The Clinical Problem Solvers Episode 343 – Clinical Unknown – Ravi and Reza dealing with silent jaundice
Jul 5, 2024
Ravi and Reza discuss a case of silent jaundice in a 76-year-old woman, exploring potential causes such as primary biliary cirrhosis, chronic lymphocytic leukemia, and autoimmune hemolytic anemia. They focus on the diagnostic journey, including lab interpretations and treatment options, emphasizing the importance of clinical expertise and problem-solving skills.
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Jaundice Framework Overview
- The initial approach to jaundice should consider hemolytic, hepatic, or posthepatic causes systematically.
- Considering silent jaundice without other symptoms can hint towards hemolysis or liver dysfunction without inflammation.
Use Coombs Test Early
- Always check a Coombs test in hemolytic anemia workup to differentiate immune from non-immune causes.
- Peripheral smear finding of spherocytes suggests autoimmune hemolytic anemia linked with CLL.
Three S's in Hemolytic Anemia
- The triad of spherocytes, schistocytes, and smudge cells on a peripheral smear points towards CLL with hemolytic anemia.
- Combining clinical and lab findings helps integrate autoimmune hemolysis secondary to hematologic malignancy.