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Unusual case of immune haemolytic disease causing severe neonatal cholestasis in a newborn
  1. Reema Garegrat1,
  2. Prince Pareek1,
  3. Snehavardhan Pandey2 and
  4. Pradeep Suryawanshi1
  1. 1Neonatology, Bharati Vidyapeeth University, Pune, Maharashtra, India
  2. 2Pediatric Hepatology and Liver Transplant, Sahyadri Hospital, Pune, Maharashtra, India
  1. Correspondence to Dr Reema Garegrat; coolreem18{at}


Neonatal hyperbilirubinaemia is a very common entity witnessed in most of the newborns. Rarely are there events where the bilirubin levels reach extreme values mandating invasive therapy. Unconjugated hyperbilirubinaemia when solely present is easy to manage and diagnose the common aetiological factors associated with it. The issue arises when we come across a mixed picture of conjugated with unconjugated hyperbilirubinaemia and puts us in a dilemma as to what are we treating. Our case highlights a similar picture where we witnessed the highest documented levels of total bilirubin but to our surprise the major component of which was direct bilirubin. This report takes us through the differentials which were ruled out and our management strategies for solving this rare mystery.

  • haematology (incl blood transfusion)
  • biliary intervention
  • liver disease
  • neonatal intensive care

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  • Contributors RG made substantial contributions to the conception and design of the work, the acquisition, analysis and interpretation of data. PP did the drafting and revising it critically for important intellectual content. SP gave the final approval of the version published. PS made an agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.