An Interesting and Rare Case of Hemoglobin D-Punjab Variant in Tamil Nadu

Hemoglobin D (Hb D), a variant of hemoglobin appears in a few Asian individuals belonging to India, Pakistan, Iran, Iraq, and other parts of the world. In India, it is mainly reported in the North-Western states. Hb D disease causes subclinical jaundice, or it may be asymptomatic with pallor in its heterozygous form. Being a country with hunger and poverty, pallor is always attributed to iron deficiency anemia, but one should not miss out on various other causes. Here, we report a rare case of Hb D with iron deficiency anemia in a 13-year-old child of South Indian origin (Tamil Nadu) and emphasize the detailed evaluation of cases with severe pallor. He presented with gradually progressing generalized weakness with easy fatigability for the past four weeks. On examination, he was pale, there was no icterus and systemic examination was normal. Investigation revealed a microcytic hypochromic type of anemia. Hb electrophoresis showed the Hb D-Punjab variant. Iron indices were suggestive of iron deficiency anemia. He was advised iron supplements for three months, and he improved with that. He was counseled about his disease and was advised regular follow-up.