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Chronic myeloid leukaemia in a child. A closely observed case.

thalassaemia, adds validity to the above suggestion. As shown in the follow-up data this very rapid fall in Hb was essentially limited to the first 2 months of life. Alternatively, the early onset of the disease may have been caused by the exchange transfusion performed at birth for hyperbilirubinaemia of unknown aetiology. Blood regeneration after exchange transfusion occurs at a time when the synthesis of y-chain has declined and the synthesis of f-chain predominates. For this reason the genetic defect of 3-chain synthesis would be expressed clinically earlier than usual. This hypothesis would be correct only if the exchange transfusion had lowered the infant's Hb. However, the low Hb level observed after the exchange transfusion was quickly corrected by transfusion of 400 ml whole blood, which should have raised her Hb to at least 17 g/dl. From a practical point of view this paper demonstrates the use of globin-chain synthesis measurements in the identification of homozygous r-thalassaemia when haematological data are inconclusive. This should also be considered in the differential diagnosis of hypochromic anaemia developing in the first 2 months of life after exchange transfusion at birth.