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Indirect reacting hyperbilirubinemia in cirrhosis: Its relation to red cell survival

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Summary

The clinical, biochemical, and hematologic findings in 16 patients with Laennec's cirrhosis and predominantly indirect hyperbilirubinemia are presented. Three patients had previously undergone a portacaval shunt. The mean51Cr-labeled red-cell halflife obtained in 12 of the cirrhotics with indirect hyperbilirubinemia was 17.9 days, compared to a mean of 23.6 days in the control group of 12 cirrhotics with direct hyperbilirubinemia. This difference was statistically significant (p<0.01).

There was a tendency for the serum indirect bilirubin concentration and the red-cell halflives to be inversely related in the patients with indirect hyperbilirubinemia.

Splenic sequestration of red cells was demonstrated in 5 of 10 patients with indirect hyperbilirubinemia and in 1 patient from the control group.

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References

  1. van den Bergh, A. A. H., andMüller, P. Uber eine direkte und eine inderkte Diazoreaktion auf Bilirubin.Biochem Z 77:90, 1916.

    Google Scholar 

  2. Billing, B. H., Cole, P. G., andLathe, G. H. Excretion of bilirubin as diglucuronide giving direct, van den Bergh reaction.Biochem J 65:774, 1957.

    PubMed  Google Scholar 

  3. Schmid, R. Identification of “direct reacting” bilirubin as bilirubin glucuronide.J Biol Chem 229:881, 1957.

    PubMed  Google Scholar 

  4. Levine, R. A., andKlatskin, G. Unconjugated hyperbilirubinemia in the absence of overt hemolysis. Importance of acquired disease as an etiologic factor in 366 adolescent and adult subjects.Amer J Med 36:541, 1964.

    Article  PubMed  Google Scholar 

  5. Israels, L. G., Suderman, H. J., andRitzman, S. E. Hyperbilirubinemia due to an alternate path of bilirubin production.Amer J Med 27:693, 1959.

    Article  Google Scholar 

  6. Watson, C. J. The importance of the fractional serum bilirubin determination in clinical medicine.Ann Int Med 45:351, 1956.

    PubMed  Google Scholar 

  7. Hyman, G. A., andSouthworth, H. Hemolytic anemia associated with liver disease.Amer J Med Sci 221:448, 1951.

    PubMed  Google Scholar 

  8. Chaplin, H., andMollison, P. L. Red cell life-span in nephritis and in hepatic cirrhosis.Clin Sci 12:351, 1953.

    PubMed  Google Scholar 

  9. Jones, P. N., Weinstein, I. M., Ettinger, R. H., andCapps, R. B. Decreased red cell survival associated with liver disease; use of radioactive sodium chromate in measurement of red cell survival.Arch Intern Med (Chicago) 95:93, 1955.

    Google Scholar 

  10. Jandl, J. H. The anemia of liver disease. Observations on its mechanism.J Clin Invest 34:390, 1955.

    PubMed  Google Scholar 

  11. Allen, F. A., Carr, M. H., andKlotz, A. P. Decreased red blood cell survival time in patients with portal cirrhosis; correlation of laboratory and clinical findings.JAMA 164:955, 1957.

    Google Scholar 

  12. Sheehy, T. W., andBerman, A. Anemia of cirrhosis.J Lab Clin Med 56:72, 1960.

    PubMed  Google Scholar 

  13. Cawein, M. J., III, Hagedorn, A. B., andOwen, C. A., Jr. Anemia of hepatic disease studied with radiochromium.Gastroenterology 38:324, 1960.

    PubMed  Google Scholar 

  14. Conrad, M. E., Jr., Berman, A., andCrosby, W. H. Iron kinetics in Laennec's cirrhosis.Gastroenterology 43:385, 1962.

    PubMed  Google Scholar 

  15. Katz, R., Velasco, M., Guzman, C., andAlessandri, H. Red cell survival estimated by radioactive chromium in hepatobiliary disease.Gastroenterology 46:399, 1964.

    PubMed  Google Scholar 

  16. Fauvert, R., Loverdo, A., Nicollo, S., andBoivin, P. L'hémolyse dans les cirrhoses. Étude de 40 cas par le methods des hématies marquées au chrome 51.Path Biol (Paris) 34:1801, 1958.

