Chapter 043. Jaundice (Part 3) Evaluation of the patient with jaundice. MRCP, magnetic resonance cholangiopancreatography; ALT, alanine aminotransferase; AST, aspartate aminotransferase; SMA, smooth-muscle antibody; AMA, antimitochondrial antibody; LKM, liver-kidney microsomal antibody; SPEP, serum protein electrophoresis; CMV, cytomegalovirus; EBV, Epstein-Barr virus. Isolated Elevation of Serum Bilirubin Unconjugated Hyperbilirubinemia The differential diagnosis of an isolated unconjugated hyperbilirubinemia is limited (Table 43-1). The critical determination is whether the patient is suffering from a hemolytic process resulting in an overproduction of bilirubin (hemolytic disorders and ineffective erythropoiesis) or from impaired hepatic uptake/conjugation of bilirubin (drug effect or genetic disorders). Table 43-1 Causes of Isolated Hyperbilirubinemia I. Indirect hyperbilirubinemia A. Hemolytic disorders 1. Inherited a. Spherocytosis, elliptocytosis Glucose-6-phosphate dehydrogenase a nd pyruvate kinase deficiencies b. Sickle cell anemia 2. Acquired a. Microangiopathic hemolytic anemias b. Paroxysmal nocturnal hemoglobinuria c. Spur cell anemia d. Immune hemolysis B. Ineffective erythropoiesis 1. Cobalamin, folate, thalassemia, and severe iron deficiencies C. Drugs 1. Rifampicin, probenecid, ribavirin D. Inherited conditions 1. Crigler- Najjar types I and II 2. Gilbert's syndrome II. Direct hyperbilirubinemia A. Inherited conditions 1. Dubin- Johnson syndrome 2. Rotor's syndrome . Chapter 043. Jaundice (Part 3) Evaluation of the patient with jaundice. MRCP, magnetic resonance cholangiopancreatography; ALT,