Beta Thalassemia Manifesting as a Leukemoid Reaction: A Rare Case Report

The occurrence of marked leukocytosis in hemoglobinopathies is generally uncommon. Herein, we describe a 41-year-old male patient with a history of chronic alcoholism who presented for the first time with shortness of breath and abdominal distension. On complete blood counts and peripheral smear examination, there was a microangiopathic hemolytic anemia with leukemoid reaction, which turned out to be beta thalassemia trait on hemoglobin high-performance liquid chromatography. He was ultimately diagnosed with beta thalassemia trait in conjunction with chronic alcoholic liver disease and spontaneous bacterial peritonitis. The presence of leukocytosis accompanied by cytopenias in other hematopoietic cell lines and organomegaly presents a considerable diagnostic challenge. Increased leukocyte counts do not invariably indicate leukemia. A comprehensive analysis of the hemogram, which includes an examination of each cell line, relevant indices, and a thorough peripheral smear evaluation in relation to the clinical presentation, is essential for determining suitable investigations and management strategies.