The impact of iron deficiency on the diagnostic level of HbA2 in beta- thalassemia trait from the Sulaimani hemoglobinopathies screening program

Background and objectives: The identification of carriers of beta- thalassemia depends on the detection of a high level of hemoglobin A2. The hemoglobin A2 level is influenced by some elements including iron. The consequence of concomitant iron deficiency on the hemoglobin A2 level is critical in screening laboratories for hemoglobinopathies, particularly in resource-limited ones where molecular identification of hemoglobin A2 levels is unavailable. The aim of this study is to evaluate the consequence of iron deficiency on hemoglobin A2 level to obtain a definite diagnosis of beta- thalassemia trait. Methods: A total of one hundred forty -five subjects were involved, divided into three groups: (50) healthy controls, (50) beta-thalassemia trait, and (45) coincident iron deficiency with beta-thalassemia trait. Full blood count, Iron status including serum iron with total iron-binding capacity, lastly hemoglobin A2 with hemoglobin F estimation were performed for all enrollees. Results: The age range in the beta-thalassemia trait group was 7-40 years, with mean of (26.6± 5.3) years, while the concomitant group has an age range of 15-36 years, with a mean of (24.4 ±5.1) years. Meanwhile the age of control group ranged from 19-36 years with a mean of (24.6 ±3.8) years. The hematological parameters were significantly reduced in beta- thalassemia trait and concomitant iron deficiency in comparison to the controls with no significant difference in hemoglobin A2 between beta thalassemia trait and concomitant iron deficiency (5.1± 0.9) and beta-thalassemia minor (5.2 ± 0.9). Conclusion: No influence of iron deficiency on the identification of beta-thalassemia minor detected in the screened population.