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Although unpleasant, this was not dangerous and the discolouration eventually faded over time with no long-term health effects. [5] A more serious consequence of working with TNT powder was liver toxicity, which led to anaemia and jaundice. This condition, known as "toxic jaundice", gave the skin a different type of yellow hue.
Hepatic jaundice is caused by abnormal liver metabolism of bilirubin. [26] The major causes of hepatic jaundice are significant damage to hepatocytes due to infectious, drug/medication-induced, autoimmune etiology, or less commonly, due to inheritable genetic diseases. [27] The following is a partial list of hepatic causes to jaundice: [28]
Physical examination reviews clinical symptoms like degree of jaundice, vital signs and sensations of pain, further followed by urine tests, blood analysis and imaging. [3] [4] The degree of yellowish staining of the conjunctiva and skin in jaundice is proportional to hyperbilirubinemia to some extent. [6]
They found that the effects of the TNT could be roughly split into two areas: irritative symptoms, mainly affecting the skin, respiratory tract, and digestive system; and toxic symptoms, including nausea, jaundice, constipation, dizziness, etc. [3] It is possible that the irritative symptoms were also partly caused by the cordite in the shell ...
Mild jaundice may appear under conditions of exertion, stress, fasting, and infections, but the condition is otherwise usually asymptomatic. [7] [8] Severe cases are seen by yellowing of the skin tone and yellowing of the conjunctiva in the eye. [9] Gilbert syndrome has been reported to contribute to an accelerated onset of neonatal jaundice.
Acute liver failure is the appearance of severe complications rapidly after the first signs (such as jaundice) of liver disease, and indicates that the liver has sustained severe damage (loss of function of 80–90% of liver cells).
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The above list is not exhaustive, and rare causes of hemolysis such as Bartonella infection, [18] hemolysis due to transfusion reactions, [19] and microangiopathic hemolytic anemia [20] should be suspected when symptoms specific to those causes manifest.