Obstructive jaundice and haemolytic disease of the newborn.

Although in most cases of haemolytic disease of the newborn practically all the bilirubin in the serum is of the indirect reacting type, a quarter of a century ago Still (1927) and Hawksley and Lightwood (1934) described cases in which the serum direct reacting bilirubin was raised and signs of obstructive jaundice appeared. This condition came to be known as the 'inspissated bile syndrome' (Hsia, Patterson, Allen, Diamond and Gellis, 1952). In 1959 Oppe and Valaes reported a systematic study of this condition. They confirmed that the findings of hepatosplenomegaly (Lathe, 1955), gross anaemia and hyperbilirubinaemia, including an elevated conjugated fraction (Cornblath, Kramer and Kelly, 1955; Stempfel, Broman, Escard6 and Zetterstrom, 1956), were present at birth. They also noted that the jaundice in these babies took on a greenish hue and that a tendency to bleed sometimes developed. Recent papers (Billing and Lathe, 1958; Zuelzer and Brown, 1%1b) have shown that the 'indirect' fraction is made up of free bilirubin and bilirubin monoglucuronide, both of which are largely formed at extrahepatic sites. The 'direct' fraction represents bilirubin diglucuronide which is probably formed only in the liver. TABLE I