Microcytic Anemia: An Insidious Presentation of Sickle Cell Beta+ Thalassemia, a Rare Sickle Cell Variant

Abstract

Sickle cell disease variants can commonly present as life-threatening complications, like sequestration crisis, hypersplenism, or stroke. However, clinicians should also look for milder findings like asymptomatic chronic anemia mimicking iron deficiency as a milder, more insidious clue to an underlying sickle cell variant. Early investigations of these milder symptoms can potentially reduce the risk of more severe complications such as vaso occlusive crisis. In this report, we present a 75-year-old African-American female, who was referred to the hematology clinic for chronic anemia without any history of vaso occlusive crisis and was eventually diagnosed with sickle cell beta plus thalassemia as per hemoglobin electrophoresis. Here, we review the challenges in diagnosing rarer types of sickle cell disease and the importance of educating patients about the diagnosis. This rare type demands clinicians' awareness to identify the disease early and to understand the etiology of the complications, if any, that occur.

Management of gingival hyperpigmentation induced by increased ferritin level in a HbS‐β+ thalassemia patient using diode laser

“…Sickle cell β + thalassemia has a milder course, due to HbA synthesis. It may present with no symptoms, and can be misdiagnosed as iron deficiency anemia 6 …”

“…It may present with no symptoms, and can be misdiagnosed as iron deficiency anemia. 6 All these factors can cause increased iron levels primarily in the form of ferritin including ineffective erythropoiesis, excessive gastrointestinal iron absorption due to hemolysis, and frequent red blood cells transfusion. 7,8 Many studies had shown that ferritin levels and pigmentations of skin and gingiva are correlated especially in thalassemia patients or those who undergo blood transfusion regularly.…”