--- title: An 18-year-old boy had a CBC performed as part of a college physical description: It's CBC Quiz Time with Med-Challenger! image: https://challengercme.com/hubfs/QUIZ%20TIME.png --- [![Med-Challenger-green-logo-1024x244](https://challengercme.com/hubfs/Med-Challenger-green-logo-1024x244.webp) ](https://challengercme.com/) - [SHOP EXAM PREP & CME ](https://challengercme.com/blog/an-18-year-old-boy-had-a-cbc-performed-as-part-of-a-college-physical#) ### [EMERGENCY MEDICINE](https://challengercme.com/emergency-medicine-exam-review-cme-course) [ABEM exam prep](https://challengercme.com/emergency-medicine-exam-review-cme-course), [MyEMCert](https://challengercme.com/emergency-medicine-myemcert-exam-review-course), etc. ### [FAMILY MEDICINE](https://challengercme.com/family-medicine-exam-review-cme-course) [ABFM exam prep](https://challengercme.com/family-medicine-exam-review-cme-course), [ABFM KSA](https://challengercme.com/family-medicine-moc-ksa-course), etc. ### [INTERNAL MEDICINE ABIM exam prep, MOC points, etc.](https://challengercme.com/internal-medicine-exam-review-cme-course) ### [OBGYN ABOG exam prep, CREOG, etc.](https://challengercme.com/obgyn-exam-review-cme-course) ### [PEDIATRICS ABP exam prep, MOCA-PEDS, etc.](https://challengercme.com/pediatric-medicine-exam-review-cme-course) ### [PEDIATRIC EM](https://challengercme.com/pediatric-emergency-medicine-3rd-edition) [ABP/ABEM exam prep Ed.3](https://challengercme.com/pediatric-emergency-medicine-3rd-edition), [Ed.2](https://challengercme.com/pediatric-emergency-medicine-pack2), etc. ### [SPECIAL PURPOSE / SPEX FSMB exam prep, etc.](https://challengercme.com/special-purpose-exam-review-spex-exam-preparation-course) ### [PHYSICIAN ASSISTANT](https://challengercme.com/physician-assistant-exam-review-cme-course) [PANCE / PANRE](https://challengercme.com/physician-assistant-exam-review-cme-course), [CAQ-EM](https://challengercme.com/pa-caq-em-review-course), etc ### [NURSE PRACTITIONER](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course) [FNP](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course), [ENP](https://challengercme.com/emergency-nurse-practitioner-exam-review-cne-course), [AGNP](https://challengercme.com/adult-gerontology-nurse-practitioner-exam-review-cne-course), [PNCB/CPNP](https://challengercme.com/pediatric-nurse-practitioner-exam-review-cne-course), etc. ### [NURSING / NCLEX NCLEX, CNE, etc.](https://challengercme.com/nursing-certification-nclex-exam-review-cne-courses) ### [STATE-REQUIRED CME / CE State CME requirements, etc.](https://challengercme.com/state-required-cme) ### [JOINT COMMISSION CME](https://challengercme.com/stroke-center-ce-review-course) [Stroke](https://challengercme.com/stroke-center-ce-review-course), [Cardiac](https://challengercme.com/cardiac-center-ce-review-course), [Trauma](https://challengercme.com/trauma-center-ce-review-course), [ALS](https://challengercme.com/advanced-life-support-and-resuscitation-center-ce-review-course), etc. ### [PROFESSIONALISM CME Professionalism review with CME](https://challengercme.com/professionalism-review-course) ### [DERMATOLOGY CME Dermatology review with CME](https://challengercme.com/dermatology-review-course) ### [USMLE STEP 2CK / STEP 3 USMLE exam prep, etc.](https://challengercme.com/usmle-certification-exam-review-clerkship-exams-shelf-exam-review) - [INSTITUTIONS ](https://challengercme.com/atlas-pro-inst) - [BLOG ](https://challengercme.com/blog) - [SUPPORT ](https://support.challengercme.com/knowledge) [SIGN IN ](https://fuse.challengercme.com/sign-in?redirectURL=%2Fuserdash) quick quiz # An 18-year-old boy had a CBC performed as part of a college physical It's CBC Quiz Time with Med-Challenger! 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He was asymptomatic. CBC was remarkable for mild anemia with a hemoglobin level of 12 g/dL and mean corpuscular volume that was quite low at 65 fL. He denied any hematochezia, melena, or hematuria, and his urinalysis finding was normal. Iron levels, ferritin level, total iron-binding capacity, and transferrin saturation levels were normal. On hemoglobin electrophoresis, the patient is found to have reduced hemoglobin A levels (2 alpha chains and 2 beta chains) and increased levels of hemoglobin A2 (2 alpha chains and 2 delta chains). Which of the following is the appropriate management approach for this patient’s anemia? - transfusion of packed red blood cells (PRBCs) - cyclophosphamide therapy - observation - corticosteroids The correct answer is: observation   **Educational Objective:** Manage thalassemia minor. **Key Point:** Often characterized by mild microcytic anemia, beta thalassemia minor does not generally require treatment, whereas patients with beta thalassemia major require transfusion. **Explanation:** In this case, observation is the appropriate management approach for beta thalassemia minor. Thalassemias are genetic disorders distinguished by abnormal hemoglobin chains. In alpha thalassemia, the alpha chains are reduced or absent. In beta thalassemia major, both genes for beta hemoglobin are defective, and there is severe anemia evident in infancy and accompanied by delayed growth and other abnormalities. It is treated with lifelong transfusion, often resulting in iron overload and the need for chelation. In beta thalassemia minor, or thalassemia trait, only one gene defect is present, and patients are often asymptomatic, perhaps having mild microcytic anemia. Patients with beta thalassemia minor require no treatment. Transfusion with PRBCs and sometimes hemopoietic stem cell transplantation are treatments for beta thalassemia major. With many transfusions, iron overload is an additional risk for patients with beta thalassemia major. **References:** Capellini MD. The Thalassemias (Chapter 162). In: Goldman L, Schafer A. *Goldman-Cecil Medicine*. 