in liver
- Glucuronyl transferase deficiency: Type 1 Criler Najaar Syndrome (recessive, poor prognosis) Type 2 dominant good prognosis
- Gilbert's Syndrome- dominant, benign, get ill and become jaundiced in older age, scleral icterus in AA children, decreassed glucuronyl transferase |
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Term
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Definition
- Normal weight gain
- Prolonged unconjugated hyperbilirubinemia, peaks at 10-15 days
- Unknown factor in breast milk prevents conjugation of bilirubin
- Increased enterohepatic circulation
- Interrupt breast feeding for 24 hours, levels drop rapidly, resume breast feeding after 24-48 hours |
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Term
| Is breast milk jaundice common? |
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Definition
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Term
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Definition
"lack of feeding"
- Decreased intake <10min/feeding or less than 8 feedings/day
- Decreased stooling < 4/day
- Decreased UOP < 6/day
- Weight loss > 8-10%
- Increased enterohepatic circulation
- Failure to establish milk supply
- Supplement with formula and/or increase BF to every 2 hours |
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Term
| Important hx questions for jaundice newborn? |
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Definition
BAMMCC
- Birth trauma
- Antibody titers
- Maternal DM or infections
- Maternal/infant blood type
- Cord blood hemoglobin
- Coombs test |
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Term
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Definition
- bruising/hematoma?
- HSM (spleen palpable in 30% of nml newborns)
- Plethora |
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Term
| Lab studies to order on jaundice newborn: |
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Definition
- CBC
- Peripheral smear (check for hemolysis)
- Reticulocyte count (check for hemolysis)
- IBT and Coombs test (even if mom is not O or Rh- b/c can find anti-Duffy or anti- Kell antibodies
- Total bilirubin
- Fractionated bilirubin |
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Term
| Kernicterus is staining of the __ __ leading to ___. List the acute sympotoms of this. |
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Definition
- basal ganglia
- encephalopathy
Acute symptoms:
- lethargy
- decreased tone
- high pitched cry
- poor feeding
- vomiting
- hypertonic seizures
- opisthotonus
- scissoring of feet |
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Term
| Late sequellae of kernicterus: |
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Definition
- neuro deficits
- mental retardation
- deafness
- choreoatheltoid cerebral palsy |
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Term
| risk of kernicterus in term infants: |
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Definition
| - small if without hemolysis, even at bilirubin of 25 |
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Term
| 3 main aspects of management of indirect hyperbilirubinemia: |
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Definition
1. Hydration with supplmental feeding
2. Glycerin suppository to increase stooling
3. Phototherapy |
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Term
| when to start phototherapy: |
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Definition
| full term infant bili 15-18 |
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Term
| In a hemolytic full term infant, phototherapy should be used to keep bili less than __. |
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Definition
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Term
| 5 treatment steps for management of jaundice newborn: |
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Definition
1. hydration
2. glycerin suppository to increase stooling
3. Phototherapy
4. IV albumin to increase binding
5. Exchange transfusion (only severe cases) |
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Term
| Risks with exchange transfusion: |
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Definition
- Bleeding
- Hypocalcemia
- Infection
- Death |
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Term
Difficulty feeding
Excess weight loss
Jaundice at DOL 3-5 |
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Definition
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Term
| elevated retic count indicates: |
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Definition
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Term
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Definition
AMA
- AA
- Mediterranean
- Asian |
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Term
| AA, Meditteranean, Asian, male, sibling affected jaundice; |
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Definition
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Term
| spherocytosis is autosomal __. |
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Definition
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Term
| FHx anemia and splenectomy: |
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Definition
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