Is blood transfusion indicated in a 19-year-old with chronic anemia and subclinical hypothyroidism?

Question

Hello doctor,

My daughter is 19 years old. She has chronic anemia, and the Hgb range is 8 to 9 g/dL, which never exceeded the Hgb of 9.5 g/dL since birth. There is no history of blood disorders in the family, no abnormal bleeding, and normal menses, according to her. Her father and mother are relatives, and her height and weight are within normal limits. She took iron for about four months in childhood based on a medical prescription at that time but has not benefitted. She has subclinical hypothyroidism and is on Thyroxine 75 mg but controlled TSH. I uploaded the investigation results for you to check. We would like to know about the diagnosis and more importantly, the management. Does she need a blood transfusion or iron supplements?

Answer 1

Hi,

Welcome to icliniq.com.

I thoroughly read your query and understand your concern.

I am a hematologist with 20 years of experience in treating hematological, oncological, immunological, rheumatological, and infectious diseases. There is no obvious cause of low hemoglobin. I suggest you get her LDH (serum lactate dehydrogenase), ESR (Erythrocyte sedimentation rate), CRP (C-reactive protein), and reticulocyte tests as the first step for further diagnosis of anemia. This would rule out any systemic illness. I suggest you get genetic mutation testing for beta and alpha thalassemia. She might be a carrier of alpha thalassemia. In the hereditary persistence of fetal hemoglobin, the level of HBF (fetal hemoglobin) is usually more than 10 %, and hemoglobin is high, not low. I also suggest you give a trial of Folic acid 5 mg a day and Pyridoxine (Vitamin B6) 50 mg a day for a month and repeat CBC (complete blood count). Her vitamin D level is borderline build it as well.

I hope this has cleared your queries.

Regards.