    Google Scholar 

  17. de Silva, L. C., Jamra, M., Maspes, V., Pontes, J., Pieroni, R., andCintra, A. Pathogenesis of indirect reacting hyperbilirubinemia after portacaval anastomosis.Gastroenterology 44:117, 1963.

    PubMed  Google Scholar 

  18. Dacle, J. V. Practical Hematology. Churchill, London, 1950.

    Google Scholar 

  19. Henry, R. J., Sobel, C., andChiamori, N. On the determination of serum iron and iron binding capacity.Clin Chim Acta 3:523, 1958.

    Article  PubMed  Google Scholar 

  20. Henry, R. J., Jacobs, S. C., andBerkman, S. Studies on the determination of bile pigments. III. Standardization of the determination of urobilinogen as urobilinogenaldehyde.Clin Chem 7:231, 1961.

    PubMed  Google Scholar 

  21. Harrison, G. A. Chemical Methods in Clinical Medicine. Churchill, London, 1937.

    Google Scholar 

  22. Ducci, H., andWatson, C. J. The quantitative determination of the serum bilirubin with special reference to the prompt reacting and the chloroform-soluble types.J Lab Clin Med 30:293, 1945.

    Google Scholar 

  23. Beierwaltes, W. H., Johnson, P. C., andSolari, A. J. Clinical Use of Radioisotopes. Saunders, Philadelphia, 1957.

    Google Scholar 

  24. Lester, R., andSchmid, R. Bilirubin metabolism.New Eng J Med 270:779, 1964.

    PubMed  Google Scholar 

  25. Robinson, S. H., Owen, C. A., Flock, E. V., andSchmid, R. Bilirubin formation in the liver from nonhemoglobin sources. Experiments with isolated perfused rat liver.Blood 26:823, 1965.

    PubMed  Google Scholar 

  26. Crosby, W. H. The capacity of bilirubin production as reflected by the concentration of plasma bilirubin.J Clin Invest 37:887, 1958.

    Google Scholar 

  27. Weech, A., Vann, D., andGrillo, R. The clearance of bilirubin from the plasma; a measure of the excreting power of the liver.J Clin Invest 20:323, 1941.

    Google Scholar 

  28. Tisdale, W. A., Klatskin, G., andKinsella, E. D. The significance of the direct-reacting fraction of serum bilirubin in hemolytic jaundice.Amer J Med 26:214, 1959.

    Article  PubMed  Google Scholar 

  29. Sherlock, S. Diseases of the Liver (ed. 3). Davis, Philadelphia, 1963, p. 242.

    Google Scholar 

  30. Donohue, D. M., Motulsky, A. G., Giblett, E. R., Pirzio-Biroli, G., Viranuvatti, V., andFinch, C. A. The use of chromium as a red cell tag.Brit J Haemat 1:249, 1955.

    PubMed  Google Scholar 

  31. Bothwell, T. H., andFinch, C. A. Iron Metabolism. Little, Boston, 1962.

    Google Scholar 

  32. Zieve, L. Hemolytic anemia in liver disease.Medicine 45:497–505, 1966.

    PubMed  Google Scholar 

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Author notes

  1. Bertram F. Felsher M.D.

    Present address: Department of Hematology, Walter Reed Army Institute of Research, Walter Reed Army Medical Center, 20012, Washington, D. C.

Authors and Affiliations

  1. From the Department of Medicine of the University of Southern California School of Medicine and the Hepatic Service of the John Wesley County Hospital, Los Angeles, Calif

    Bertram F. Felsher M.D., Allan G. Redeker M.D. & Telfer B. Reynolds M.D.

Authors
  1. Bertram F. Felsher M.D.
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  2. Allan G. Redeker M.D.
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  3. Telfer B. Reynolds M.D.
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Additional information

Supported by Grant HE 09316 from the National Institutes of Health, United States Public Health Service.

The authors wish to thank Mr. Richard Suzuki for his assistance in performing the red cell survival studies.

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Felsher, B.F., Redeker, A.G. & Reynolds, T.B. Indirect reacting hyperbilirubinemia in cirrhosis: Its relation to red cell survival. Digest Dis Sci 13, 598–607 (1968). https://doi.org/10.1007/BF02232966

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