Mediterranean Anemia: Why High Red Blood Cell Count?

Mediterranean anemia, please help clarify, thank you?

Hello, Doctor.
I would like to ask you a few questions regarding my complete blood count report.
My white blood cell count is 9,400 (normal range: 4,500–10,000/µL), which is normal.
My red blood cell count is 621 (normal range: 470–610), which is elevated.
My hemoglobin level is 13.2 (normal range: 14–18), which is low.
My hematocrit is 43.2 (normal range: 42–52), which is normal.
My mean corpuscular volume (MCV) is 70 (normal range: 80–94), which is low.
My mean corpuscular hemoglobin (MCH) is 21.3 (normal range: 27–31), which is low.
My mean corpuscular hemoglobin concentration (MCHC) is 30.6 (normal range: 33–37), which is low.
The note states: suspected thalassemia.

My question is: if I have thalassemia, shouldn't my hemoglobin and mean corpuscular volume be low as well? Why is my red blood cell count so high? If I truly have anemia, shouldn't it also be low? Is it still possible for me to have thalassemia given these results? (Both of my parents have mild thalassemia.) Would the best approach be to schedule a comprehensive blood test? Thank you, Doctor, for your assistance.

Lala, 10~19 year old female. Ask Date: 2010/01/13

Dr. He Dongjin reply Cardiology

You should find a time to consult a hematologist for a definitive diagnosis based on your report, which suggests mild thalassemia.
Patients with thalassemia lack normal hemoglobin, resulting in poor oxygen-carrying capacity of red blood cells.
Consequently, the body's primary hematopoietic organs engage in vigorous blood production, but the red blood cells produced are often of poor quality and prone to destruction, leading to an increased relative number of red blood cells.
You can visit the Taiwan Thalassemia Association at http://www.thala.org.tw/ for more relevant information.
However, mild hereditary thalassemia is quite common, and as long as diet and health are managed properly, it usually does not pose significant issues.
Changhua Hospital cares about your well-being.

Reply Date: 2010/01/13

More Info

Understanding Mediterranean Anemia, commonly known as Thalassemia, can be quite complex, especially when interpreting blood test results. Your inquiry about why you have a high red blood cell (RBC) count despite having low hemoglobin and other related indices is a common question among those diagnosed with this condition.

Thalassemia is a genetic blood disorder characterized by the body’s inability to produce adequate amounts of hemoglobin, which is essential for transporting oxygen in the blood. In individuals with thalassemia, the body compensates for the low hemoglobin levels by producing more red blood cells. This compensatory mechanism can lead to an elevated RBC count, even when the hemoglobin levels are low.
In your case, the blood test results indicate:
- WBC: 9400 (normal range)
- RBC: 621 (high)
- Hemoglobin: 13.2 (low)
- Hematocrit: 43.2 (normal)
- Mean Corpuscular Volume (MCV): 70 (low)
- Mean Corpuscular Hemoglobin (MCH): 21.3 (low)
- Mean Corpuscular Hemoglobin Concentration (MCHC): 30.6 (low)
The elevated RBC count alongside low hemoglobin and MCV suggests that your body is producing more red blood cells in response to the ineffective erythropoiesis (production of red blood cells) due to thalassemia. In thalassemia, the red blood cells are often smaller (microcytic) and contain less hemoglobin (hypochromic), which explains the low MCV and MCH values.
The presence of thalassemia can be confirmed through specific tests such as hemoglobin electrophoresis, which can identify the different types of hemoglobin present in your blood. Given that both of your parents have mild thalassemia, it is plausible that you have inherited this condition, which can manifest in various degrees of severity.

To address your question about whether you should undergo a more comprehensive blood test, it is indeed advisable. A complete blood count (CBC) along with additional tests such as iron studies, reticulocyte count, and hemoglobin electrophoresis can provide a clearer picture of your hematological status and confirm the diagnosis of thalassemia.
In summary, while it may seem counterintuitive to have a high RBC count with low hemoglobin levels, this is a characteristic feature of thalassemia. The body attempts to compensate for the ineffective hemoglobin production by increasing the number of red blood cells. Consulting with a hematologist who specializes in blood disorders can provide you with tailored advice and management options based on your specific condition. Regular monitoring and appropriate treatment can help manage symptoms and prevent complications associated with thalassemia.

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