DR FLO: Is this urine colour normal?

Dr Flo, I am a 24-year-old man. Every time I go for a short call, my urine is yellowish in colour. This has gone on for three years now. What might be the problem? Dennis

Dear Dennis,

Normal urine is yellow due to pigments that are excreted in the urine. The colour ranges from pale yellow to deep yellow, depending on the amount of pigment and how much water you have taken.

The more water you take, the lighter the urine colour. If you are dehydrated, or you sweat a lot because of being in a hot environment or due to exercise, the urine colour is usually deep yellow. Some foods, food dyes and medications can change the colour of your urine. If the colour is too dark, you can have the urine tested for urinary tract infection, and get tests to check for kidney and liver disease.

***

Dr Flo, what is the relationship between haemolysis, thalassemia minor, anaemia, and the liver-spleen-bile system? Where does sludge feature in all this? How can this system be made manageable? Upin

Dear Upin,

In the red blood cells there is a protein called haemoglobin, which is responsible for carrying oxygen from the lungs and delivering it to body tissues. Adult haemoglobin is a complex protein, made up of 4 protein chains, 2 alpha chains and 2 beta chains. These proteins are made by specific genes.

When these genes have a problem, they make abnormal protein chains that either don’t work at all, or abnormal protein chains that don’t work well.

The specific genes may also be absent so the protein chains are not made at all. If the genes making the alpha chains have a problem, you get alpha thalassemia, if it is the beta chains genes with a problem, you get beta thalassemia.

Thalassemia is a genetic disorder, which means you inherit it from your parents. Because it is a recessive disorder, you have to get the abnormal genes from both your parents to get severe disease. Thalassemia minor means that the disease is mild, because you are a carrier or you got the abnormal genes from only one of your parents and you do not have the “full” disease.

Because the haemoglobin in the red blood cells is abnormal, there is excessive destruction of the red blood cells, called haemolysis, leading to anaemia. Anaemia is the lack of enough healthy red blood cells to carry oxygen. This results in getting tired easily, running out of breath, headaches, dizziness and looking pale.

The spleen removes old or abnormal red blood cells from circulation and breaks them down to the heme and globin components. The heme part is broken down to bilirubin which is sent to the liver and removed through bile, into the intestines and out through stool. Some of it is removed through urine.

When there is excessive breakdown of red blood cells, the spleen might enlarge due to being overworked. The excessive breakdown of red blood cells also produces a lot of bilirubin, which goes to the liver and passes to the bile duct.

Biliary sludge refers to a thick fluid (viscous) mixture of components form the bile, which includes cholesterol, mucus, calcium salts, including calcium bilirubinate. Since the sludge does not flow easily, one possible outcome is that gallstones can form.

If there is excess production of bilirubin, there is an increased likelihood of forming calcium bilirubinate, which would cause the sludge. At very high concentrations, gallstones called pigment stones can also be formed from bilirubin.

If there are no symptoms or complications from the biliary sludge, there is no treatment necessary. Some medications can be used to try and dissolve the sludge. If gallstones form or there is inflammation or infection of the gall bladder, then the gall bladder is removed.

Thalassemia cannot be cured, but you can take folic acid supplements to help manage the anaemia. Avoid iron supplements because you can easily get iron overload. If the anaemia is severe, blood transfusion can be done.

The destruction of the red blood cells cannot be reduced or stopped, since it is the body’s way of dealing with old, abnormal or worn out cells. The spleen can be removed if it is quite enlarged, and this may slow down the haemolysis. To reduce the chances of getting sludge, maintain a low-fat, low-sodium, low-cholesterol, plant-protein diet.

***

Send your medical questions to [email protected] for absolutely free expert advice