A 24-year-old man comes to the clinic for a routine physical examination required for a new job. He reports feeling well and has no current complaints. However, he mentions that he occasionally notices a mild yellowish tint to his eyes, particularly when he is stressed or fasting for religious holidays. He takes no medications and does not consume alcohol. Vital signs are temperature 37.0°C (98.6°F), blood pressure 118/76 mmHg, pulse 72/min, and respirations 14/min. Physical examination is notable for mild scleral icterus but no abdominal tenderness or hepatosplenomegaly.
Laboratory results are as follows:
| Laboratory Test | Result | Reference Range |
|---|---|---|
| Hemoglobin | 15.2 g/dL | 13.5-17.5 g/dL |
| Platelet count | 250,000/mm³ | 150,000-400,000/mm³ |
| Reticulocyte count | 1.2% | 0.5-1.5% |
| Total bilirubin | 2.8 mg/dL | 0.1-1.2 mg/dL |
| Direct bilirubin | 0.4 mg/dL | 0.0-0.3 mg/dL |
| Aspartate aminotransferase (AST) | 18 U/L | 8-20 U/L |
| Alanine aminotransferase (ALT) | 20 U/L | 8-20 U/L |
| Alkaline phosphatase | 70 U/L | 44-147 U/L |
A peripheral blood smear shows normal red blood cell morphology.
Based on these laboratory findings, which of the following is the most likely diagnosis?
- Gilbert syndromeCevap
- BAutoimmune hemolytic anemia
- CAcute viral hepatitis
- DCholedocholithiasis
- EPrimary sclerosing cholangitis