Hematologic Evaluation in Transfused B - Thalassemia Major Patients

Abstract

Background: In β thalassemia major, there is impaired synthesis of β globin chain of hemoglobin moiety leading to severe anemia. As a therapy, patients are given regular blood transfusions. Transfusion associated hemosiderosis is a major complication in these patients. The ineffective hematopoeisis, hemolysis and associated hemosiderosis causes multitude of morphological changes in the peripheral blood cells. We hereby intend to highlight some of the possible causes leading to these changes. Aims & Objectives: To study the complete blood counts, red blood cell indices and peripheral blood smear findings in transfused β thalassemia major patients. Materials & Methods: Venous blood was collected in ethylenediaminetetraacetic acid vacutainers from 50 β thalassemia major patients who had taken more than 12 transfusions. Complete blood count was performed on 5 part automated hematology analyser ADVIA 2120i. Peripheral smears were stained with Leishman's stain and studied under light microscope. Results: Out of the 50 β-thalassemia major patients, 27 were males (54%) and 23 were females (46%). The age group ranged from 2 years to 19 years. The mean hemoglobin level was 8.32g/dl. 44% patients showed microscopic hypochromic red blood cell morphology followed by 30% showing dimorphic blood picture. Schistocytes, target cells, tear drop cells and erythroblasts were also seen. Conclusion: In transfused patients, the morphological changes in peripheral blood can be attributed not only to ineffective erythropoeisis or hemolysis but also transfusion associated hemosiderosis, infections, chronic liver disease, splenomegaly and associated nutritional deficiencies. Thus the peripheral smear and complete blood counts can serve as indicators of underlying co-morbidities.