A 22-year-old man has incidental bilirubin of 2.4 mg/dL, entirely indirect reacting. Hemogram, reticulocyte count, LDH, haptoglobin, AST, ALT and ALP are all normal. Urinalysis shows no bilirubin. Fasting for two days before a recent blood donation drive raised his bilirubin further. The MOST likely diagnosis is:
- A Hereditary spherocytosis with compensated hemolysis
- B Crigler-Najjar syndrome type II
- C Gilbert syndrome ✓
- D Rotor syndrome
Correct answer: C. Gilbert syndrome
Explanation
Gilbert syndrome is a common benign condition with reduced hepatic UDP-glucuronosyltransferase activity, producing mild unconjugated hyperbilirubinemia, usually under 4 mg/dL, that worsens with fasting, illness or exertion. All other liver tests are normal and bilirubin is absent from urine because the pigment is unconjugated. Crigler-Najjar type II gives much higher levels, and hemolysis is excluded by the normal hemogram and LDH.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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