1. Asymptomatic (physical examination is normal)
a. Discovered on routine blood test: slightly reduced hemoglobin, basophilic stippling, low MCV, normal RDW.
b. Discovered in family investigation or family history of heterozygous or homozygous P-thalassemia.
c. Confirmed with hemoglobin electrophoresis, demonstrating slightly decreased hemoglobin A (90-95% typically), increased hemoglobin A2 (>4%); hemoglobin F mildly elevated in 50% of cases.
2. Thalassemia trait of unusual severity. There are cases of P-thalassemia trait of unusual severity secondary to the co-inheritance of a-gene duplication with increased a-globin synthesis, thereby increasing a- and P-chain imbalance.
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