Patient who is on indinavir treatment presented with jaundice. On detailed evaluation is is found that the elevated bilirubin is mainly indirect fraction. The probable mechanism of indirect hyperbilirubinemia in this setting would be:
Unconjugated Hyperbilirubinemia Increased bilirubin production Eg: hemolysis, ineffective erythropoiesis, blood transfusion, resorption of hematomas) Decreased hepatocellular uptake eg: drugs such as rifampin, Gilbe's syndrome ) Decreased conjugation Eg:Gilbe's syndrome, Crigler-Najjar syndrome, physiologic jaundice of the newborn, drugs such as indinavir, atazanavir) Ref:Sleisenger and Fordtran's,E-9,P-325
Increased bilirubin production
Decreased hepatocellular uptake
Decreased conjugation
Hemolysis