A 20-year-old asymptomatic man has Hb 11 g/dL, MCV 68 fL, and a smear with target cells. His father has similar findings. Hemoglobin electrophoresis shows HbA2 6%. Why is iron therapy inappropriate for him?

• A His iron studies will show low ferritin requiring parenteral iron instead
• B Elevated HbA2 confirms iron refractory states that respond only to erythropoietin
• C The anemia results from a globin chain synthesis defect, and iron overload is the actual risk ✓
• D Target cells indicate a membrane disorder corrected by splenectomy, not iron

Explanation

Beta-thalassemia minor shows mild microcytic anemia, elevated HbA2 above 3.5 percent, and autosomal dominant transmission, exactly matching this patient. The defect is reduced beta globin synthesis, not iron shortage, so iron therapy is useless and risks iatrogenic iron overload over time. Iron deficiency actually lowers HbA2, which helps separate the two conditions. Target cells reflect membrane surface area excess from ineffective erythropoiesis, not a spectrin or band 3 membrane disorder.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.