During the nursing assessment of a patient with hemolytic anemia, which physical examination findings should the nurse specifically focus on?

Choice A rationale:

Elevated serum bilirubin levels can be seen in hemolytic anemia due to increased breakdown of red blood cells.

However, it is not specific to hemolytic anemia and can occur in other conditions as well.

Choice B rationale:

Haptoglobin is a protein that binds to free hemoglobin released from the destruction of red blood cells.

In hemolytic anemia, there is increased hemolysis, leading to a decrease in haptoglobin levels as it gets consumed to bind to the released hemoglobin.

This is consistent with the clinical picture described in the question.

Choice C rationale:

Lactate dehydrogenase (LDH) is an enzyme found in various tissues, including red blood cells.

Elevated LDH levels can be seen in hemolytic anemia due to the release of LDH from damaged red blood cells.

However, LDH elevation is not specific to hemolytic anemia and can occur in other conditions.

Choice D rationale:

The absence of abnormalities in the peripheral blood smear does not rule out hemolytic anemia.

Some forms of hemolytic anemia may not show distinct abnormalities in the appearance of red blood cells on a peripheral blood smear.

"Bilirubin is primarily excreted through the kidneys." This statement is not accurate.

While some bilirubin is excreted through the kidneys, the primary route of bilirubin excretion is through the liver and bile.

Bilirubin is converted to conjugated bilirubin in the liver, which is then excreted in bile.

Choice B rationale:

"Bilirubin is stored in the liver as hemosiderin." This statement is incorrect.

Hemosiderin is not a form of bilirubin but rather a storage form of iron in the liver and other tissues.

Choice C rationale:

"Bilirubin is recycled into iron and biliverdin." This statement is not accurate.

Bilirubin is primarily metabolized in the liver and conjugated before being excreted in bile.

It does not get recycled into iron and biliverdin.

Choice D rationale:

"Bilirubin is conjugated in the liver and excreted in bile." This is the correct answer.

Bilirubin is produced from the breakdown of heme in red blood cells and is then processed in the liver, where it is conjugated (combined with glucuronic acid) to form conjugated bilirubin.

Conjugated bilirubin is excreted in bile and eventually eliminated from the body in feces.