A 5 year old boy of African descent was brought to the clinic because his eyes t

Question

A 5 year old boy of African descent was brought to the clinic because his eyes turned yellow after taking a tablet of anti-malarial drug: primaquine for malarial prophylaxis because he will travel to a malaria-endemic country next week with his parents.  His urine also turns darker in color.  He did no experience any fever, abdominal pain, nausea, vomiting.   This is the first time he had this condition, and he had completed his basic immunization with his pediatrician.

Physical exam:

Temperature: 37o Celsius (normal: 36.10-37.20)Blood pressure: 110/80 mmHg (normal: 120/80 mmHg)heart rate: 95 beat/minute (normal 60-100 x/minute)respiratory rate: 16/minute (normal 12 – 20 x/minute)Normal weight boy, yellow-appearing, normal developmental milestone. Looks alert, have normal eye-contact.Skin and sclera of the eyes appear yellow, conjunctivae look anemic.Heart: heart sound normal, no heart enlargement, no murmurLung: clear to auscultation.Liver and spleen: no enlargement.

Other physical examination is normal for his age.

1)what are the possible diagnoses(differential diagnoses)..give 3
2) Explanation of pathophysiology of each of the differential diagnoses: (explain the pathophysiology of
the differential diagnoses you choose above in 3-5 paragraphs each, along with the reason you think this
patient fit your diagnoses)
3) Suggestion of what extra work-up/laboratory/diagnostic tests/information needed to come to a more
definite diagnosis for this patient

Explanation / Answer

1) The eye color of the child is yellow, the urine appears yellow in color, yellow skin coloration. All these signs clearly shows that the child might be suffering from jaundice and the conjunctivae looks anemic, so the patient might be suffering from hemolytic anemia.

The diagnostic tests used for confirmation of the diagnosis, Urine can be tested for urobilinogen. Liver function test includes, AST, ALT, ALP, Albumin and GGT. The reticulocyte examination is also carried out to examine if the RBCs are abnormal.

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