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 pathology of each of the differential diagnoses
3) suggestion of what extra work up/laboratory/diagnoses test/information needed to come to a more definite diagnosis for this patient

Explanation / Answer

1. The possible differential diagnosis suggest - Jaundice, Anemia with iron deficiency, VIT B12 deficiency .

2. Pathophysiology;

Anemia with iron deficiency: lack of red blood cells and pale skin and pale eyes

Jaundice : yellowing of skin and eyes

Vitamin B 12 deficiency: pale skin and weakness

3. Extra lab work required are :

Vit B12 testing

Liver function test

Normal CBC

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