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Erythrocyte in SAO is remarkably rigid and this abnormality is reported to be developed because it protects against Plasmodium vivax malaria and cerebral malaria cause by Plasmodium falciparum. Although two categories of SAO was described previously, SAO and dRTA combination ended up being reported only once in someone from Anuradhapura district. Distal renal tubular acidosis, SAO combo and its related complications including nephrocalcinosis, persistent kidney disease and metabolic bone condition