Jaundice a condition manifested by yellowness of the skin and eyes owing to deposition of bile pigment resulting from excess bilirubin in the blood. Locally the disease is also known as pandurog, kamla or nayba. During the normal breakdown of old erythrocytes (red blood cells), their heamoglobin is converted into bilirubin. Normally the bilirubin is removed from the bloodstream by the liver and eliminated from the body in the bile, which passes from the liver into the intestine. There are several conditions that may interrupt the elimination of bilirubin from the blood and cause jaundice.
Heamolytic jaundice is a rare chronic form of jaundice that results from increased destruction of red blood cells. It occurs in hemolytic and other types of anemia. Some infectious diseases like malaria, or improper matching of blood groups at the time of blood transfusions may induce jaundice. In this case, the serum bilirubin may be slightly elevated even though bile pigment production may be increased to as much as six times the normal level. In this case the spleen is usually enlarged. In Bangladesh, heamolytic jaundice occurs in mostly due to the results of thalassemia and haemoglobin-E diseases.
Parenchymal or hepato-cellular jaundice occurs when diseases such as viral hepatitis or cirrhosis of the liver, bacterial or protozoal infection etc damage the liver cells. The damaged liver is unable to remove bilirubin from the blood. Among the jaundice affected patients in Bangladesh, parenchymal or hepato-cellular jaundice is more common. Hepatitis B or Hepatitis C virus causes this kind of jaundice, whereas the Hepatitis B virus is more active than the Hepatitis C virus. HB virus contaminates fresh bodies through drinking water or receiving infected bloods. Unlike the reports from developed countries, the morbidity of patients with HB virus infection in Bangladesh appears to be higher. A study conducted from January 1987 to June 1990 showed that a great majority of the patients with hepatitis developed chronic liver disease within a short period after HBV infection and most of them died from hepatic failure. Another medical report in 1991 indicated that the blood of 20 percent professional blood donors, 11 percent prostitutes and 8 percent drug abusers bear Hepatitis B virus.
Obstructive jaundice results from obstruction of bile passage, usually the gallstone in the bile duct and blocks the passage of bile from the liver into the intestine.
In some cases jaundice occurs to children during the first 24 hours after birth which is named as pathological jaundice of newborn. It is caused by the destruction of red blood cells by maternal antibodies generated by previous faetal-maternal transfusion. In the newborn severe jaundice may damage the cells of the basal ganglia and the brainstem, and may lead to deafness, cerebral palsy or death.
Taking rest, enough of drinking water and sugared food and avoiding fats are the essential curative measures for jaundice infected patients. HBV infection is now preventable by vaccination and the vaccine is available in all hospitals and major health centres of Bangladesh. [Md Mahbub Murshed]