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Medical Report Interpretation - Mrs. Annada Chutia, 44F
Treating Doctor: Dr. Milon Kumar Taye, Prof. OBS & GYNAE, LMCH
Date of Consultation: ~01-09 July 2026
1. Complete Blood Count (CBC) - 01/07/2026
| Parameter | Result | Normal (Adult Female) | Status |
|---|---|---|---|
| WBC | 7.50 × 10³/µL | 4.0-11.0 | Normal |
| Neutrophils % | 62.6% | 50-70% | Normal |
| Lymphocytes % | 25.3% | 20-40% | Normal |
| Eosinophils % | 8.4% | 1-4% | HIGH ↑ |
| Basophils % | 1.3% | 0-1% | HIGH ↑ |
| Hemoglobin | 8.5 g/dL | 12-16 g/dL | VERY LOW ↓↓ |
| HCT | 27.8% | 36-46% | LOW ↓ |
| MCV | 62.2 fL | 80-100 fL | LOW ↓ (Microcytic) |
| MCH | 19.0 pg | 27-33 pg | LOW ↓ |
| MCHC | 30.6 g/dL | 32-36 g/dL | LOW ↓ |
| RDW-CV | 21.1% | 11.5-14.5% | HIGH ↑ (Anisocytosis) |
| Microcytes | 52.7% | <10% | Very High |
| Platelets | 114 × 10³/µL | 150-400 | LOW ↓ (Mild) |
CBC Instrument Flags: Anisocytosis, Microcytosis, Anemia, Iron Deficiency? / PLT Abnormal Distribution
CBC Interpretation:
- Severe microcytic hypochromic anemia (Hb 8.5, MCV 62.2, MCH 19.0)
- Markedly elevated RDW (21.1%) = extreme variation in red cell size (anisocytosis)
- Over 52% of red cells are microcytes
- Mild thrombocytopenia (PLT 114)
- Mild eosinophilia (8.4%) - may suggest parasitic infection or reactive process
2. Hemoglobin Typing (HPLC) - Key Finding
| Fraction | Patient Result | Normal Range | Interpretation |
|---|---|---|---|
| Hb A0 (Adult Hb) | 15.8% | 95-99% | Severely LOW |
| Hb A2/E | 90.8% | 2-3.5% | Massively ELEVATED |
| HbF | 1.9% | 0-2% | Normal |
Lab Diagnosis: Hemoglobin E Disease (Hb E/E - Homozygous)
What This Means:
This patient has Homozygous Hb E Disease, a structural hemoglobin variant. In Hb E/E:
- Nearly all hemoglobin is the abnormal Hb E type (90.8%)
- Normal adult Hb A is almost absent (only 15.8%)
- The HbA2/E fraction at 90.8% represents Hb E, which co-elutes with HbA2 on HPLC
Hb E disease is very common in Northeast India (Assam), Thailand, and Southeast Asia. Homozygous form causes:
- Mild to moderate hemolytic anemia
- Microcytosis and hypochromia
- Splenomegaly (in some patients)
- Generally well tolerated, but can cause significant anemia under stress (infection, iron deficiency)
Important: The lab recommends DNA study for confirmation and parental screening.
3. Widal Test (Typhoid Serology) - 09/07/2026
Result: NEGATIVE at all dilutions (O, H, AH, BH antigens all negative at 1:20 through 1:320).
- No evidence of active Salmonella typhi or paratyphi infection.
4. Serology Tests (LMCH Microbiology)
| Test | Result |
|---|---|
| Hepatitis B (HBsAg) | Negative |
| Anti-HCV | Negative |
- No evidence of viral hepatitis.
5. Doctor's Clinical Notes (Dr. M.K. Taye)
Chief Complaints:
- Weakness
- History of amenorrhea from 04/04/26 to 27/06/26 (approximately 3 months of missed periods)
- History of blood transfusion on 11/06/26 when Hb was 6.3 g% (very severe anemia at that time)
Clinical Examination:
- Weight: 50.6 kg | Pulse: 68/min | BP: 110/70 mmHg
- Pallor: Positive (clinically anaemic)
- Oedema: Absent | Icterus: Absent
- Liver and Spleen: Not palpable
Gynaecological History:
- Menarche at 18 years
- Tubectomy done
- LMP: 27/06/26
- Cycle: irregular (30-90 days/3 days flow) - oligomenorrhea/irregular cycles
Prescription:
- Tab. Bactin (Ciprofloxacin) 500mg - 10 tablets
- One tablet twice daily after meals x 5 days
- (Prescribed likely for a UTI or other bacterial infection)
Overall Clinical Picture - Summary
Mrs. Annada Chutia has a multi-problem presentation:
Primary Diagnosis: Homozygous Hemoglobin E (Hb E/E) Disease
- This is the root cause of her chronic microcytic hypochromic anemia
- Hb E is a genetic hemoglobinopathy extremely prevalent in Assam/Northeast India
- She required blood transfusion earlier (Hb dropped to 6.3 g/dL)
- Current Hb of 8.5 g/dL is improved post-transfusion but still significantly low
Secondary Concern: Iron Deficiency component possible
- The CBC instrument flags "Iron Deficiency?" - this is common in Hb E disease patients where concurrent iron deficiency worsens the anemia further
- Iron studies (serum ferritin, serum iron, TIBC) should be done to confirm
Gynecological Issue: Irregular/Absent Periods (Amenorrhea)
- 3-month amenorrhea likely related to severe anemia - the body suppresses menstruation when hemoglobin is critically low
- Periods resumed on 27/06/26 after transfusion improved her Hb
Negative Findings (reassuring):
- No Typhoid
- No Hepatitis B or C
- No organomegaly on exam
Recommended Next Steps (based on lab suggestions and clinical picture)
- DNA/Molecular confirmation of Hb E/E - as advised by pathologist
- Parental and family screening for hemoglobinopathy (important for genetic counselling)
- Iron studies (serum ferritin, TIBC) to rule out co-existing iron deficiency
- Monitor Hb regularly - transfusion threshold typically at Hb <7 g/dL
- Consider hematology referral for long-term Hb E disease management
- Complete the antibiotic course (Ciprofloxacin) as prescribed
Note: This interpretation is for informational purposes. All findings must be correlated clinically by her treating physician.
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