A 3 week 6 day old neonate presents with pallor and an Hemoglobiin concentration of 5.3 g/dl. Just one week previously he was transfused as his haemoglobin had been 7.4 g/dl. He was admitted to the nursery on day 0 of life because of respiratory distress secondary to meconium aspiration and at that time was also found to have leukocytosis. While in the nursery he was screened and given 10 days of antibilitics. His spleen was notably palpable below the left costal margin.
All cultures (blood, urine and CSF) reported no growth. He was discharged with a haemoglobin of 12.4g/dl to use iron and tropovite and to return in one week to the nursery for a review. It is at this review when he is 3 weeks and 6 days that he is found to be pale with a haemoglobin of 5.3 g/dl. How would you proceed in determining the cause of his anemia?
