13 year old male with jaundice

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CASE:
A 13 year old male came with chief complaint of yellowish discoloration of eyes and yellowish discoloration of urine since 15days
History of present illness:
The patient was apparently asymptomatic 15 days ago ,then he developed dark colored urine and dark colored stools,not associated with fever ,head ache, abdominal pain
-The patient had one episode of bilious vomiting
-History of itching of both upper and lower limbs
-No history of shortness of breath
Past history:
-The patient had jaundice at birth which resolved spontaneously.
-At 8months of age,the patient had diarrhoea for 1week
-Immunized as per schedule
- History of hypothyroidism from 5years and on medication
Family history:
-His parents had 2nd degree consanginous marriage
-Their first child at the age of 2years developed SOB and taken to hospital her blood cells were reduced, blood transfusion done for every 25days,afer few months blood transfusion was delayed and she died.
-Personal history :
Appetite- Normal
Diet- mixed
Bowel and bladder habits are regular
Sleep is adequate
No addiction
Treatment history :
Patient is using beclometasone ointment for itching
General examination:
The patient is conscious ,coherent ,cooperative ,well oriented to time ,place and person
Pallor and icterus is present
Cayanosis ,clubbing,generalised lyphadenopathy,pedal oedema is absent


Vitals:
Temperature:Afebrile
Pulse:80bpm
BP:110/60 mm Hg
RR:20cpm
Systemic examination:
Inspection:
-Shape of abdomen is scaphoid
-Position of umbilicus is central and inverted
-All quadrants of abdomen moves equally on respiration
-No visible scars,sinuses,pulsation
Palpation:
-Abdomen is soft ,non-tender
-Liver is not palpable
-Spleen is slightly palpable
Percussion :
-No shifting dullness
-No fluid thrill
Auscultation:
Bowel sounds heard
Cvs examination: S1 and S2 are heard,no added murmurs
Respiratory examination : Bilateral air entry present,vesicular breath sounds heard
CNS examination:No focal neurological deficit
Investigation:
Haemogram

Haemoglobin -Reduced
Pcv-reduced
RBC count - reduced
Total bilirubin- Increased
Direct bilirubin - Increased
SGOT - Raised
Total proteins - reduced

THYROID PROFILE
 T3; 61
T4;8.66
TSH; 91.85
ANTI TPO ANTIBODIES;771.1

COOMBS TEST;
DCT; POSITIVE 
ICT;NEGATIVE
AUTO CONTROL POSITIVE 

Stool for occult blood - Negative
Provisional diagnosis :Auto immune haemolytic anemia with hypothyroidism
Treatment:
-Tab.methyl prednisolone
-Tab.thyronorm
-Tab.atarax

ECG:

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