Written by Sickle Cell Warrior on 29 November 2010
Go the mirror. Look at your eyes. Your sclera (the white part around your pupil) might be white, or it might be varied shades of yellow. This is as a result of Jaundice, and many sickle cell patients have yellow eyes.
Jaundice, also referred to as icterus, is the yellow staining of the skin and sclerae (the whites of the eyes) by abnormally high blood levels of the bile pigment, bilirubin. The yellowing extends to other tissues and body fluids and also may turn the urine dark.
So what happens in sickle cell patients that gives us yellow eyes so much of the time?
It all starts and ends with the red blood cells. When red cells die, they are broken down and destroyed by the body, broken down into base parts and sent for either excretion or recycling. This is a normal process that leaks hemoglobin into the blood. The hemoglobin is converted to bilirubin so that it can be excreted by the body. However, bilirubin is not water soluble and must be mixed with other substances to make it disposable. The liver modifies bilirubin into bile, and then the bile goes to the intestines, is converted by bacteria to urobilirubin and is then excreted in stool (this is what makes poop brown) or in urine.
The average healthy red cell lives about 90-120 days. The average sickle cell lives about 10-12 days. So with sickle cell patients, the volume of cells being destroyed, repackaged and dumped is exponentially greater than those who do not have sickle cells. As a result, the system becomes overloaded and sometimes, the bilirubin just keeps floating around and around in the blood until your liver is able to convert and excrete it. In light skinned people, there might be a yellow tinge to their skin. For those of a darker persuasion, the yellowing is only noted in the sclerae of the eyes and sometimes in the fingernail beds.
Even those who get regular blood transfusions are prone to jaundice. This is because with blood transfusions, hemolysis (cell death), occurs with the red blood cells that are transfused into you. Anytime red blood cells are manipulated, some of them die. There is much manipulation from getting the blood from the donor, processing it, sterilizing it, storage, transferring and even infusing it into you. So even if you get transfused with a fresh bag of blood, there are still dead cells floating in there that your body has to convert and excrete. If you get several units, this could lead to a backup of your system.
If your liver is unable to deal with the overload, or you have a damaged liver from medications, vaso-occlusive crises, hepatitis or other conditions, the jaundice might overwhelm your system and lead to other complications like sepsis (infection), cholangitis, biliary cirrhosis, pancreatitis, coagulopathy, renal and liver failure.
One day, I was walking across my college campus and a lovely woman stopped me. “Excuse me, can I ask you a personal question?” When I said yes, she asked me if I had sickle cell disease. I was shocked and surprised, and immediately asked her, “How did you know?” To which, she told me that it was by my yellow eyes. Yellow eyes, which I had always thought were an anomaly served as an external identifier of having sickle cell disease.
Since then, I look at my eyes every morning. The shades of yellow tell me about what’s going on in my body. I always have some shade of yellow, but the more yellow my eyes, are, the more prone I am to having a full blown crises. Also, when I just get transfused, my eyes are yellow for several weeks until my body processes the blood.
So how do you get rid of yellow eyes and jaundice?
The first line of defense is to drink a lot of water. Hydrating your system will help dilute the bilirubin and get rid of other waste products in your system via the kidneys, leaving the liver with less work to do.
The second important thing is to ensure you have a healthy liver. The liver is one of the most important organs in the body, and with sickle cell patients, we must love and care for our livers. All foods, medications and drugs that you take are broken down by the liver, so before you pop the pill or eat that French fry; think of the work your liver must do to excrete it.
Vitamins A and D are excreted by the liver, so take only the recommended daily requirement and no more.
Ensure that you take only medications that are not harmful to the liver. Tylenol is broken down by the liver, so use with discretion.
At your next doctor appointment, ask for her to draw your AST/ALT (liver enzyme) levels so you know how damaged or awesome your liver is.
Have a low fat diet. Fatty deposits can attach to your liver, making it inefficient, unable to do its work, and…well fat;) So stick to a healthy diet.
Watch your protein intake. The liver is in charge of processing protein, and a diet high in protein can overload the liver. Dairy and vegetarian proteins are easier to process than meat proteins, so choose wisely.
Stay away from over-processed foods. The chemicals in processed, canned, pickled, packaged foods have to be broken down by the liver, so try to stick to fresh, whole, organic and natural foods as much as possible.
Beware of your herbal remedies. Plants of Senecio, Crotalaria, and Heliotopium families are hepato-toxic (harmful to the liver). Plus chaparral, germander, comfrey, mistletoe, skullcap, margosa oil, mate tea, Gordolobo yerba tea, pennyroyral and Jin Blu Huan.
Foods Recommended to Reduce Jaundice:
For Your Juicing try: Beets, gooseberry, ripe banana, sugar cane juice with half a lemon, lime juice, ginger juice, tomato juice, or barley water
For Your Teas, boil and steep: Bitter leaves like karela, luffa, lemon leaves, radish leaves, or 2 teaspoons of oregano for 10 minutes
For Your Snacks try: Almonds, dates, cardamoms, prunes
Fauci, Anthony S., et al. Harrison’s Principles of Internal Medicine. 17th ed. United States: McGraw-Hill Professional, 2008.