Which of the following are typical findings in extravascular hemolysis?
a. Increased serum and urine conjugated bilirubin
b. Increased serum and urine unconjugated bilirubin
c. Increased serum unconjugated bilirubin and increased urine urobilinogen
d. Decreased urine and stool conjugated bilirubin
ANS: C
During the process of extravascular hemolysis, macrophages phagocytize and break down hemoglobin into its various component parts. Unconjugated bilirubin is thus increased. This is taken to the liver, where it is conjugated. Bacteria in the gut oxidize conjugated bilirubin into various water-soluble compounds that together are called urobilinogen. Some of this is reabsorbed into the plasma and because of its water solubility will be filtered by the renal glomerulus and excreted into urine. This results in an increase in urobilinogen in the urine.
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