Marked increase in serum bilirubin in sickle cell anemia

Six patients with sickle cell anemia developed extremely high levels of serum bilirubin. In 4 instances, the elevated levels occurred during an episode of viral hepatitis. Two cases occurred at the time of common bile duct obstruction. The heavy burden of pigment resulting from increased red cell destruction was thought to lead to extreme hyperbilirubinemia, when combined with acute hepatic damage or common bile duct obstruction. Under similar circumstances, increased hemolysis from any cause may lead to markedly elevated levels of serum bilirubin.