A 5-year-old Laotian boy was examined in the emergency department for a 1-week history of coughing and a low-grade fever. The physical examination showed him to be quite pale. A chest roentgenogram showed an infiltrate in the middle lobe of the right lung. Results of routine bacterial, fungai, and viral cultures were negative. The results of the CBC count at admis-sion are shown.
    Examination of the Wright-stained peripheral blood smear revealed a microcytic hypochromic RBC morphology with poikilocytosis, and moderate polychromasia (Slide 1). The smear was remade because of a discrepancy between the results from the automated cell counter and the peripheral smear RBC morphology. The morphology on the remade slide was consistent with that of the original. An inquiry revealed that a CBC count was performed on this patient 1 month previously during a routine clinic visit. These test results arc also shown.

Laboratory Results.

Patient Result
 

Test	Current Admission	Previous Visit	Reference Range
WBC count, /uL (x 109/L)	10,600 (10.6)	6000 (6.0)	4000-12,000 (4.0-12.0)
RBC count, x 106/uL (x 1012/L)	2.2 (2.2)	3.9(3.9)	3.0-5.5 (3.0-5.5)
Hemoglobin, g/dL (g/L)	6.3 (63)	7.6 (76)	11.0-13.5 (1 10-135)
Hematocrit, %	19.0 (0.19)	26.1 (0.26)	33.0-40.0 (0.33-0.40)
MCV, um3 (fL)	85.5 (85.5)	67.2 (67.2)	78.0-92.0 (78.0-92.0)
MCH, pg	28.5	19.6	27.0-31.0
MCHC, g/dL (g/L)	33.3 (333)	29.1 (291)	32.0-36.0 (320-360)
RDW	21.4	20.9	11.5-14.5
Platelet count, x 103/uL (x 109/L)	384 (384)	370 (370)	140-440 (140-440)

MCV, mean corpuscular volume; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin concentration; RDW, red cell distribution width.
 

Table 1. Hemoglobin Electrophoresis.
 

Hemoglobin	Patient Result (%)	Reference Range (%)
A	78.3	95-98
A2	2.8	1.5-3.0
F	1.8	0-2
Barts	1.3	0
H	15.8	0

Figure. Hemoglobin electrophoretic pattern with hemoglobin H disease.

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