Sickle Cell Trait, Refractory Anemia, and Nutritional Anemia with Variable Expression of A and S Hemoglobin

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Abstract
The 40-yr. -old patient presented in this report was found to have a complex hematologic disorder involving congenital, acquired hemolytic and nutritional causes for his anemia. The most outstanding feature was a variation in the percentage of hemoglobin A and S which appeared to be related to the presence of megaloblastic anemia. Variability in expression of hemoglobin synthesis has been reported in 2 other patients and suggests the possibility of regulatory mechanisms operating by nongenetic factors. Some hypothetical mechanisms are discussed in this report. These might involve hemoglobin chain synthesis at the level of translation of genetic information or alterations in release of hemoglobin chains by polyribosomes.