In jaundice there is an unconjugated hyperbilirubinemia which is most likely due to:

 # In jaundice there is an unconjugated hyperbilirubinemia which is most likely due to:

A. Hepatitis

B. Cirrhosis

C. Obstruction of bile in canaliculi

D. Increased breakdown of red cells

The correct answer is D. Increased breakdown of red cells.

Hemolysis Increased destruction of erythrocytes leads to increased bilirubin turnover and unconjugated hyperbilirubinemia; the hyperbilirubinemia is usually modest in the presence of normal liver function.

In particular，the bone marrow is only capable of a sustained eightfold increase in erythrocyte production in response to a hemoIytic stress. Therefore， hemolysis alone cannot result in a sustained hyperbilirubinemia of more than -68 μmol/L (4 mg/dL) . Higher values imply concomitant hepatic dysfunction. When hemolysis is the only abnormality in an otherwise healthy individual， the result is a purely unconjugated hyperbilirubinemia，with the direct-reacting fraction as measured in a typical clinical laboratory being less or equal to 15% of the total serum bilirubin.

Reference: Harrison's Principles of Internal MEDICINE, 19th Edition Page no: 2000

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