Objectives 
We present a case of neonatal jaundice to highlight the importance of red blood cell morphology in haemolytic anaemia.


Results
A 7-day-old female presented with jaundice at the paediatric consultation. She was born at 37 weeks by uncomplicated caesarean section, with normal haemoglobin levels of 13,5 g/dL but elevated total bilirubin levels of 19.2 mg/dL for which she had successfully received two days of phototherapy. She was breastfed and was supplemented with vitamin D and K. She was born to a G8P3A4 Caucasian mother with blood type A positive with normal screening maternal laboratories. The father was of African origin. The family history was negative. Clinical examination was normal, except for moderate jaundice. 
The laboratory evaluation showed a O Rhesus positive blood group, negative direct Coombs, haemoglobin 10.7 g/dL (reference range: 9.5-13.5 g/dL), total bilirubin of 21.5 mg/dL (reference range: 0.0-10.8 mg/dL) with a direct bilirubin of 0.1 mg/dL, slightly increased reticulocytes and LDH of 1018 U/L (reference range: 125-220 U/L). Microscopic examination of her blood smear revealed poikilocytosis and fragmentocytes (figure 1). The patient was admitted for phototherapy, which decreased her bilirubin to 15,1 mg/dL and after two days she was discharged. At follow-up we saw a slow normalisation of her normocytic anaemia and on blood smear elliptocytes were emerging. Haemoglobin electrophoresis, eosin-5-maleimide binding test, glucose-6-phosphate dehydrogenase and pyruvate kinase levels were normal. Six months later she was asymptomatic with a normal complete blood count and biochemistry parameters but still pronounced elliptocytosis on blood smear (figure 2). Red blood cell membrane protein electrophoresis performed by the reference laboratory demonstrated diminished protein 4,1 which together with the clinical course confirmed the diagnosis of common hereditary elliptocytosis.

Conclusions
Common hereditary elliptocytosis is a rare congenital red blood cell disorder which can lead to haemolytic episodes throughout life, even with neonatal presentation.

Neonatal haemolytic anaemia: a case of common hereditary elliptocytosis