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Figure 1 : Patterns of hemoglobin, reticulocytes, platelets and bilirubin levels in the first 96 hours and onwards. (A) Peripheral blood smear (60X) showing non-specific variable morphology: anisocytosis with microcytes, spherocytes, schistocytes, elliptocytes, macrocytes given elevated reticulocyte count, tear-drop cells, all co-occurring with transfused red blood cells of normal
appearance. (B) Early anemia & thrombocytopenia associated with brief reticulocytosis requiring
multiple blood transfusions, pRBCs transfusions (green arrowhead) and platelet transfusions (black arrowhead). (C) pRBCs transfusion (green arrowhead) requirement and hemoglobin maintenance with reticulocytopenia and rapidly resolving thrombocytopenia over time. (D) Refractory hyperbilirubinemia despite phototherapy and exchange transfusions (red arrowhead) and a progressive conjugated fraction over time. (E) Resolution of conjugated and unconjugated hyperbilirubinemia over time.
Table 1: Previous CDA4 cases described in the literature.