Newborn with Lethargy, Jaundice, and Coagulopathy

Laboratory results include the following: white blood cell count, 21,600/ μL (21.6 × 109/L; reference range, 9,000 –30,000/μL [9–30 × 109/L]); hemoglobin, 18.2 g/dL (182 g/L; reference range, 14.0 –24.0 g/dL [140–240 g/L]); platelet count, 111 × 103/ μL (111 × 109/L; reference range, 150 –450 × 103/ μL [150–450 × 109/L]); blood type, B+; direct antiglobulin test, negative; and reticulocyte count, 4% (reference range, 3% –7%). Comprehensive metabolic panel is significant for hyponatremia, with a sodium level of 132 mEq/L (132 mmol/L; reference range, 135–145 mEq/L [135–145 mmol/L]). Liver enzyme levels are normal (alanine aminotransferase, 41 U/L [0.68 μkat/L]; aspartate aminotransferase, 86 U/L [1.44 μkat/L ]), as are total protein (5.4 g/dL [54 g/L]) and albumin (3.0 g/dL [30 g/L]) levels. Repeated bilirubin level is 12.4 mg/dL (212 µmol/L) at 14 hours after birth, with an elevated direct bilirubin level of 2.9 mg/dL (49.6 µmol/L). Direct or conjugated hyperbilirubinemia is defined as a direct bilir ubin level greater than 2 mg/dL (34.2 mmol/L) or more than 20% of total bilirubin. γ-Glutamyl transferase level is normal. Coagulation studies show an elevated prothrombin time of 23.4 seconds (reference range, 11–17 seconds), with an international normalized ratio of 2.1 (reference range, 0.9– 1.3); activated partial thromboplastin level is 49.5 seconds (reference range, 30–60 seconds). Fibrinogen level is decreased ...
Source: Pediatrics in Review - Category: Pediatrics Source Type: research