title: Prolonged phototherapy needed for a neonate with four mutations in genes involved in bilirubin production and metabolism.
abstract: We cared for a neonate with hyperbilirubinemia requiring phototherapy during the birth-hospitalization, at home, and during two subsequent hospital readmissions. Abnormal red blood cell forms including elliptocytes were seen on his blood film but this failed to explain, to our satisfaction, why his jaundice required such prolonged treatment. Next-generation sequencing, using a panel of 27 genes involved in neonatal jaundice and hemolytic anemia revealed four previously described heterozygous variations, which we postulate resulted in increased bilirubin production from hemolysis, plus retarded bilirubin uptake and conjugation. Mutations were found in the erythrocyte membrane protein band 4.1 gene (EPB41), the alpha-spectrin gene (SPTA1), the gene encoding the enzyme for bilirubin conjugation (UGT1A1), and the gene encoding a transporter of bilirubin from the blood into hepatocytes (SLCO1B1).
authors.affiliation: Department of Women and Newborns, Intermountain Healthcare; Salt Lake City, UT, USA.
authors.forename: R
authors.initials: R
authors.lastname: Christensen
authors.affiliation: Department of Pathology and ARUP Laboratories, Salt Lake City, UT, USA.
authors.forename: R
authors.initials: R
authors.lastname: Nussenzveig
authors.affiliation: Department of Pediatrics, Division of Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: B
authors.initials: B
authors.lastname: Eldridge
authors.affiliation: Department of Pathology and ARUP Laboratories, Salt Lake City, UT, USA.
authors.forename: A
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Department of Pediatrics, Division of Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: H
authors.initials: H
authors.lastname: Yaish
keywords: Jaundice; bilirubin; elliptocytosis; hemolysis; neonate