Rapidly Progressive Hyperbilirubinemia
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Introduction
Hyperbilirubinemia is one of the most common reasons for admission to an intensive care nursery. Despite a systematic approach towards prevention, bilirubin encephalopathy still occurs and remains as a neonatal emergency requiring early intervention to prevent permanent neurologic sequelae. Here we report an atypical presentation of bilirubin encephalopathy due to congenital thrombotic thrombocytopenic purpura (TTP).

Case Presentation
A 40-week gestation, 3.1?kg, Hispanic male infant was born via spontaneous vaginal delivery to a 22-year-old gravida 4 para 3 spontaneous abortion 1 mother without significant past medical history. Maternal blood type was O+ and antibody screen was negative. Other maternal prenatal labs were unremarkable. There was no known history of jaundice, anemia, or hematologic disorders in family members. Apgar scores were 7 and 8 at 1 and 5 minutes, respectively. At 4 hours of age, the infant was noted to have a hematoma at his vitamin K intramuscular injection site. He developed jaundice at <24 hours of age, with a total serum bilirubin (TSB) of 33.3?mg/dL at 29 hours of age. High intensity phototherapy was promptly initiated and he was transferred to a level III neonatal intensive care unit.....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3830790/
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