Pediatric Problem Solving -Case 14

Pediatric Problem Solving – Case 14
A 3 day old infant presents with the complaint of yellowish skin. Both the mother and the baby have O +ve blood. The baby's direct serum bilirubin is 0.2 mg/dl. With a total serum bilirubin of 11.8 mg/dl. The hemoglobin is 17 gm/dl. Platelets count is 278,000/ul. Reticulocyte count is 1.5%. the peripheral smear doesn’t show abnormalities.
The most likely diagnosis:

A. Rh or ABO incompatibility

B. Physiologic jaundice

C. Sepsis

D. Congenital spherocytic anemia

E. Biliary atresia
Key points:
3 days old: physiologic jaundice occurs at this age,Both mom and baby have O+ve blood: not incompatibility,Hemoglobin 17, reticulocyte 1.5%: this is normal, so no hemorrhage nor hemolysis occurred [ no anemia]
N.B: if hemoglobin was 11.5 for example, the right answer would be hemolytic anemia.
Platelete count is normal: platelete count decreases in sepsis. So this isn’t sepsis
Peripheral smear shows no abnormality: normal shape of blood cells, so no Spherocytosis.
 Choice (A): points against: no hemolysis evident by hemoglobin and reticulocyte count
 Choice (B): points with: age, indirect hyperbilirubinemia [as the direct bilirubin is not more than 20% of total bilirubin], didn’t cross maximum level of total bilirubin in physiological jaundice which is 12, exclusion of other causes.
 Choice ( C ): points against:no sepsis evident by normal platelete count
 Choice (D): point against: normal peripheral smear, no Hemolysis
 Choice (E): not direct hyperbilirubinemia