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.