A rare case of coinheritance of Hemoglobin H disease and sickle cell trait combined with severe iron deficiency

We present a case of a 40-year-old female from Turkey, who was referred to our outpatient clinic for an undetermined thalassemia and sickle cell trait. At first consultation hemoglobin was decreased (71 g/ L) with microcytosis (MCV 55.1 fL), and hypochromia (MCHC 239 g/ L). The patient had severe iron deficiency. Brilliant cresyl blue staining showed > 50% of the erythrocytes with typical Hemoglobin H (HbH) inclusions. High-performance liquid chromatography (HPLC) revealed normal levels of HbA2 and Hemoglobin F (HbF), and additionally a hemoglobin S (19%). Molecular diagnostics revealed the mutations alpha 2 IVS-I donor site -5nt and a --MED II deletion in the alpha gene complex and confirmed the heterozygote mutation of the beta-gene at codon 6 (HBB: c. 20A> T; HbS). In conclusion, we present an extremely rare combination of HbH disease and sickle cell trait. This combination may explain the mild form of the HbH disease, with moderate anemia, splenomegaly but iron deficiency, rather than iron overload, as usually observed in HbH disease.