Acquired haemoglobin H disease associated with myelodysplastic syndrome

A 60-year-old male patient presented with jaundice. Initial investigations showed anemia, indirect hyperbilirubinemia, raised Lactic Dehydrogenase [LDH] and increased reticulocyte count suggestive of hemolysis. Considering hemolysis low MCV and basophilic stippling on peripheral film, hemoglobin electrophoresis was done that showed Haemoglobin H [15.5%] that in the absence of family history was thought to be acquired. After bone marrow examination, the final diagnosis was Myelodysplastic Syndrome [MDS], Refractory anemia with excess of blast [RAEB] associated with acquired Haemoglobin H [Hb H] disease