25th ed., 2016:1089-1095. Sayani FA, Kwiatkowski JL. Increasing prevalence of thalassemia in America: implications for primary care. *Ann Med*. 2015;47:592-604.   This question appears in [Med-Challenger Physician Assistant Exam Review with CME](https://challengercme.com/physician-assistant-exam-review-cme-course) [Try for free and save](https://fuse.challengercme.com/fulltrial/204). Ace your exams and meet your CME/MOC requirements for just $26 a month! 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All rights reserved [Privacy Policy](https://support.challengercme.com/knowledge/what-are-your-terms-of-service-privacy-policy-user-agreement) ```json { "@context" : "https://schema.org", "@id" : "https://challengercme.com/blog#webpage", "@type" : "WebPage", "description" : "The Challenger Medical Education Blog offers informative patient cases, medical certification exam preparation courses and board exam review tips.", "inLanguage" : "en", "isPartOf" : { "@type" : "WebSite", "name" : "Med-Challenger", "url" : "https://challengercme.com/" }, "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog", "@type" : "WebPage" }, "name" : "Challenger Medical Education Blog", "primaryImageOfPage" : { "@type" : "ImageObject", "url" : "https://challengercme.com/hubfs/Webpage%20Featured%20Images/Medical%20Education%20Blog%20-%20Free%20CME%20resources%2c%20certification%20exam%20tips%2c%20clinical%20challenge%20questions%20and%20more.png" }, "publisher" : { "@type" : "Organization", "name" : "Challenger Corporation", "url" : "https://challengercme.com/" }, "url" : "https://challengercme.com/blog" } ``` ```json { "@context" : "https://schema.org", "@type" : "BlogPosting", "about" : [ "beta thalassemia minor", "microcytic anemia", "complete blood count (CBC) interpretation", "hemoglobin electrophoresis", "iron studies", "medical education", "exam preparation", "physician assistant exam review" ], "articleSection" : "Hematology", "author" : { "@type" : "Organization", "name" : "Challenger Corporation" }, "dateModified" : "2025-01-19T16:15:01.102Z", "datePublished" : "2025-01-19T16:15:00.000Z", "description" : "An asymptomatic 18-year-old with mild microcytic anemia (hemoglobin 12 g/dL, MCV 65 fL), normal iron studies, and hemoglobin electrophoresis showing reduced HbA and increased HbA2 consistent with beta thalassemia minor — presented here as a medical-education/exam-prep case.", "headline" : "An 18-year-old boy had a CBC performed as part of a college physical", "image" : [ { "@type" : "ImageObject", "description" : "Med-Challenger Medical Education, a Division of Challenger Corporation", "url" : "https://challengercme.com/logo.png" } ], "inLanguage" : "en-US", "keywords" : [ "thalassemia minor", "beta thalassemia", "microcytic anemia", "hemoglobin A2", "CBC", "hemoglobin electrophoresis", "observation management", "Med-Challenger", "exam question" ], "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog/an-18-year-old-boy-had-a-cbc-performed-as-part-of-a-college-physical", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "url" : "https://challengercme.com/logo.png" }, "name" : "Challenger Corporation" } } ``` ```json { "@context" : "https://schema.org", "@type" : "QAPage", "mainEntity" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Observation. The clinical presentation and electrophoresis pattern are consistent with beta thalassemia minor (thalassemia trait), which commonly causes mild microcytic anemia and is typically asymptomatic; patients with beta thalassemia minor generally require no treatment. Transfusion and stem cell transplantation are treatments for beta thalassemia major." }, "name" : "Appropriate management for beta thalassemia minor?", "text" : "An 18-year-old boy had a complete blood count (CBC) performed as part of a college physical examination. He was asymptomatic. CBC was remarkable for mild anemia with hemoglobin 12 g/dL and MCV 65 fL. He denied bleeding and urinalysis was normal. Iron levels, ferritin, TIBC, and transferrin saturation were normal. On hemoglobin electrophoresis the patient is found to have reduced hemoglobin A levels and increased hemoglobin A2. Which of the following is the appropriate management approach for this patient’s anemia? Options: transfusion of packed red blood cells (PRBCs); cyclophosphamide therapy; observation; corticosteroids." } } ``` ```json { "@context" : "https://schema.org", "@type" : "ItemList", "description" : "Exam-style review questions based on this article’s teaching points.", "itemListElement" : [ { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Observation. Beta thalassemia minor typically causes mild microcytic anemia and does not require treatment; transfusion and stem cell transplant are treatments for beta thalassemia major." }, "name" : "What is the appropriate management for an asymptomatic patient with beta thalassemia minor?" }, "position" : 1 } ], "name" : "Practice Questions", "numberOfItems" : 1 } ```