what is the cause of anemia and how we treat it?!!

Three months male baby from Yemen complianing of pallor since first month. Condition was started since birth when the baby developed jaundice at 1st day. (He was full term, normal vaginal delivery).
Investigation at 1st day:
• His Blood group  O-ve – Mother’s B-G O+ve
• Bilirubin was 23,5 mg/dl – direct 2,03 mg/dl
• Reticulocyes 20%
• Hb = 9,7 g/dl  - pcv  31,7%
• WBC = 27,70  
o Neutrophil = 26
o Lymphocyte = 65
• Platelet = 125
Bilirubin not respond to phototherapy so Blood exchange was done after it HB was 11,3 g/dl  - pcv = 34%  - Bilirubin = 8.5 – Direct = 0.74.
After that he was on phototherapy, investigation at 3rd day:
• Hb = 13,8
• Pcv = 43,1
• Wbc = 9
o Neutrophil = 62
o Lymphocyte = 32
 MCV = 86,9
 MCH=27,8
 MCHC=32,1
 RDW=15,0
 Bilirubin =15 mg/dl
 Ritcs=5.5%
o Platelet = 63
With Blood Film:
• RBc   normocytic  normchromic with some marocytes of few nucleated cells no specific abnormalities .
• WBc Normal count, Normal Morphology.
• PLTs  Low count with Normal Morphology.
Platelet transfusion was done and it became = 185 AND continued on phototherapy.
He discharged after 7 days with total bilirubin 10,20 mg/dl – direct 1,1 T. bilirubin repeated after 1 WK  1 mg/dl.
Patient is well active, normal breast feeding in addition he get artificial milk.
He was ok until he was two months when his mother noted that he was pale -  

• Hb = 5 g/dl
• Pcv = 15,6
• Wbc = 9,4
• PLT = 213
• MCV = 89
• MCH= 28
• McHc= 32
• RDW = 23,4

Blood Film report:
RBC  Normocytic Normochromic with some polychromatic and few spherocytes fragmented and nucleated cells.
WBC  Normal.
• Reticulocytes = 8.5%
• Bilirubin = 2
• LDH = 3244
• Direct combs test –ve
• G6PD = 243 (Normal 60-130)
• Osmotic fragility test –ve
• Electrophoresis Normal
• Fe = Normal – Ferrtin = high
Transfusion of 80 cc packed RBc was done (he was 5 kg).
One month later, patient became pale again with Hb 7 g/dl retics = 3.2 and other 80 cc were given.
• By examination of patient there’s only spleenomegaly that confirmed by ultrasound + He was pale.
Chest is clear, Normal heart sound
• No change in urin color
B.W = 5,5 kg
What is the possible cause?!!!
What other investigation is needed?
how frequnts to do investigation?
what is  the haemoglobin level for blood transfusion?

[sweetpea03]

There are a number of different reasons for anemia as well as different types of anemia. Any process that can disrupt the normal life span of a red blood cell may cause anemia. Normal life span of a red blood cell is typically around 120 days. Anemia is caused essentially through two basic pathways. Anemia is either caused: 1. by a decrease in production of red blood cell or hemoglobin, or 2. by a loss or destruction of blood. There is also Iron deficiency anemia which can be another cause. Though I can think of several causes for how the anemia came about, but the previous ones are the most common.

Personally I'd go to another doctor for a second opinion. Have him or her do another another CBC and then they can tell you what they think. Good luck.

[alzahra]

thank you but Imain in this case beaucase the doctors I asked don"t  know what is the under lying cause.