Guided example

An adult outpatient specimen was received at 09:20 and tested at 10:05. Automated CBC on EDTA whole blood reports hemoglobin 11.2 g/dL, RBC 5.62 × 10^12/L, MCV 63.0 fL, MCH 19.9 pg, and RDW 13.2%. Local illustrative intervals are hemoglobin 12.0-16.0 g/dL, RBC 3.80-5.20 × 10^12/L, MCV 80-100 fL, MCH 27-33 pg, and RDW 11.5-14.5%. The analyzer flags microcytosis and hypochromia.

Ferritin collected the same day is 48 ng/mL against a local 15-150 ng/mL interval. That iron result does not support iron deficiency in this case. It also does not make the CBC independently diagnostic.

Cation-exchange HPLC on the local validated method reports HbA 94.8%, HbA2 4.6%, and HbF 0.6%, with no reportable variant peak. The local illustrative intervals are HbA2 2.0-3.5% and HbF 0.0-1.0%. No transfusion is documented in the preceding four months. Increased HbA2, marked microcytosis relative to mild anemia, relatively high RBC count, and nondeficient ferritin together support a beta-thalassemia carrier pattern.

The supported action is a bounded released interpretation under local policy, with molecular or family correlation when clinically requested or when the pattern is discordant. The fractionation pattern is not a genotype: this result does not establish an HBB genotype, exclude coinherited alpha-thalassemia, or exclude a method-limited variant. Release the evidence-supported pattern and its limits, not a genotype inferred from HbA2 alone.