Question

A 36 yo woman gave birth to infant by elective C sections after an unremarkable pregnancy. The 3.4 kg boy was hypotonic and needed intubation at birth. A first blood count revealed anemia and platelet count of 41,000. Nrbcs were 242/100 white blood cells when the peripheral blood smear of the infant was analyzed. At 5 hours of life, LDH reached 5411 and conjugated bill was 57. The patient developed generalized edema over a few hours, the absolute relic count was 337x10⁹. A finding of the auto hemolysis test was there was no decrease in hemolysis when glucose was added to the test system. These findings are consistent with

Answer 1

The infant's symptoms suggest a hemolytic disease, potentially glucose-6-phosphate dehydrogenase deficiency, given the findings of anemia, low platelet count, elevated LDH, conjugated bilirubin, and lack of response to glucose in the autohemolysis test.

Step-by-step explanation:

The infant in question is presenting with symptoms that may suggest a hemolytic disease of the newborn. The anemia and low platelet count, along with the presence of nucleated red blood cells (nRBCs), are indicative of hemolysis. Additionally, the elevated lactate dehydrogenase (LDH) and conjugated bilirubin levels point towards ongoing hemolysis and liver involvement, respectively. The fact that adding glucose to the auto hemolysis test did not decrease hemolysis might indicate an inherited enzyme deficiency such as glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency), rather than immune-mediated hemolytic disease where the addition of glucose typically stabilizes the RBCs membrane and reduces hemolysis.

The findings of generalized edema and high reticulocyte count are consistent with the body's response to anemia by producing more red blood cells. It's also possible that Rh incompatibility or ABO incompatibility could be at play, given the severe hemolytic presentation, although the negative autohemolysis test would typically favor a non-immune cause such as G6PD deficiency.