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Clinical Problem:

Ira Shah
Medical Sciences Department, Pediatric Oncall, Mumbai, India

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056

A 3 years old boy presented with persistent indirect jaundice since 1 month of life. At 4 months of age he was detected to have involuntary movements with developmental delay. MRI brain showed hypomyellination with hyper intensities in globus pallidus. He was investigated for indirect hyperbilirubinemia.
• G6PD – Normal
• Thyroid function tests – Normal
• Osmotic fragility – Normal
• Pyruvate kinase levels – Normal
• RBC membrane defect – Not detected
• Reticulocyte count – Normal

At 3 years, bilirubin = 12.4 mg, dl {11.4 mg, dl – indirect}.

What is the cause of indirect hyperbilirubinemia_?

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