Which disorder can be classified as a form of prehepatic jaundice?

• A. Acute hemolytic anemia
• B. Cirrhosis
• C. Dubin-Johnson syndrome
• D. Neoplasm of common bile duct

Answer: (A)

Prehepatic jaundice occurs when there is excessive production of bilirubin that the liver cannot keep up with, so unconjugated bilirubin rises in the blood even though the liver itself is intact. In acute hemolytic anemia, red blood cells are destroyed rapidly, releasing heme that is converted to bilirubin. The surge in unconjugated bilirubin can overwhelm the liver’s conjugation capacity, leading to a buildup of bilirubin before it has a chance to be excreted, which fits the prehepatic pattern.

Cirrhosis involves damaged liver tissue and impaired conjugation and excretion, producing a hepatic (intrahepatic) pattern rather than a purely prehepatic one. Dubin-Johnson syndrome is a defect in hepatic excretion of conjugated bilirubin, resulting in conjugated hyperbilirubinemia and cholestasis, not excess production. Neoplasm of the common bile duct causes obstruction, leading to posthepatic (cholestatic) jaundice with elevated conjugated bilirubin.