What initial investigations should I perform for a patient presenting with jaundice in primary care?

For a patient presenting with jaundice in primary care, initial investigations primarily aim to determine the urgency and appropriate pathway for referral, as most cases require urgent admission or referral to secondary care due to serious underlying causes ¹.

• Clinical Assessment: Assess for the presence of red flag signs and symptoms ¹.
• Blood Tests:
  • Liver Function Tests (LFTs): These should include total bilirubin, alanine aminotransferase (ALT) or aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) ¹,⁴.
  • Clotting Profile: Specifically, prothrombin time ¹,⁴.
  • Renal Function: Assess for abnormal renal function ¹.
  • Full Blood Count (FBC): Perform a full blood count ⁴.
  • Other Blood Tests: Include serum albumin and total globulins ⁴.

It is important to note that a bilirubin level greater than 100 micromol/L, an abnormal clotting profile, or abnormal renal function are criteria for arranging same-day secondary care assessment and admission ¹.

In specific circumstances, such as a well person with serologically confirmed Hepatitis A or a diagnosis of Gilbert's syndrome, management may occur in primary care ¹.