- Unconjugated (pre-hepatic) jaundice results from increased production of bilirubin, typically due to excessive breakdown of red blood cells.
- In hemolytic anemia, accelerated hemolysis leads to an increased load of unconjugated bilirubin overwhelming the liver’s capacity to conjugate it.
- This causes a rise in serum unconjugated bilirubin without affecting conjugated bilirubin levels.
- In contrast, conditions like viral hepatitis, gallstones, and alcoholic liver disease impair bilirubin conjugation or excretion, resulting in conjugated (hepatic or post-hepatic) jaundice.
- Therefore, hemolytic anemia is a classic cause of unconjugated, pre-hepatic jaundice.

Reference: Davidson’s Principles and Practice of Medicine, 24th Edition, Chapter: Jaundice and Liver Disease, Page 807.