Chulalongkorn Medical Journal


Hemoglobin H disease (Hb H) in adult patients can be diagnosed by identifying theband of Hb H with or without Hb Bart on Hb electrophoresis, and probably confirmed bygenotyping study. However, Hb H may be suppressed by some acquired factors includingiron deficiency anemia. Herein, we report a case of a 55-year-old woman was recognized ashaving chronic anemia since childhood. She was treated with occasional transfusions, oneor two units a year. Her first Hb electrophoresis showed: HbA2A, HbA2 2.1%, while her Hbwas 5.1 d/dL, her ferritin 6.2 ng/mL, and transferrin saturation 13.2%. She was diagnosed ashaving iron deficiency anemia and treated with iron compound. The causes of iron deficiencycould not be definitely concluded. Two months later, her Hb level and ferritin were 8.8 g/dLand 110.7 ng/mL, respectively. Her new Hb electrophoresis showed: HbA2ABartH, HbA2 1.7%, and HbF 0.8%. The diagnosis of Hb H disease was therefore added. In spite of the rarityof iron deficiency anemia superimposing over Hb H, if the patients with Hb H disease withunusually severe anemia were encountered, iron deficiency should be considered as one ofthe contributing factors. On the contrary, when iron was adequately supplemented in case ofiron deficiency anemia, the Hb level could not access the normal range; Hb H disease shouldtherefore be excluded because iron deficiency could completely suppress Hb H band.


Faculty of Medicine, Chulalongkorn University

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