Differential Diagnosis for Elevated Bilirubin, AST, and Creatinine in a Sickle Cell Patient

Single Most Likely Diagnosis

• Sickle Cell Nephropathy with Hepatic Involvement: This condition is a common complication in sickle cell patients, leading to renal impairment (elevated creatinine) and can also affect the liver, causing elevated bilirubin and AST due to sickling within the liver and kidneys.

Other Likely Diagnoses

• Hemolytic Crisis: A condition where red blood cells are destroyed faster than they can be made, leading to elevated bilirubin. It can also cause AST elevation due to liver involvement and potentially affect kidney function.
• Sepsis: Infections can lead to multi-organ dysfunction, including liver and kidney impairment, which would explain the elevated bilirubin, AST, and creatinine in a sickle cell patient.
• Medication-induced Hepatotoxicity and Nephrotoxicity: Certain medications used in the management of sickle cell disease can cause liver and kidney damage, leading to the observed laboratory abnormalities.

Do Not Miss Diagnoses

• Acute Hepatic Sequestration: A life-threatening complication of sickle cell disease where red blood cells sequester in the liver, leading to liver enlargement and potentially elevated liver enzymes and bilirubin.
• Renal Infarction: Sickle cell disease increases the risk of renal infarction, which can cause a sudden increase in creatinine and potentially affect liver function tests if there is associated systemic illness.
• Hepatic Venous Outflow Obstruction (Budd-Chiari Syndrome): Although rare, this condition can occur in sickle cell patients and would lead to elevated liver enzymes, bilirubin, and potentially affect kidney function due to decreased renal perfusion.

Rare Diagnoses

• Wilson's Disease: A genetic disorder leading to copper accumulation in the liver and potentially the kidneys, causing liver and kidney dysfunction. It's rare but could present similarly in a patient with sickle cell disease if not properly diagnosed.
• Autoimmune Hemolytic Anemia with Renal and Hepatic Involvement: A condition where the immune system attacks red blood cells, potentially causing hemolysis, and could have associated autoimmune hepatitis and nephritis, leading to the observed lab abnormalities.