On medical check up of a Punjabi student following findings were seen Hb of 9.9gm/dl,, RBC count of 5-lmillion, MCV of 62.5 fl and RDW of 13.51%. What is the most probable diagnosis?
Correct Answer: Thalassemia trait
Description: ANSWER: (B) Thalassemia traitREF: Harrison 17th ed chapter 98, Wintrobe's 8th ed ch: 48See APPENDIX-52 below for "TYPES OF ANEMIA"The question tests the knowledge and interpretation of RDW of red cell distribution width. The patient is having anemia ( Hb: 9.9mg/dl)Her MCV is low 62.6 FI (Normal: 80-100F1)Her RDWT is normal 13.51% (Normal: 11.5-14.5%)The patient has normal RDW and low MCV. Therefore the patient is expected to have one of the following conditions as per the table belowAnemia of chronic diseaseHeterozygous thalassemiaHemoglobin E traitRed cell distribution width (RDW) is a parameter that measures variation in red blood cell size or red blood cell volume. RDW is elevated in accordance with variation in red cell size (anisocytosis) t ie , wThen elevated RDW is reported on complete blood count, marked anisocytosis (increased variation in red cell size) is expected on peripheral blood smear review.RDW along with mean corpuscular volume (MCV) is helpful in narrowing the cause ofanemiaNormal RDW and low MCVAnemia of chronic diseaseHeterozygous thalassemiaHemoglobin E traitElevated RDW and low MCVIron deficiencySickle cell-b-thalassemiaNormal RDW and high MCVAplastic anemiaChronic liver diseaseChemotherapy/antivirals/akoholElevated RDW and high MCVFolate or vitamin B12 deficiencyImmune hemolytic anemiaCytoxic chemotherapyChronic liver diseaseMyelodysplastic syndromeNormal RDW and normal MCVAnemia of chronic disease Acute blood loss or hemolysis Anemia of renal diseaseElevated RDW and normal MCVEarly iron, vitamin B12, or folate deficiencyDimorphic anemia (for example, iron and folate deficiency)Sickle cell diseaseChronic liver diseaseMyelodysplastic syndromeOption (D); Hb Punjabi also known as HbD: It is a hemoglobinopathy in which there is a substitution of glutamine with glycine in the beta chain of the hemoglobin. It interacts with HbS in forming deoxy hemoglobin aggregates and causing sickling of RBC'S. Hb D Punjab is now recognized to be identical with Hb D Los Angeles. Hb D has been found in many parts of the world, including Africa, northern Europe, and India. APPENDIX - 52Types of Anemia Iron Deficiency(SideropenicAnemia)ThalassemiaSideroblasticAnemiaAnemia Of Chronic DiseasePeripheral smearMicrocytichypochromicMicrocytichypochromicMicrocytichypochromicNormocytic normochromic (Microcytic hypochromic can be seen)Serum ironLowNormalNormalLowTIBCHighNormalNormalLowSaturation %|N/|N/ ||Ferritin (ug/1)|||N/|
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