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January 1985

Failure to Suspect and Diagnose Thalassemic Syndromes: Interpretation of RBC Indices by the Nonhematologist

Author Affiliations

From the Departments of Medicine (Drs Hansen and Anderson) and Pathology (Dr Hanson), Medical College of Wisconsin, Milwaukee.

Arch Intern Med. 1985;145(1):93-94. doi:10.1001/archinte.1985.00360010121019

• A three-year review of the medical records of 76 patients with apparent thalassemic syndromes (mean corpuscular volume, <75 cu μm; RBC count, >5 × 106 /cu mm) was performed to assess overall physician response to this information at a midwestern teaching institution. Abnormal indices were recognized in only 50% of the cases; in only 32% of cases was a thalassemic syndrome considered in the differential diagnosis. Residents in internal medicine failed to recognize microcytic indices and to consider thalassemic syndromes 42% and 59% of the time, respectively. Even though hemoglobin electrophoresis was performed in 25 patients, in only 15 (56%) of the 25 cases was β-thalassemia proved or α-thalassemia presumptively diagnosed. In 17% of all cases, the patients were treated with iron without diagnostic findings on iron studies and/or in spite of data suggesting a thalassemic syndrome. The RBC indices are an underused portion of the complete blood cell count, and readily apparent thalassemic syndromes are often not considered.

(Arch Intern Med 1985;145:93-94)

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