CASE REPORT: A RARE PRESENTATION OF HEMOGLOBIN D TRAIT

INTRODUCTION: Hemoglobin D Punjab was first discovered in the early fifties in a mixed British and American family of Indian origin from the Los Angeles area; hence it is also sometimes called as “D Los Angeles”. Hemoglobin D is the 4th common hemoglobin variance. It developed as a response to the selective pressures of malaria in these regions. The substitution in Hb D is a glutamic acid to glutamine at the 121st amino acid of the beta -globin chain (121Glu Gln). Hb D has an S-like mobility on alkaline electrophoresis but co-migrates with HbA on acid pH. Osmotic fragility may be decreased. Blood films may show target cells. [1] Two to 3 percent of the population of Punjab carries the Hb D gene. Subsequently, it has also been found in a number of other populations including Europeans, Mediterranean region, and Americans of African descent.[2] Hb D heterozygotes (Hb D trait) are usually asymptomatic, not anemic, and have normal red cell Indices.[3]Hb D homozygotes (Hb D disease) manifests as mild hemolytic anemia and splenomegaly.[4]But here we present a case of symptomatic Hb D trait, who presented with hemolytic anemia and splenomegaly from Hubli, Karnataka which is a rare phenomenon.