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30 year old man referred from GP to A&E with jaundice and "tea…

- - - - Inherited RBC hemolysis: enzyme deficiency, cytoskeletal, hemoglobin abnormality e.g G6PD deficiency, spherocytosis, thalassemia, sickle cell anemia
      - Acquired RBC hemolysis: autoimmune (infective, neoplastic, etc); microangiopathic hemolytic anemia, mechanical hemolysis, or malaria
      - (IF NEONATES): prone to hepatic jaundice as their immature liver has a lower capacity for conjugation; in neonates, also consider, sepsis, hypothyroidism, reabsorption of large hematoma
      - In hemolysis, splenomegaly tends to equal or exceed hepatomegaly; check LFT with LDH + FBC with reticulocytes, peripheral blood film, haptoglobin, direct Coomb's test
    - - Impaired hepatic uptake: drugs (e.g. contrast, rifampicin, probenecid); congestive heart failure or portosystemic shunts which decrease bilirubin delivery to liver
      - Impaired conjugation: congenital Gilbert's or Crigler-Najjar syndrome, affecting the UGT enzyme important in conjugation
      - (IF NEONATES): consider elevated enterohepatic recirculation due to breast milk jaundice, breast feeding jaundice or intestinal obstruction