Can hemoglobin A2 level 4.3 indicate a carrier of beta-thalassemia?

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Your attached CBC report shows normal hemoglobin and MCV with RBC count is also within range (attachment removed to protect patient identity). I have calculated the Mentzer index as well which is also not in favor of thalassemia minor. Moreover, in the report also it has been mentioned that a referral to a higher laboratory is needed for confirmation. So, your chance of having thalassemia minor is less. I suggest you investigate with Hb electrophoresis by HPLC method to exclusively rule out thalassemia minor in a different laboratory.

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Kindly find answers to your questions below.

The Mentzer index is calculated from MCV divided by RBC count. You can also calculate it from the CBC report. If it is less than 13, then thalassemia is more likely. If it is more than 13, then it is iron deficiency anemia or a normal finding. In your case, it is 18, so thalassemia is unlikely. In short, it is used to differentiate between thalassemia and iron deficiency anemia.

HPLC is a gold standard test to rule out thalassemia-like hemoglobinopathy. So you can investigate with the HPLC method to rule out thalassemia minor conclusively. (HPLC is high-performance liquid chromatography).