Posted On :
08 Sep 2004
A 9 year old child ,product of consangious marriage is brought to us with history of pallor. On examination child was markedly pale with thalassemic facies {prominent cheeks}.On systemic examination, he was jaundice, with liver of 3cm below the right coastal margin and spleen just palpable. Others system normal. Height and weight normal for his age. There is no history of blood transfusion in the past.His mother is thallasemic carrier and one on his younger sister is thalssemic major being transfused every month. Our admitting diagnosis was hemolytic anemia most likely thalasemia intermedia. But lab shows picture as thalassemia minor as his HB electrophoresis showed HbA as 83.1 Percent, HbA2 as 10 Percent and HBF as 6.9 Percent. Retic counts were 4 Percent, Hb on admission was 5g,dl. His LFT's showed liver enzymes normal, bilirubin was 2.6mg,dl. His RDW was 42. Peripheral film show anisocytosis, piokiolocytosis and fragmented RBC. Urine R,E showed no bilirubin in urine. His Ferritin is 111ng,ml{N} My question is this child is clinically behaving as thalassemia intermedia but Hb electrophoresis show thalassemia minor picture. It is mentioned in literature that con-comitent iron deficiency anemia can interfere with HB electrophoresis by interfereing with HbA2 being high. But how to diagonse iron deficiency anemia in thalaseemic child when serum ferritin is 111ng,ml. What should be done further in this child to arrive at a conclusion?
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