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Q. Please suggest the future prognosis of a child with abnormal hemoglobin pattern.

Answered by
Dr. Prakash H. Muddegowda
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jul 03, 2016 and last reviewed on: May 20, 2020

Hi doctor,

My friend is going to adopt a 6 months old female child. Certain routine tests were performed on the child. I have attached the reports for your reference. The Hb electrophoresis for thalassemia screening is showing an abnormal hemoglobin pattern. The treating pediatrician is not sure about the prognosis that is whether the child will be symptomatic and transfusion dependent. Presently, the child is asymptomatic except for mild splenomegaly. Please suggest about the future prognosis of the child to facilitate the further course of action.

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Hi,

Welcome to icliniq.com.

Based on your query and attached report (attachment removed to protect patient identity), my opinion is as follows:

  • Looking at the report of HbD trait (hemoglobin D), the prognosis is excellent.
  • The child will be very rarely transfusion dependent and mostly asymptomatic.
  • However, in future, counseling will be necessary as this heterozygous variety could turn into homozygous variety with other hemoglobinopathies such as sickle cell disease, thalassemia, etc., and affect the future generation.
  • The child will have mild splenomegaly and rarely hemolysis, otherwise will lead a normal life.
  • Risk of malarial infection will be very low due to this particular hemoglobin variety.
  • Maintaining good nutrition should be adequate and no other management will be essential.

For further information consult a hematologist online --> https://www.icliniq.com/ask-a-doctor-online/hematologist


Thank you doctor,

From the Hb electrophoresis pattern, is it possible to ascertain that it is a HbD heterozygous trait only and not associated with beta thalassemia? There are certain case reports where a Hb D heterozygous trait is associated with beta thalassemia .Besides, as per your statement, this heterozygous variety could turn into homozygous variety with other hemoglobinopathies. If so, then how come the prognosis is excellent? The pedigree of the child is unknown.

#

Hi,

Welcome back to icliniq.com.

  • No, beta thalassemia minor or trait cannot be ruled out. DNA analysis could be helpful.
  • As the levels of HbA2 (hemoglobin alpha 2) are very high, HbD trait is strongly suspected. As the hemoglobin is near normal, possible mild disease with rare symptoms can only be thought of.
  • HbA1 will be absent or very mild in thalassemia major or intermedia. However, beta thalassemia minor cannot be ruled out based on electrophoresis.
  • In the future generation, when the girl here is planning for a family, at that point, genetic or electrophoresis test of the boy will be compulsory to rule out any hemoglobinopathies. If both have some hemoglobin disorder, then it can get compounded and the risk for the newborn is high.
  • For the girl, the prognosis is excellent, as she could survive with mild disease and will be rarely symptomatic.

For further doubts consult a hematologist online --> https://www.icliniq.com/ask-a-doctor-online/hematologist


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