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Jaundice Work-Up and Management After Threshold for Phototherapy

Writer: MaytaMayta
Aug 4, 20242 min read

Initial Work-Up

  1. Complete Blood Count (CBC) and Peripheral Blood Smear (PBS)

    • CBC: Assess overall health, detect anemia, infection, and other disorders.

    • PBS: Identify abnormal red blood cell shapes, which may indicate hemolytic diseases.

  2. Reticulocyte Count

    • Purpose: Measure young red blood cells, which can indicate the bone marrow's response to anemia.

  3. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency

    • Purpose: Screen for G6PD deficiency, a common cause of hemolytic jaundice.

  4. Blood Group (ABO and Rh) of Both Mother and Child

    • Purpose: Identify ABO or Rh incompatibility which can cause hemolytic disease of the newborn.

  5. Direct Antiglobulin Test (DAT) or Coombs Test

    • Purpose: Detect antibodies that are bound to the surface of red blood cells, indicating immune-mediated hemolysis.

Follow-Up

  1. Hematocrit (HCT)

    • Purpose: Measure the proportion of red blood cells in the blood to assess anemia.

  2. Methemalbumin (MB)

    • Purpose: Identify significant hemolysis, as methemalbumin is released during hemolysis.

Management After Phototherapy Threshold

  1. Phototherapy

    • Indication: Initiate when bilirubin levels reach the threshold according to guidelines based on age in hours and risk factors.

    • Goal: Reduce bilirubin levels through photo-oxidation, making bilirubin more water-soluble and easier to excrete.

  2. Hydration

    • Purpose: Maintain adequate hydration to enhance bilirubin excretion.

  3. Monitoring Bilirubin Levels

    • Frequency: Regular monitoring of serum bilirubin levels to assess the effectiveness of phototherapy and decide on continuation or escalation of treatment.

  4. Exchange Transfusion (if necessary)

    • Indication: Consider if bilirubin levels are dangerously high or if there are signs of acute bilirubin encephalopathy despite intensive phototherapy.

    • Goal: Rapidly decrease serum bilirubin levels and remove antibody-coated red blood cells.

Summary

This structured approach ensures a comprehensive evaluation and management plan for jaundiced infants requiring phototherapy. Continuous monitoring and timely interventions based on guidelines are crucial to prevent complications such as kernicterus.

 
 
 

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Post: Blog2_Post

Message for International Readers
Understanding My Medical Context in Thailand

By Uniqcret, M.D.
 

Dear readers,
 

My name is Uniqcret, which is my pen name used in all my medical writings. I am a Doctor of Medicine trained and currently practicing in Thailand, a developing country in Southeast Asia.
 

The medical training environment in Thailand is vastly different from that of Western countries. Our education system heavily emphasizes rote memorization—those who excel are often seen as "walking encyclopedias." Unfortunately, those who question, critically analyze, or solve problems efficiently may sometimes be overlooked, despite having exceptional clinical thinking skills.
 

One key difference is in patient access. In Thailand, patients can walk directly into tertiary care centers without going through a referral system or primary care gatekeeping. This creates an intense clinical workload for doctors and trainees alike. From the age of 20, I was already seeing real patients, performing procedures, and assisting in operations—not in simulations, but in live clinical situations. Long work hours, sometimes exceeding 48 hours without sleep, are considered normal for young doctors here.
 

Many of the insights I share are based on first-hand experiences, feedback from attending physicians, and real clinical practice. In our culture, teaching often involves intense feedback—what we call "โดนซอย" (being sliced). While this may seem harsh, it pushes us to grow stronger, think faster, and become more capable under pressure. You could say our motto is “no pain, no gain.”
 

Please be aware that while my articles may contain clinically accurate insights, they are not always suitable as direct references for academic papers, as some content is generated through AI support based on my knowledge and clinical exposure. If you wish to use the content for academic or clinical reference, I strongly recommend cross-verifying it with high-quality sources or databases. You may even copy sections of my articles into AI tools or search engines to find original sources for further reading.
 

I believe that my knowledge—built from real clinical experience in a high-intensity, under-resourced healthcare system—can offer valuable perspectives that are hard to find in textbooks. Whether you're a student, clinician, or educator, I hope my content adds insight and value to your journey.
 

With respect and solidarity,

Uniqcret, M.D.

Physician | Educator | Writer
Thailand

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