Which of the following is characteristic of hemolytic jaundice?

• A. Unconjugated serum bilirubin level increased
• B. Urinary bilirubin level increased
• C. Urinary urobilinogen level decreased
• D. Fecal urobilin level decreased

Answer: (A)

In this scenario, the issue is excessive breakdown of red blood cells, so bilirubin production soars. The liver conjugates bilirubin, but because much of it is unconjugated, the circulating bilirubin is predominantly the unconjugated form. Unconjugated bilirubin is not water-soluble, so it cannot be excreted in the urine. That’s why the hallmark of hemolytic jaundice is an increased level of unconjugated bilirubin in the blood. The other findings don’t fit because urinary bilirubin appears only when bilirubin is conjugated, and in prehepatic jaundice bilirubin in urine is not elevated; urinary urobilinogen is typically increased due to more bilirubin reaching the gut, and fecal urobilinogen is not characteristically decreased.