A 16-year-old boy presented to my OPD with fatigue and dyspnoea, which began over one month ago. He had no history of palpitations, resting dyspnoea, or decreased appetite. He also noticed yellow discoloration in his eyes over a week; homocysteine levels were elevated. His Hb was 5.5g/dl, MCV = 100, and RDW = 28%, total WBC count = 3800 with predominant neutrophil and platelet count was 1.3 lacs. LFT showed bilirubinemia of 3.3g/dl with AST-156, ALT-48, and a high ESR of 70.
An elevated LDH and reticulocyte count of 0.8% were reported. Both Coombs tests were negative. Please suggest how I can manage the patient. Is this just a case of pancytopenia with jaundice or some other condition?