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Forum Name: Hematology Topics

Question: Elevated RBC related to Thalassemia trait?


 Worthington - Thu Jul 29, 2010 4:04 pm

Hello! I would like to know if my elevated RBC count is cause for concern or simply a result from my low MVC and MCH, probably due to having Thalassemia trait? My mom recently almost died from a massive MI so I'm just concerned that the high count might be related to possible heart disease. Is the number actually high or just slightly elevated and nothing to worry about? I had labwork done because I've been severely fatigued, dizzy, and experiencing heavy pressure in my head daily . It's been going on for 2 yrs now. TSH is normal. I have what appears to be a blood clot behind my knee but am not overly concerned because it seems to be in the shallow vein. Any info is very much appreciated as I do not have a doctor or insurance yet. Here's my info:

30 yr old White/Asian female
5'3, 100 pounds
Thalassemia trait
BP systolic ususally 120-130
Cholesterol excellent
No alcohol or meds, except for Ibuprofen at times
Non-smoker
Live in non elevated area.

CBC results: Range:

WBC 4.8 x10E3/uL 4.0-10.5
RBC 5.81 H x10E6/uL 3.80-5.10
Hemoglobin 13.0 g/dL 11.5-15.0
Hematocrit 38.8 % 34.0-44.0
MCV 67 L fL 80-98
MCH 22.4 L pg 27.0-34.0
MCHC 33.5 g/dL 32.0-36.0
RDW 14.4 % 11.7-15.0
Platelets 323 x10E3/uL 140-415
Neutrophils 55 % 40-74
Lymphs 36 % 14-46
Monocytes 6 % 4-13
Eos 2 % 0-
Basos 1 % 0-3
Immature Cells
Neutrophils (Absolute) 2.6 x10E3/uL 1.8-7.8
Lymphs (Absolute) 1.7 x10E3/uL 0.7-4.5
Monocytes(Absolute) 0.3 x10E3/uL 0.1-1.0
Eos (Absolute) 0.1 x10E3/uL 0.0-0.4
Baso (Absolute) 0.0 x10E3/uL 0.0-0.2
Immature Granulocytes
Immature Grans (Abs)
NRBC
 Dr.M.Aroon kamath - Sun Aug 01, 2010 2:25 am

User avatar .
Hi,
Iron deficiency is the most common acquired cause of anemia and
Thalassemia is perhaps the most frequent gene mutation in human beings.

A suspicion of Iron deficiency anemia (as it is the commonest) often begins with the finding of ‘microcytosis’(smaller than normal sized RBCs) and 'hypochromia" (paler than normal RBCs) on a blood smear. In the not so distant past, microcytosis and anisocytosis were diagnosed based on stained peripheral blood smears. In recent times, automated blood analysers are becoming increasingly available widely available thus provide parameters such as HgB, red cell indices, RDW as well as others.

Faced with a situation of microcytosis and hypochromia, one must not succumb to the temptation to jump to a diagnosis of Iron deficiency. Thalassemia must always be excluded before a decision to prescribe iron is made.

Differentiating iron deficiency anemia and thalassemias (with their very heterogeneous nature) has remained challenging. Usually iron deficiency can be ruled out using free erythrocyte protoporphyrin (FEP), transferrin saturation or ferritin as a screening test. But diagnostic dilemmas are not unusual.

Efforts on to find ways of improving the sensitivity and specificity of tests to separate out iron deficiency from thalassemia traits. Various discrimination indices (such as Mentzer's index, Shine Lal index, England and Fraser idex and several others) have been used for this discrimination. Osmotic fragility test is one other test that may help in some cases.

All these still lack an ideal discrimination index. RDW is another index frequently available as part of the reports in the automated analysers.This index has further been refined as RDW- SD (stands for Standard Deviation) and RDW-CV (stands for Coefficient Variation).

α thalassemia trait: Here, the affected individuals are clinically normal but frequently have minimal anemia, reduced mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). The red blood cell count is usually increased to over 5.5 x 1012/L. Red cell distribution width (RDW) is usually increased.
Alpha thalassemia is common throughout parts of the world where malaria is endemic and is common in people of Asian, African, and Mediterranean heritage.

Beta thalassemia trait: In this, the affected individuals have minimal clinical effects, usually manifested as a borderline anemia with disproportionate microcytosis and a reciprocally high RBC count. They also have a normal (12.7-16.3%) or near normal (up to 17%) red cell distribution width.

The distinguishing finding in beta thalassemia is a hemoglobin electrophoresis with the finding of elevated minor hemoglobins Hgb A2 and F. Both will be increased in beta thalassemia trait without iron deficiency, and will be normal or decreased in alpha thalassemia and isolated iron deficiency anemia. However, one must remember that rarely some individuals with beta-thalassemia also have normal levels of Hb A2 and Hb F and if both alpha and beta thalassemia coexist, the changes in Hgb A2 and F may not be apparent.

Thus, in your case, the laboratory values provided suggest what could be either
an α thalassemia trait or a beta-thalassemia trait. Distinction between these may need further tests such as measurement of the minor hemoglobins
Hgb A2 & Hgb F, modified hemoglobin H inclusion staining, and RDW-SD (seen to be consistently low in heterozygous alpha-1 thalassemia but not in heterozygous alpha-2 thalassemia).

You perhaps need the guidance from your regular doctor as well as a hematologist
Best wishes!

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