The Fluctuation of Red Blood Cell Indices in Beta Thalassemia Trait: A Case Report
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Abstract
Abstract: One common characteristic of thalassemiatraitis microcytosis or the mean corpuscular volume (MCV) of red blood cells (RBC) is less than 80 fL. However when the CBCs have been repeatedly studied, the RBC indices including MCV are found fluctuated as in our case study. She is 45-year old Thai who was accidentally found to have mild microcytic anemia with profound thrombocytopenia. Her hemoglobin electrophoresis shows
the higherpercentages of Hb A2 (4.9%) and of Hb F (8.0%). She is later confirmed using the genotype study to harbor the beta thalassemia, IVS1#5, heterozygosity without alpha-thalassemia-1 or alpha-thalassemia-2 genes. She has no underlying disease and no physical abnormality on the examination. After CBCs have been repeatedly tested for 18 times for the thrombocytopenia surveillance, there are fluctuations of many blood parameters, viz., 10 of 18 Hb concentrations less than 12 g% (55.6%), 8 with MCV less than 80 fL (44.4%), 15 with MCH less than 27 pg (83.3%) and all of them with RDW more than 15% (100%). In clinical practice, the MCV less than 80 fL or MCH less than 27 pg from one cross-sectional test is usually used as one of the screenings for thalassemia trait and MCV will have more chance than MCH to leave some cases with thalassemia traits unrecognized. Or in case of morphologic approach of anemia, MCV of beta thalassemia trait may alternatively mislead to wrong category between microcytic and normocytic groups.
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