A 6-year-old girl is brought to the clinic by her parent due to repeated episodes of jaundice
, pallor, and fatigue for the last 8 months and new-onset abdominal pain
for the last 3 days. She is at the 35th percentile for height and 20th percentile for weight. The parent reports no pregnancy or birth-related complications and states that the patient had been relatively healthy previously. The parent states that the girl’s biological father had been hospitalized with similar symptoms as a child and had abdominal surgery, but the details of the surgery are unknown. The patient’s temperature is 37°C (98.9°F), pulse
is 90/min, respirations are 24/min, and blood pressure
is 118/72 mmHg. Physical examination shows an ill-appearing pale child with scleral icterus
. Laboratory tests are obtained and the results are shown below.
The patient most likely has a defect in which of the following?