<s>[INST] Hello I have a 17 yr old son who has complained of abdominal pain and fatigue. Took him and had some bloodworm drawn 1st set of labs showed total bilirubin of 2.2....I recently took him back for followup labs to see if the total bilitubin went down but it increased up to 2.6 and now his ABC are low at 4.1! I am very worried! Any suggestions as to what this may be? [/INST] Hi,Thanks for asking.Based on your clinical history and query, my opinion is as follows:1. Increased hemolysis is probably the cause of raised bilirubin and low hemoglobin.2. The RBC count could have been reduced due to similar reasons. However, do get a peripheral smear and reticulocyte count done to identify any abnormal cells in smear and whether the bone marrow response is present.3. Also check, if it is unconjugated bilirubin, which is raised. It would indicate hemolytic anemia. If conjugated is raised, possible liver cause or gall bladder obstruction needs to be ruled out.Hope it helps.Any further queries, happy to help again. </s>