In India, a microcytic blood count is often treated as iron deficiency without further testing. Beta-thalassaemia trait gives a similar picture with a low mean cell volume, but usually a normal or high red cell count and only mild anaemia.
Check ferritin, and if it is normal, request haemoglobin electrophoresis or HPLC; HbA2 can be falsely normal when iron deficiency coexists, and HPLC does not reliably detect alpha-thalassaemia trait. Identifying carriers avoids months of unnecessary iron and allows partner testing before pregnancy.
- Check ferritin before starting iron for microcytic anaemia.
- Suspect thalassaemia trait when the red cell count is normal or raised despite a low mean cell volume.
- Request haemoglobin HPLC or electrophoresis when ferritin is normal; a normal result does not exclude alpha-thalassaemia trait.
- Offer partner testing to carriers planning a pregnancy.
Why it matters
Carrier detection is the step that prevents the next child with transfusion-dependent disease.
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