Laboratory tests

• FBC and reticulocytes.

• MCV and RBC morphology, bilirubin and Kleihauer (on mother)

Interpret as follows:

- Reticulocyte count normally very low in first 6 weeks of life.

- 4 haemolysis, blood loss.

- +ve Kleihauer suggests fetomaternal bleed (quantitate amount).

- Bilirubin 4 (unconjugated).

- Check DAT: +ve in immune haemolytic anaemia (except ABO HDN).

- Negative in other haemolytic anaemias, including ABO HDN).

- Bilirubin 4 (conjugated/mixed look for hepatobiliary obstruction/dysfunction).

- Note: 4 polychromasia, occasional NRBC, poikilocytes and sphero-cytes day 1-4 in healthy babies.

- RBC morphology may suggest congenital spherocytosis, other RBC membrane disorders or HDN.

• 5 MCV—a thalassaemia syndromes.

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