Approach to jaundice (unconjugated hyperbilirubinemia) Quiz: Ace Your Exams

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A 51-year-old man presents to the emergency department due to lethargy and weakness. The symptoms started abruptly three days ago and have gotten slowly worse since then. The patient has no significant past medical history and takes no medications. Temperature is 36.8ºC (98.2ºF), pulse is 96/min, blood pressure is 98/61 mmHg, respirations are 16/min and SpO2 is 99% on room air. On physical examination the patient is pale and lethargic. There are no abnormal findings on abdominal exam. There is no lower extremity edema. Bloodwork is obtained and results are shown below. Which of the following tests should be ordered next?
 
Serum Test
Result
Hemoglobin
6.8 g/dL
Haptoglobin
Decreased
Total Bilirubin
7.4 mg/dL
LDH
450 U/L (nml: 140-280 U/L)

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