Description

This patient was diagnosed with beta thalassemia minor.

The peripheral blood showed normal WBC and differential counts, with normal PLT and RBC counts. However, HGB concentration, HCT, MCH and MCHC were low, and the MCV was extremely low. The reticulocyte concentration was slightly high with elevated IRF, indicating high RBC turnover. The RDW was low-normal, implying uniformly sized RBC.

These results are consistent with hypochromic microcytic anemia. The two main causes of microcytic hypochromic anemia are iron deficiency and thalassemia trait (Han). In iron deficiency, RBC, MCV and MCH are decreased proportionately to the degree of anemia, while in thalassemia trait MCV and MCH tend to be significantly low, despite of moderate anemia, and are accompanied with normal to high RBC count (Hoffbrand, Harrington). RDW is typically elevated in iron deficiency anemia, due to variation in red cell size, while in thalassemia (alpha or beta) red cells tend to be more homogeneous in size and thus RDW is low or normal (Flynn). Further testing, like analysis and serum iron, ferritin and total iron binding capacity, hemoglobin electrophoresis and molecular diagnostic tests are required to confirm the diagnosis.