Introduction: Hereditary spherocytosis (HS) is a congenital hemolytic anemia, often under-recognized in neonates. Co-inheritance with other genetic disorders like Gilbert syndrome (GS) and beta-thalassemia trait (BTT) can complicate the diagnosis. Case Report: We report a neonate presenting with significant unconjugated hyperbilirubinemia and anemia. Genetic testing revealed a triple diagnosis- HS due to a heterozygous deletion in the SPTB gene, BTT with a splice-site variant in the HBB gene, and heterozygosity for UGT1A1 promoter polymorphism associated with GS. The father, previously diagnosed with GS, was also found to have HS, explaining his long-standing splenomegaly and history of cholelithiasis. Conclusion: This rare triple genetic diagnosis highlights the need for comprehensive evaluation of neonatal jaundice and anemia, considering combined hemolytic, enzymatic and hemoglobinopathy causes. Detailed clinical evaluation of family members is crucial to avoid missed diagnoses.
Keywords: Beta-thalassemia trait; Gilbert syndrome; genetic diagnosis; hereditary spherocytosis; neonatal jaundice.