A 5–years old male child presents with episodic anaemia and jaundice since birth. He is least likely to have which of the following

Causes of Jaundice since birth are: (i) Rh incompatibility (erythroblastosis fetalis) ABO incompatibility Congenital infections (TORCH) Sepsis Concealed hemorrhage Red cell membrane defect (hereditary spherocytosis) Red cell enzyme defect (G6PD deficiency) So, option a & d can cause jaundice since birth. In sickle cell anemia, affected infants do not develop symptoms in the first few months of life because the hemoglobin produced by the developing fetus (fetal hemoglobin) protects the red blood cells from sickling. This fetal hemoglobin disappears after 5 month of age so that by 5 months of age, the sickling of the red blood cells is prominent and symptoms begin. PNH is manfested in adults. So, both PNH and sickle cell anemia does not cause jaundice since birth. But among these two I would prefer PNH as the answer because it is manifested in adulthood while the patient in question is a 5-years old child. Sickle cell anemia symptoms develop at the age of 5 months and it is one of the cause of jaundice