Coexisting Iron Deficiency Anemia and Beta Thalassemia Trait: Effect of Iron Therapy on Red Cell Parameters and Hemoglobin Subtypes

Background. Coexistence of iron deficiency anemia (IDA) and beta thalassemia trait (BTT) has been the topic of few studies. However, no study from our country was found evaluating the effect of iron therapy in patients with concomitant IDA and BTT. Methods. Over a period of two years, 30 patients with concomitant IDA and BTT were included. All the patients had a complete blood count, serum iron studies, and thalassemia screening using BIORADTM hemoglobin testing system. The patients received oral iron therapy in appropriate dosages for a period of twenty weeks, after which all the investigations were repeated. Appropriate statistical methods were applied for comparison of pre- and posttherapy data. Results. All except two patients were adults with a marked female preponderance. Oral iron therapy led to statistically significant improvement in hemoglobin, red cell indices ( ), and marked change in serum iron, ferritin, and HbA2 levels ( ). There was a significant reduction in the total iron binding capacity levels. Conclusion. The present study shows the frequent occurrence of iron deficiency anemia in patients with beta thalassemia trait, which can potentially confound the diagnosis of the latter. Hence, iron deficiency should be identified and rectified in patients with suspicion of beta thalassemia trait. 1. Introduction Thalassemia syndromes and iron deficiency anemia (IDA) are the two most common etiologies of microcytic hypochromic anemia in children and adults. It has long been considered that iron deficiency does not exist in thalassemia syndromes, including thalassemia major as well as trait. However, studies have shown the occurrence of iron deficiency in patients with beta thalassemia trait (BTT). Earlier authors have demonstrated lower initial hemoglobin levels in patients with coexisting IDA and BTT [1–3]. This has been explained by the lack of hemopoietic nutrients due to iron deficiency superimposing on the imbalance in globin chain synthesis [4]. Similar changes have also been shown in other red cell parameters, serum iron, ferritin, and total iron binding capacity. These changes have also been demonstrated to improve after adequate iron replacement therapy [1, 2, 5]. HbA2 levels have been reported to be lower in patients with coexisting IDA and BTT, with improvement in levels after iron therapy [1, 6]. However, other studies have shown no significant difference in HbA2 levels in such patients [7, 8]. The reduction in HbA2 levels in patients with concomitant BTT and IDA has been suggested to interfere in the diagnosis of the former. A