Honors Urinalysis Home Middle Aged Woman Case Study Teenage Boy Case Study |
Middle-Aged Woman with Dark Urine | ||||||||||||||||||||||||
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2. If the patient shows signs of jaundice, and there is urobilinogen present, then why is the bilirubin negative? Hemoglobin in the blood is made into unconjugated bilirubin in the reticuloendothelial system, then into conjugated bilirubin in the liver, which is in turn made into urobilinogen in the intestines. Since the patient suffers from hemoglobinuria, there is excess unconjugated bilirubin presented to the liver; however, the liver is not impaired in any way. In this prehapatic jaundice, the healthy liver converts all the unconjugated bilirubin into bilirubin, and the intestines convert all the bilirubin into urobilinogen which gets absorbed back into the blood and eventually makes its way into the urine. Since all the conjugated bilirubin is made into urobilinogen (and the unconjugated bilirubin cannot cross the glomerulus), bilirubin is negative on the stix. A 35 year old woman went to the doctor complaining of fatigue, shortness of breath, and dark urine. Her skin was very pale, and the whites of her eyes were slightly yellow. She reported recently having a sinus infection which was treated with penicillin. Urinalysis results are:
Microscopic amorphous 2+ hemosiderin granules present Upon receiving the urinalysis results, the physician orders a blood test for haptoglobin which comes back less than 5 mg/dL (reference range = 26-185 mg/dL). |