Emeka Patrick Chukwuka: The Numbers Don’t Lie, But Context Matters
Emeka Patrick Chukwuka, Hematologist and Clinical Pathologist, shared a post on LinkedIn:
“Clinical Haematology Education Series – Teaching Case 03
A 42-year-old male with confirmed homozygous sickle cell disease (Hb SS) attended routine haematology review. Serial HPLC over 10 months told a story that almost changed his diagnosis — until the transfusion record was checked.
The finding: Hb A, which should be absent in true Hb SS, reappeared — jumping from 0% to 24.3%, then falling back to 9.1% over approximately nine weeks.
The question every haematologist must ask: Is this a co-inherited β⁺-thalassaemia allele making this Hb S/β⁺-thal — or is this transfused donor blood clearing from circulation?
The answer lies in the trajectory.
- A genotypic Hb A fraction (as in Hb S/β⁺-thal) is proportionally stable visit to visit — it doesn’t spike and decay.
- A transfusion-derived Hb A follows the donor red cell lifespan (~120 days) — a sharp rise, then a gradual fall as donor cells senesce. Here, the 0% to 24.3% and then to 9.1% curve fits transfusion kinetics precisely. The timing correlated with a red cell transfusion 2–8 weeks prior.
The teaching pearl: In confirmed Hb SS, Hb A on HPLC or electrophoresis is transfusion-derived until the blood bank record proves otherwise — never a standalone basis for reclassifying genotype.
Practical implications are significant: Do not reclassify Hb SS as a compound heterozygote on electrophoresis alone.
Defer %HbS/%HbF targets for hydroxyurea or exchange transfusion until more than 3 months post-transfusion.
Always correlate HPLC with transfusion history before signing out the report
This case is a reminder that laboratory context is clinical context. The numbers don’t lie — but they do require the right question.”
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