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Is Hemoglobine at risk of thalassemia dangerous?

  • Hemoglobin
  • Read Time - 4 Min

The doctor mentioned paleness and abnormal blood cell, so I got a blood test to check. 
Doctor, please help explain the results. 
Clam down, I will explain it in a simple point for you to understand, don’t worry. 
Blood test result
Hb E heterozygote may also have alpha-thalassemia.
Hb 11.3 g/dI Hemoglobin type: EA
MCV 75.4 fl Hb A2(E) 25.7 %
MCH 24.0 pg Hb F 3.0 %
MCHC 31.8 g/dI Hb A 63.7 %
RDW 15.6 % Abnormal Hb %
Others %
The first point  From the test results, your child's anemia turned to be Hb 11.3 g / dl or hemoglobin 11.3 g / 100 cc blood. Look at the big picture in adult, this is an anemia for sure! But for a child, it is even more complex, moreover, the HB value also changes with age and gender. For a child over 1 month, the normal HB value is = 11-13 gm / dl, so the 4-year-old child with 11.3 is considered normal.

The 2nd Point The volume per a red blood cell (MCV) is = 75.4 fl. The normal range is 80-100, which means that the size of the red blood cell is just a little bit small. Your child's average amount of hemoglobin found in the red blood cells (MCH) is = 24.0 pg, which is less than the normal range of 27-33, and the normal hemoglobin concentration is 32-36 but your child’s result is 31.8 / dl, so it is a confirmed result that Hemoglobin is a little too little. Finally, the normal range of mean difference in red blood cell shape (RDW) is at 11-14% while your child’s is 15.6% = the shape of the blood cells is a little bit distorted. Other than this, I wonder if there might be a possible percentage of inherited blood disorder. Let's look at the third point.

The 3rd Point Hemoglobin type. I will briefly explain that the hemoglobin molecule is made up of two and four double chains, each pair contains unique controlling genes. From the hemoglobin type testing result, I will summarize as follows.
1.    Hb A has a pair of alpha and beta chain. In general, more than 90% are required, but in this case 63.7% is measured, indicating that there is a present of other hemoglobin. 
2.    Hb F has one pair of alpha and gamma chain each. Usually this type is only available for a baby in the womb. After birth, there might be some left, your child is measured at 3.0%, so it can be suspected that normal hemoglobin is not enough, so this one is needed. 
3.    HB A2 has a pair of alpha and delta chain each. In general population, there is 1.5-3.5%, but your child’s has 25.7% and it is also Hb A2 (E), a special type of hemoglobin, which is considered a mutated gene called gamma E. However, there are not many disorders of hemoglobin. So it can infer that he has got a hidden gene from either parent's side.

Therefore, from the blood test result, it can be concluded that he has got the inherited thalassemia gene, hemoglobin E trait. But don't worry, because there have been cases of pregnant women who found this gene up to 25%.

Alpha thalassemia also suspected. Is it a serious disease?
In this part, you need to get your child a direct genetic testing ( PCR) because the hemoglobin typing test can only tell the abnormalities of the beta-regulating gene.

How should I behave, do you have any advice? 
For your child, I recommend eating foods that contain protein, B 1-6-12, iron, and folic acid, which help the body to produce enough blood cells. Once grown up, take him or her to get the confirmatory genetic test using PCR to identify alpha thalassemia gene.  Having any latent gene of thalassemia trait either alpha or beta would get out of hand, if there is any, your child would definitely have thalassemia.  

For parents, it depends on your desire whether you want to have more children or not, if you feel you have enough, then it’s fine. In case you already have a prepared plan, I recommend marching to screen for thalassemia trait and hemoglobin analysis first. If both of you have a thalassemia trait, a child to be born would definitely have thalassemia.  

Come to this point, many people would understand that if Hemoglobin E had the thalassemia gene, what need to be done. The more we learn how to prevent and pay attention to our health, get ready to cope with any problems, then don't have to think too much.
Dr. Sant Chaiyodsilp