Question : The blood film of an apparently healthy female aged 20 years who attended a health screening centre where she was found to have a palpable spleen. Hb = 13.7g/dl.‚ red cells 7.21x10^12/l‚ MCV 61.7fl.
Answer : The red cell indices are consistent with a thalassaemia trait. From the Hb and red cell count you will have determined that the MCH is 19pg‚ and this value x100 divided by the MCV gives the MCHC‚ approximately 31g/dl. The red cells are small‚ and in the film many of them show punctate basophilia (Basophilic stippling aka Punctate basophilia refers to an observation found when observing a blood smear in which erythrocytes display small dots at the periphery. These dots are the visualization of ribosomes and can often be found in the peripheral blood smear, even in some normal individuals). The usual explanation of such findings is a thalassaemia. At this age further investigation into the type of thalassaemia may be required and consideration given to future genetic implications.
