The transiently high percentage of hemoglobin F during active hemolysis due to an autoimmune hemolytic anemia in a hemoglobin E trait
Keywords:
Autoimmune hemolytic anemia, Hemoglobin E trait, Transiently high hemoglobin FAbstract
Background: Actually the percentage of hemoglobin F in an adult hemoglobin E trait is around 0.9 ± 0.7% whereas Hb E is 29.4 ± 2.3%.
Objective: The study aimed to report an adult Hb E trait that had transiently high hemoglobin F during active hemolysis due an autoimmune hemolytic anemia (AIHA).
Case Presentation: A 19-year-old Thai woman presented with acute fever, chills, and jaundice for 3 days. The physical examination revealed a body temperature of 38.5 ํCelsis, PR 134/min, no goiter, marked pallor, mild jaundice and just palpable hepatosplenomegaly. The blood tests showed: Hb 3.6 g/dL, WBC 12 x109/L, platelet 331 x109/L, NRBC 11/100 WBC, MCV 133.0 fL, reticulocyte 5.0% and ferritin 91.2 ng/mL. Concerning Hb analysis by HPLC method: Hb E 28.7%, Hb F 8.7%, direct antiglobulin tests-positive, indirect bilirubin 1.7 mg/dL, ESR 119 mm/hour, ANA/ANF-positive, and coarse speckled nuclear titer > 1:1,280. Her diagnosis was acute hemolytic crisis due to an AIHA with underlying either Hb E heterozygosity or beta thalassemia / Hb E disease and treatment was corticosteroid. Six weeks later, her signs comprised Hb 13.0 g/dL, MCV 86.2 fL, Hb E 28.5%, Hb F 1.0%. The Hb E heterozygosity could be concluded. The percentage of Hb F in Hb E trait was found transiently high during the active hemolysis due to AIHA and became normal after the recovery of hemolysis.
Conclusion: During active hemolysis, the Hb analysis in Hb E trait should be delayed. Otherwise it may lead to the misdiagnosis of beta thalassemia / Hb E disease.
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