Urgent Investigation in Acute Jaundice
- Full blood count and film (Chapter 100)
- Coagulation screen (Chapter 102)
- Blood glucose
- Sodium, potassium, urea and creatinine
- Liver function tests: bilirubin (total and unconjugated), aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transpeptidase, alkaline phosphatase, albumin
- Paracetamol level (Appendix 36.1)
- Serum lactate dehydrogenase (LDH) and haptoglobin if suspected haemolysis
- Blood culture if febrile
- Urine stick test, microscopy and culture
- Markers of viral hepatitis (anti-HAV IgM, HBsAg, anti-HBc IgM, anti-HCV, anti-HEV, EBV)
- Test for HIV
- Autoimmune screen (ANA, AMA, SMA, ANCA and immunoglobulins)
- Microscopy and culture of ascites if present (aspirate 10 mL for cell count (use EDTA tube) and culture (inoculate blood culture bottles) (see Chapter 24)
- Ultrasound of liver, biliary tract and hepatic/portal veins
- Pregnancy test in women of child-bearing age
- Consider copper studies in young adults (Wilson disease, see Table 77.1)
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EDTA, ethylene diaminetetra-acetic acid; HAV, hepatitis A virus; HBc, hepatitis B core; HBsAg, hepatitis B surface antigen; HCV, hepatitis C virus; HEV, hepatitis E virus; IgM, immunoglobulin M; HIV, human immunodeficiency virus; LDH, lactate dehydrogenase; EBV, Epstein-Barr Virus; ANA, anti-nuclear antibody; AMA, anti-mitochondrial antibody; SMA, smooth muscle antibody; ANCA, anti-neutrophil cytoplasmic antibody.