Hi XXXXXXX,
Thanks for writing in.
I would suggest you to attach a copy of reports. You can upload the reports using the 'Upload your reports' section on the right. I would like to know when the tests were done?
Considering only raised indirect bilirubin, few possibilities exists in case of your daughter.
1] Hepatitis.
2] Sickle cell anemia.
3] Biliary obstruction.
4) Certain haemolytic anaemias

I would suggest you to consult a pediatrician and get few investigations done to rule out above possibilities.
Investigations would be abdominal ultrasound, liver enzyme levels, sickle cell test and hemoglobin levels. We would also need a peripheral smear and a bone marrow biopsy possibly.

I hope I have answered your query. In case of doubt I shall be happy to help you.
Best regards,
Dr. Neelam.

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Hi XXXXXXX,

Thanks for writing in.

I have gone through the reports attached here. The reports are dated since 2009 and this is a long time back. The reports are indicative of "newborn jaundice". And in one of reports mentioned, liver enzyme was too high nearing 600.

As your daughter's eyes are still yellow colored (icteric), we need to rule out underlying pathological conditions mentioned in our prior discussion. I would suggest you now to get peripheral smear and liver enzymes done now. You also need to get sickle cell tests and abdominal ultrasound done as well.

Bone marrow aspiration need not be done immediately.

I understand your concern. As your daughters symptoms have been since birth, she needs a thorough evaluation starting initially with aforementioned tests. A competent pediatrician can you guide get the tests done. We can plan a proper management once the root cause is found.

I hope this helps. In case of further doubt; feel free to revert back.

Best regards,
Dr. Neelam

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Hi XXXXXXX,

Thanks for writing in.

I have gone through the reports attached. Latest report as done in March 2010 also shows high bilirubin levels.

'ABO' incompatibility can occur in your daughter when IgG antibodies against B positive blood enter her blood circulation through her mother. This requires prior sensitization of mother which is possible if your wife had an earlier pregnancy with B positive child or if she had been faulty transfusion with B positive blood group; besides this condition is usually confirmed within first 24 hours after birth.

As your daughter's continues to have symptoms, we need to check the latest liver functions and red blood status to rule out the aforementioned possibilities. Hence I encourage you to visit your pediatrician and discuss about it and get the tests done as early as possible.

Hope this answers your query. Should you have any more queries, I will be glad to answer them.

Best regards,
Dr.Neelam.

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Hi XXXXXXX,

Thanks for reports.
After going through reports, I have realized that her red blood cells are normal, no sickling as per her peripheral blood smear report. So there is no need to repeat peripheral smear test and sickle test. Sickle cell anemia is out of the question now.

But her liver enzymes are still high. We are probably looking at a problem with her liver. This could be simply an infection or probably biliary obstruction or just inflammation of hepatic drainage system.
Get CT scan of the abdomen done. We will come to know the cause for it.

As you have mentioned about her mother's past history, there is no relation between two. So get test done and attach report so we can conclude probable diagnosis.

Best regards,
Dr. Neelam.

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