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What Causes Fatigue Along With Unconjugated Hyperbilirubinemia And Enlarged Spleen?

Posted on Tue, 13 Sep 2016

Question: hope all is well. I am a 35 year old male that has not being feel well for the last year or so. my main complaint is fatigue. I have a history of elevated unconjugated bilirubin which I assumed was from Gilbert's syndrome. I have had my alt levels increase from time to time but they always fall back to normal. because of this I had an ultrasound which showed a normal liver but a slightly enlarged spleen measuring at 11.8 Ã 11.3 x 5. I also had a positive urine dipstick for trace blood but no blood was found under the microscope. is it possible I can have a type of hemolytic anemia? my platelets run pretty high normal. On last test they were 350.

Answered by Dr. Hardik Sanghvi (1 hour later)

Brief Answer:
You may have hemolytic anemia or some other cause.

Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.

You have fatigue with unconjugated bilirubinemia and enlarged spleen.

You can have hemolytic anemia or some other causes of enlarged spleen.

First of all I need some reports. So please provide me following reports.

Complete blood count with peripheral smear examination, Reticulocytes count, coombh test and complete liver function test.

So please if you have gone through these then attach your reports and if you don't have then go for investigation.

Don't worry about platelets count. It is normal.

I will wait for your reply.

Thanks for using health care magic. Wish you very good health.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Hardik Sanghvi (13 minutes later)

is there anything else that can cause it. it's been like this since 2013. only other thing that I found that fits is cirrhosis of the liver. only reason I think this is possible is because my alt level has been elevated a few times over the years. it always comes back down though so the doctors were never concerned. cirrhosis though wouldn't explain the false positive trace urine rbc dipstick though.

Answered by Dr. Hardik Sanghvi (12 hours later)

Brief Answer:
There are many causes of enlarged spleen.

Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.

Infection, cirrhosis, hemolytic anemia, lymphoma, leukemia, storage disease and many other causes are there.

If you have cirrhosis then ultrasound abdomen indicate the changes of cirrhosis.
Moreover your SGPT, SGPT, alkaline phosphatase all are high.

Hemolytic anemia can be detected by peripheral smear examination.

You should go for standard protocol.
Go for complete blood count with peripheral smear examination and complete liver function test as well as coombh test. Then if needed bone marrow examination should be done in undiagnosed cases.

Trace blood in urine may be or may not be connected with enlarged spleen.

Chances of cirrhosis are low but still we have to keep it in mind.

So please go for all investigation and give follow up with your reports.

Hope I have answered your question. If you have any doubts then feel free to ask me. I will be happy to answer. Thanks for using health care magic. Wish you very good health.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Hardik Sanghvi (40 minutes later)

here was a copy of my last blood work. the bilirubin was not fractioned out in this one. on the last one the direct bilirubin was .3 and the indirect bilirubin was 1.1. thoughts?

Answered by Dr. Hardik Sanghvi (26 minutes later)

Brief Answer:
Your all blood reports are normal except bilirubin.

Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.

Your all reports are almost normal.

Your complete blood count is normal. Your hemoglobin is 14 so you don't have any hemolytic anemia. Your WBC count is normal so it rule out leukemia and other infection. Your platelets count is also normal.

Your liver function test is normal except bilirubin so it rule out liver disease.

Your high bilirubin is due to XXXXXXX syndrome.

So in correlation of all reports your mild enlargement of spleen is not significant clinically. Rather it is not considered as enlarged spleen.

Your urine microscopy is also normal and kidney function tests are normal.

So in my opinion you don't need to worry. Just be relaxed. You don't have any serious disease.

Your fatigue may be due to some other cause. No treatment is required for your spleen right now.

Go for ultrasound spleen and complete blood count after 3 months.

Get checked with thyroid function test once. It can leads to fatigue. If you have any other symptoms or problems then please tell me about that.

Don't worry for cirrhosis, hemolytic anemia or leukemia.

Hope I have answered your question. If you have any doubts then feel free to ask me. I will be happy to answer. Thanks for using health care magic. Wish you very good health.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Hardik Sanghvi (5 hours later)

what is a normal size spleen. is a spleen that measures 11.8 x 11.3 x 5 ENLARGED? it's been the same size since 2013.

Answered by Dr. Hardik Sanghvi (10 hours later)

Brief Answer:
Normal size is 12*6*6

Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.

Normal size of spleen is 11 to 12 cm vertically. transversely it is 6 to 7 cm and 5 to 6 cm in anterior to posterior plan.

If it is more then 13 cm in size or more then 500cc in volume or if it becomes round then it is considered as enlarged spleen. Your spleen is same size till 2013 so it is nothing to worry. Just be relaxed.

Hope I have answered your question. If you have any doubts then feel free to ask me. I will be happy to answer. Thanks for using health care magic. Wish you very good health.

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Priyanka G Raj