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Erythroblastosis fetalis
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Avinash Patil, Brian Brocato, Rebecca A. Uhlmann, Giancarlo Mari
Neonatology management of an infant with hemolytic disease of the newborn focuses on monitoring the level of anemia and hyperbilirubinemia. Symptoms of anemia, such as tachycardia, usually warrant RBC transfusions. In severe cases, exchange transfusions may be necessary to remove the maternal antibodies from the circulation of the infant. Hyperbilirubinemia clinically presents as jaundice. Bilirubin levels are monitored and controlled with phototherapy and IV hydration.
Neonatal jaundice
Published in Samar Razaq, Difficult Cases in Primary Care, 2021
Once a bilirubin level is obtained, it is plotted on a graph. The laboratory in the case outlined here is not being difficult by not giving a normal range for the unconjugated bilirubin level. The result needs to be interpreted in conjunction with the child’s gestational and actual age. The guidance from NICE provides a range of charts for infants of gestational ages ranging from 23 to 38 weeks and above. The correct chart for the child should be printed offand placed in the child’s notes. The x-axis covers the first 14 days of the child’s life. The bilirubin level is plotted on the y-axis. A blue and a red line indicate the two available treatment thresholds. If the bilirubin level falls above the blue line, phototherapy should be considered. If the bilirubin level falls above the red line, then exchange transfusion is the recommended treatment. These treatments are carried out in hospital, hence necessitating a paediatric or neonatal referral, as is locally appropriate. Otherwise, if the child is well and the bilirubin levels are below the treatment threshold, the child can be safely followed up in the community. If the child develops signs and symptoms of acute bilirubin encephalopathy, it should be referred immediately for consideration of exchange transfusion. Raised bilirubin levels requiring treatment are likely to result in further investigations to rule out pathological causes of jaundice.
Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 30 year old female with a background of medullary sponge kidney presents with right upper quadrant pain. On examination blood tests show elevated bilirubin levels. A liver ultrasound demonstrates multiple, dilated cystic structures converging towards the porta hepatis. The cysts communicate with the bile ducts. No peripheral biliary duct dilatation is identified. MRCP shows ectatic intrahepatic ducts extending into the periphery. The common bile duct is dilated but no strictures are seen.
Machine learning algorithms for integrating clinical features to predict intracranial hemorrhage in patients with acute leukemia
Published in International Journal of Neuroscience, 2023
Quanhong Chu, Wenxin Wei, Huan Lao, Yujian Li, Yafu Tan, Xiaoyong Wei, Baozi Huang, Chao Qin, Yanyan Tang
In addition, among the ICH risk features, we found that IBIL and ALB had an AUC higher than 0.8 respectively. Clinical experiences concerning the relationship between bilirubin and ICH risk are limited in the literature. For decades bilirubin was considered to be a harmful waste product and toxic, the accumulation of bilirubin in nervous system may cause irreversible damage to the brain. The levels of serum bilirubin are related to risk of hepatobiliary disease [42]. Meanwhile, albumin is predominantly synthesized in the liver [43]. Moreover, albumin interferes with hemostasis by inhibiting platelet aggregation and promoting vasodilation [44, 45]. According to a previous study [3], ALB has been significantly associated with the incidence of ICH in AL patients. It is generally believed that hepatocellular damage in patients with liver disease can lead to disorders in the synthesis of coagulation factors. Therefore, IBIL and ALB may bring a useful perspective for the dysfunction of the coagulation system. In clinical practice, we should pay attention to the changes in these laboratory data such as IBIL and ALB and make prompt correction to prevent ICH in AL patients.
The Effect of Bilirubin on Clinical Outcomes of Patients With Colorectal Cancer Surgery: A Ten-Year Volume Single-Center Retrospective Study
Published in Nutrition and Cancer, 2023
Zi-Wei Li, Bin Zhang, Xiao-Yu Liu, Bing Kang, Xu-Rui Liu, Chao Yuan, Zheng-Qiang Wei, Dong Peng
The mechanism was not clear, but the possible mechanisms might be as follows. Firstly, bilirubin levels could affect liver function. Abnormal preoperative liver function affects the nutritional and metabolic status of the body and increases the risk of postoperative complications of CRC (26, 27). Secondly, UGT1A1 plays an important role in bilirubin levels. UGT1A1 gene polymorphism with (TA) n repeat mutation is common in CRC patients, resulting in underexpression of UGT1A1 (20). In patients with advanced CRC, the process of transforming IBiI into DBiL is affected, resulting in poor prognosis (21). Thirdly, the previous studies reported that higher serum DBil was associated with an increased risk of lymph node metastasis (28–30) and lymph node metastasis increased the risk of postoperative complications (31), which also helped to explain why DBil was associated with adverse outcomes. In addition, we did not find that TBiL and IBil were significantly associated with complications. Further research might be needed to investigate the effect of TBil and IBil on postoperative complications in patients with CRC.
Bayesian approaches to variable selection in mixture models with application to disease clustering
Published in Journal of Applied Statistics, 2023
For the PBC data, the primary interest is to identify subgroups of patients with similar serum Bilirubin levels and predictors that are associated with these group assignments. Bilirubin is an orange-yellow substance made during the normal breakdown of red blood cells and higher than normal levels of bilirubin may indicate an increased risk of liver problems. Bilirubin was converted to a logarithmic scale (logbili) prior to modeling. Eight predictors were considered in the current analysis, namely treatment (trt, D-penicillamine vs. placebo), edema (edema), alkaline phosphatase (alk.phos), serum cholesterol (chol), serum albumin (albumin), triglycerides (trig), standardized blood clotting time (protime), histologic stage of disease (stage, stage 1 or 2 vs. stage 3 or 4). Here, we initially considered the 312 subjects who participated in the randomized trial. We then removed 30 (9.6%) subjects who had incomplete covariates data. Therefore, the data included in our final analysis consists of 282 subjects. Age was centered and all predictors were standardized such that the means were 0 and variances were 1.