Jaundice is a condition characterized by a yellowing of the skin and the whites of the eyes. This discoloration occurs due to an excess accumulation of bilirubin, a yellow pigment, in the blood. Jaundice affects both newborns and adults. Understanding its signs and mechanisms is important for timely recognition and management.
Understanding Jaundice
Jaundice results from a buildup of bilirubin, a yellow substance formed when old red blood cells break down. Normally, bilirubin travels to the liver, where it is processed and then excreted from the body in bile. When this process is disrupted, bilirubin levels in the blood rise, leading to jaundice.
Causes of jaundice can be categorized into three types: prehepatic, hepatic, and posthepatic. Prehepatic jaundice occurs before the liver processes bilirubin, often due to excessive red blood cell breakdown (e.g., hemolytic anemia). Hepatic jaundice occurs when the liver cannot process bilirubin efficiently, often caused by liver diseases like hepatitis or cirrhosis. Posthepatic (obstructive) jaundice results from a blockage in the bile ducts, preventing bilirubin excretion.
Specific Factors in African Americans
Certain conditions more prevalent in African Americans can influence the occurrence of jaundice. Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic disorder common in people of African, Mediterranean, and Asian descent. This deficiency can lead to the premature breakdown of red blood cells, leading to hemolysis and releasing more bilirubin into the bloodstream, causing jaundice.
Sickle cell disease (SCD) and sickle cell trait (SCT) are also more common in African Americans. In SCD, red blood cells become rigid and sickle-shaped, leading to their rapid destruction, often surviving only 10 to 20 days compared to the normal 120 days. This accelerated breakdown releases substantial bilirubin, overwhelming the liver’s processing ability and causing jaundice. Genetic variations can also influence bilirubin metabolism or liver function, potentially increasing jaundice susceptibility or severity in this population.
Identifying Jaundice in Darker Skin
Identifying jaundice in darker skin can be challenging as skin yellowing may be less apparent due to higher melanin. The most reliable area to inspect for jaundice, regardless of skin tone, is the sclera. The sclera has a high elastin content and a strong affinity for bilirubin deposition, and its lack of melanin makes the yellow discoloration more visible.
Other areas that can show signs of jaundice include the mucous membranes, such as gums, inner lips, palms, and soles of the feet. Beyond visual cues, other general symptoms include dark urine due to excess bilirubin excretion, and pale or clay-colored stools from reduced bile flow. Fatigue and itchiness are also common symptoms. Promptly noticing these signs and seeking medical attention is important.
Diagnosis and Treatment Approaches
Diagnosing jaundice involves medical tests to measure bilirubin levels and identify the underlying cause. A bilirubin blood test directly measures the amount of bilirubin in the blood, with elevated levels indicating a problem with liver function or red blood cell breakdown. A hepatic function panel assesses various markers, including albumin, ALP, ALT, and AST, to provide insights into the liver’s overall condition and detect potential damage or disease. A complete blood count (CBC) can also be used to assess overall blood health and identify conditions like anemia or infection that may contribute to jaundice.
Treatment for jaundice focuses on addressing the specific underlying cause. For newborns with high bilirubin levels, phototherapy is a common intervention. This treatment uses special blue-green light to convert bilirubin molecules in the skin into water-soluble forms that can be more easily excreted by the body. If phototherapy is not sufficient or if the jaundice is severe, intravenous immunoglobulin (IVIG) or an exchange transfusion may be necessary to rapidly reduce bilirubin levels. Medications or other interventions treat the specific condition causing jaundice in adults. Professional medical evaluation is advised for any suspected case of jaundice.