Table of Contents
ISRN Hematology
Volume 2013, Article ID 858294, 5 pages
http://dx.doi.org/10.1155/2013/858294
Research Article

Hemoglobin A2 Lowered by Iron Deficiency and α-Thalassemia: Should Screening Recommendation for β-Thalassemia Change?

1Department of Medicine, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, Abu Dhabi, UAE
2Department of Pathology, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, Abu Dhabi, UAE
3Al Ain Hospital, P.O. 1006, Al Ain, Abu Dhabi, UAE

Received 23 December 2012; Accepted 18 February 2013

Academic Editors: T. Ikuta and T. Yokota

Copyright © 2013 Srdjan Denic et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Screening for β-thalassemia trait (BTT) relies on measuring hemoglobin (Hb) A2. Since multiple factors can affect HbA2 levels, the screening can become unreliable. In 1356 healthy Arabs enrolled into a federally funded premarital BTT screening program, the effects of iron deficiency (ID), -thalassemia trait, gender, smoking, and tribalism on HbA2 were studied. The complete blood count and hemoglobin fractions were determined on the entire cohort; serum ferritin (<15 μg/L) in 391 subjects was used to determine ID. BTT was present in 29 (2.1%) subjects (HbA2 > 3.5%). Among 77(20.3%) subjects with ID, the mean HbA2 ( %) was 0.2% lower than in subjects without iron deficiency ( %, ). In 65 (38%)/172 subjects with phenotypic -thalassemia trait, the mean HbA2 ( %) was 0.13% lower than in subjects without -thalassemia trait, . The mean HbA2 did not differ between males and females, smokers and nonsmokers, and between the tribes. Thus, 35 (2.6%) subjects with HbA2 between 3.2 and 3.5% were at a risk of false negative diagnosis of BTT. Since iron deficiency and -thalassemia are both common and both lower HbA2, modifications in screening recommendations for BTT are proposed.